Private-Community Skilled Birth Attendant (CSBA): a needs based approach and showcasing public private partnerships through MNH initiative in Bangladesh

Chanda, Sanchoy Kumar

Major challenges for improving maternal health in Bangladesh are the low rate of facility delivery (23.4%) and medically trained provider at birth (26.5%). Government has developed nearly 6,000 Community Skilled Birth Attendant (CSBA) so far, however GoB-CSBAs are engaged with many other tasks, sometimes overburdened and contributes only 3.5% of deliveries at community.

To address this, the Ministry of Health emphasizing interventions at the community level that provide antenatal care, postnatal care, monitor pregnancies, conduct normal delivery, timely referral through trained Private-CSBA to reduce maternal and newborn mortality and morbidity where three-fourth of births takes place. Participants have been selected from the local community through government selection procedure, trained at accredited private training institutes, approved by the Bangladesh Nursing Council and funded by the UNFPA led Joint GoB-UN MNH Initiative. Its is a sign that the concerns of local people has been taken seriously by the Government; taking care of the health need of local people that comes up through Local Level Planning which is the driving force for the MNHI.

The six-month long training has been started in mid-2010, batch comprising of 18 participants and with a view to conduct 8 batches per year till 2016. Trained CSBAs have started working in the community by linking with Community Clinics under supervision of district health administrator. Community awareness and social barriers for women’s decision making is addressed through demand side intervention by MNHI through a cadre of Community Health Volunteer. Delivery by skilled attendant increased remarkably of which 62% are at Community Clinics indicates that rural mothers have preference towards institutional delivery.

Government and other stakeholders firmly anticipate that Private-CSBA could provide an insight on their achievements towards reducing maternal and neonatal mortality and morbidity, and could be a perfect example of the potential of Public Private Partnership in Bangladesh.