Outline of the Project

Project Name

The Project for Strengthening Health Systems through Organizing Communities

Subject

Health

Date R/D Signed

May 28,2017

Project Site

Dhaka City (north), Narsingdi District (3 Upazilas), Cox's Bazar District (3 Upazilas)

Term of Cooperation

July 29, 2017 to July 28, 2022

Implementing Organization

Operational Plans (OPs) of the Ministry of Health and Family Welfare/ Sectors-Wide Program Management and Monitoring, Health Economics and Finance, Non-communicable Disease Control (NCDC), Community Based Healthcare (CBHC), Upazila Health Care (UHC), Hospital Services Management (HSM), Lifestyle and Health Education Promotion (L & HEP)

Background

Bangladesh has made remarkable improvements in the health sector, particularly in the area of maternal and child health during the last decades. Data indicate the reduction of the maternal mortality ratio (per 100,000 live births, 574 in 1990 and 176 in 2015), and the under-five mortality rate (per 1,000 live births, 144 in 1990 and 41 in 2015).

Further, the rapid rise of morbidity and mortality caused by non-communicable diseases (NCDs), such as cardiovascular diseases (CVDs) and cancers are putting burden on the society and the health system. The WHO report in 2015 shows NCDs account for 59% of total mortality in the country.

The Ministry of Health and Family Welfare (MoHFW) has been implementing a sector wide approach since 1998 focusing on pro-poor essential service packages, which aim at reducing the gap between the rich and the poor. The 4th Health Population and Nutrition Sector Programme (2017-2022) (4th HPNSP) is the fourth sector wide approach that was formulated with development partners. For improving health service delivery, the 4th HPNSP put emphasis on development of functional referral system at all level of facilities, ensuring access to and utilization of quality health services by the poor, NCDs control and urban healthcare.

Japan International Cooperation Agency (JICA) supported implementation of a technical cooperation project (TCP), the Safe Motherhood Promotion Project II(SMPP II)during 2011-2016. SMPP II consolidated the success of its preceding TCP, SMPP I (2006-2011). The "Narsingdi model", originated from SMPP I, has been expanded in which Maternal, Neonatal and Child Health (MNCH) services are strengthening through integrated interventions targeting communities, health facilities and local government bodies.

With the view to reduce the burden of NCDs in Bangladesh, JICA has initiated its support for the Government of Bangladesh to implement the Project titled "Strengthening Health System Through Organizing Communities (SHASTO)" in July 2017 and plans to develop a model intervention in three pilot sites: Narsingdi district, Cox's Bazar district, and Dhaka city.

The project aims to improve both NCDs and MH (Maternal Health) services in an integrated manner in the pilot sites. To achieve the set objectives and outputs, the project had both facility and community level interventions including introduction of the standardized package of CVD and Diabetes Mellitus (DM) management, quality improvement of hospital services, and healthy behavior and lifestyle change promotion.

The Overall Goal

The Health status of population in Bangladesh is improved

Project Purpose

The Non-Communicable Diseases (NCDs) and Maternal Health (MH) services are improved in an integrated manner.

Output

1. Integrated NCDs (Cardiovascular Disease (CVD) and Diabetes Mellitus (DM)) and Maternal Health (MH) Services are delivered in the pilot sites.
2. Hospital management is strengthened for service quality improvement.
3. NCD prevention activities are promoted in pilot sites through working with Community Support Groups (CSGs)
4. Good practices and lessons learnt of the Project are replicated.

Project Activities

[Output 1: Integrated NCDs (Cardiovascular Disease (CVD) and Diabetes Mellitus (DM)) and Maternal Health (MH) Services are delivered in the pilot sites.]

1-1	Conduct situation analysis on NCDs services including service guideline, protocol and training manual.
1-2	Conduct situation analysis on NCDs related MH services including service guideline, protocol and training manual.
1-3	Conduct facility (CC, UZHC, DH and Urban Dispensary: UD) assessment on NCD service delivery in the pilot sites.
1-4	Develop pilot NCD intervention guideline, protocol and training manual
1-5	Implement the pilot NCD training in the pilot sites.
1-6	Try out the pilot NCD interventions in the pilot sites (CCs: NCD screening, UZHC/DH/UD: NCD screening & management).
1-7	Monitor the pilot NCD interventions in the pilot sites.
1-8	Revise the pilot NCD interventions based on the experiences of pilot activities.
1-9	Finalize the NCD intervention guideline and protocol to be expanded in other areas
1-10	Standardize the NCD intervention guideline and protocol to be provided throughout the country.
1-11	Support the expansion of standardized NCD intervention in collaboration with partners.

[Output 2: Hospital management is strengthened for service quality improvement.]

2-1	Conduct hospital quality assessment by hospital Quality Improvement Committee (QIC) in the pilot sites.
2-2	Develop a quality improvement (QI) action plan based on the assessment by the hospitals (DH, UZHC).
2-3	Implement the QI action plan by Work Improvement Team (WIT) at hospital level.
2-4	Monitor implementation of the QI action plan by the hospital QIC.
2-5	Train hospital managers and staff on PDCA and Kaizen for advancement of QI activity.
2-6	Support the function of QI mechanism at National/District/ Upazila level.

[Output 3: NCD prevention activities are promoted in pilot sites through working with Community Support Groups (CSGs)]

3-1	Assess the status of the activities of health promotion and Community Support Group (CSG).
3-2	Update the CSG training manual to include NCD management.
3-3	Support national ToT for CSG.
3-4	Support organizing CSG training (development of CSG action plan) in the pilot sites.
3-5	Support Implementation of the CSG action plan in the pilot sites.
3-6	Support resource mobilization between CSGs/health facilities and local government bodies.
3-7	Monitor the CSG activities by the Core Team in the pilot sites.
3-8	Establish the CSG monitoring and support mechanism through Core Teams.
3-9	Facilitate mobilization of community activities in Dhaka city.

[Output 4: Good practices and lessons learnt of the Project are replicated.]

4-1	Compare the data of baseline, mid-line, and end-line survey of the Project.
4-2	Conduct the studies to identify good practices and lessons learnt generated from the Project and document them.
4-3	Reflect good practices, outcomes, and lessons learnt of the Project to national policies and strategies..

Inputs
[Japanese side]

1. Dispatch of JICA Experts
   - Chief Advisor
   - NCDs
   - MNH
   - Health Promotion
   - Quality of services in Health Facility
   - Epidemiology/Research
   - Coordinator
2. Training
3. Provision of Equipment
4. Rehabilitation and renovation of basic facilities/small infrastructures
5. Overseas Activity Costs

Inputs
[Bangladesh side]

1. Assignment of counterpart and administrative personnel
   (1) Project Director
   (2) Project Managers
   (3) Project Managing Members
   (4) Officers and health personnel in the MOHFW engaged in the project activities
2. Project office facilities, equipment and materials
3. Local costs
4. Others