Effective maternal, newborn and child health programming among Rohingya refugees in Cox’s Bazar, Bangladesh: Implementation challenges and potential solutions

Sarker, Malabika; Saha, Avijit; Matin, Mowtushi; Mehjabeen, Saima; Tamim, Malika; Sharkey, Alyssa; Kim, Minjoon; Nyankesha, Elevanie; Widiati, Yulia; Shahabuddin, Asm

doi:10.1371/journal.pone.0230732

Cited by 18 publications

(19 citation statements)

References 12 publications

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“…The study results note overall support and enthusiasm for developing a core set of SRMNCAH indicators among the different humanitarian stakeholders in Cox’s Bazar. Aligned with findings from other studies conducted in Bangladesh [ 22 , 23 ], representatives from a variety of institutions highlighted numerous existing resources and systems that could be leveraged and improved to ensure the feasibility of collecting this core set of indicators for monitoring and evaluating SRMNCAH health services and outcomes in the humanitarian settings in Cox’s Bazar. The study findings, further, indicate that a core set of facility-based and community-level indicators compared to population-level indicators were perceived to be more relevant and feasible given the current context in Cox’s Bazar.…”

Section: Discussionmentioning

confidence: 70%

Feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in Bangladesh

et al. 2022

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Background Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings is often sparse and varies in quality across different humanitarian settings. To address this gap in quality data, the World Health Organization (WHO) developed a core set of indicators for monitoring and evaluating SRMNCAH services and outcomes, and assessed their feasibility in Bangladesh, Afghanistan, Jordan, and the Democratic Republic of Congo. Methods The feasibility assessments aggregated information from global consultations and field-level assessments to reach a consensus on a set of core SRMNCAH indicators among WHO partners. The feasibility assessment in Bangladesh focused on the following constructs: relevance/usefulness of the core set of indicators, the feasibility of measurement, availability of systems and resources, and ethical issues during data collection and management. The field-level multi-methods assessment included five components; a desk review, key informant interviews, focus group discussions, and facility assessments including observations of facility-level data management. Results The findings suggest that there is widespread support among stakeholders for developing a standardized core set of SRMNCAH indicators to be collected among all humanitarian actors in Bangladesh. There are numerous resources and data collection systems that could be leveraged, built upon, and improved to ensure the feasibility of collecting this proposed set of indicators. However, the data collection load requested from donors, the national government, international and UN agencies, coordination/cluster systems must be better harmonized, standardized, and less burdensome. Conclusion This core set of indicators would only be useful if it has the buy-in from the international community that results in harmonizing and coordinating data collection efforts and relevant indicators’ reporting requirements.

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Section: Discussionmentioning

confidence: 70%

Feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in Bangladesh

et al. 2022

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“…Even within country programs that successfully expanded services and demand for IPPFP, there were still challenges associated with implementation and sustainability. Sustainable human resources for health are a challenge worldwide, but notably in humanitarian settings ( 25 , 26 ). Highly skilled health providers are often scarce and, as a result of war and natural disaster, cannot always remain at their assigned health facility.…”

Section: Discussionmentioning

confidence: 99%

Immediate Postpartum Long-Acting Reversible Contraception: A Comparison Across Six Humanitarian Country Contexts

Gallagher

Morris

Fatima³

et al. 2021

Front. Glob. Womens Health

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Postpartum family planning (FP) could prevent more than 30% of maternal deaths by effectively spacing births; this is particularly relevant in humanitarian contexts given that disproportionate maternal death occurs in countries affected by crises. In humanitarian settings, where accessing functional facilities is challenging with security risks that constrain movement, many women are unable to return for their 6-week postpartum visits and thus unable to receive FP counseling and adopt a method that suits their fertility intentions. Thus, immediate postpartum family planning (IPPFP) interventions, focused on long-acting reversible contraception (LARC) and tailored toward humanitarian contexts, could contribute to healthy timing and spacing of pregnancy, particularly among postpartum women, and improve maternal and newborn health. In 2014, Save the Children integrated postpartum intrauterine device (IUD) services into its FP package in emergency settings. In 2017, this expanded to include postpartum implant uptake as well, given updated World Health Organization guidelines. Three countries (Democratic Republic of Congo, Somalia, and Pakistan) opted for higher-intensity programming for IPPFP with a specific focus on LARC. This involved training delivery-room providers on counseling and provision of IPPFP, as well as training antenatal care nurses in counseling pregnant women on IPPFP options. Three countries (Rwanda, Syria, and Yemen) did not implement notable IPPFP interventions, although they provided the standard of care and monitored provision via monthly service delivery data. Using data from 2016 to 2019, we examined trends in immediate postpartum LARC (IPP LARC) uptake and compared countries with higher-intensity IPP LARC interventions to countries providing standard care. Tests of association were performed to assess the significance of these differences. In the country programs with higher-intensity IPPFP interventions, IPP LARC as a percentage of all deliveries was much higher overall during the July 2016–December 2019 period. The IPP LARC intervention had a significant impact on the overall proportion of women and girls who adopted an IUD or implant within the first 48 h of delivery, F(1, 250) = 523.16, p < 0.001. The mean percentage of IPP LARC among all deliveries in intervention country programs was 10.01% as compared to 0.77% in countries providing standard care. Results suggest that there is demand for IPP LARC in humanitarian contexts and that uptake increases when multipronged solutions focusing on provider training, community outreach, and service integration are applied.

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“…This study was part of a larger embedded IR project conducted by BRAC University and supported UNICEF. Results of that embedded IR are reported elsewhere [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…The key objectives of the project were to identify key implementation challenges of MNCAH programs, explore potential solutions, and ensure utilization of those solutions for effective implementation of MNCAH programs in the camps through engagement of decision-makers and program implementers. Part of the findings and methods used for the project were published elsewhere [ 18 ]. In addition, one of the objectives of the initiative was to document methodological and operational challenges of conducting embedded IR in humanitarian settings, which the present study focuses on.…”

Section: Introductionmentioning

confidence: 99%

Carrying out embedded implementation research in humanitarian settings: A qualitative study in Cox's Bazar, Bangladesh

et al. 2020

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Background Embedded implementation research (IR) promotes evidence-informed policy and practices by involving decision-makers and program implementers in research activities that focus on understanding and solving existing implementation challenges. Although embedded IR has been conducted in multiple settings by different organizations, there are limited experiences of embedded IR in humanitarian settings. This study highlights some of the key challenges of conducting embedded IR in a humanitarian setting based on our experience with the Rohingya refugee population in Cox’s Bazar, Bangladesh. Methods and findings We collected qualitative data in between January and July 2019. First, we visited Rohingya refugee camps and interviewed representatives from different humanitarian organizations. Second, we conducted interviews with researchers from BRAC University who were engaged with data collection and analysis in a broader embedded IR study on maternal, newborn, child, and adolescent health (MNCAH) program implementation challenges. Data were analyzed using a thematic analysis approach. Two researchers developed and agreed on codes and relevant themes based on the objectives of this study. The findings of this study highlight several challenges encountered while conducting embedded IR in the Rohingya emergency setting in Cox’s Bazar, which may have implications for other humanitarian settings. The overall context of the camps was complex, with more than 100 organizations devoted to providing health services for approximately 1 million refugees. Despite the presence of the Bangladesh government, United Nations agencies and other international organizations played key roles in making programmatic and policy decisions for the Rohingya. Because health service delivery modalities and policies and related implementation challenges for MNCAH programs for the refugees changed rapidly, the embedded IR approach used was flexible and able to adapt to changes identified, with research questions and methods modified accordingly. Access to the camps, reaching Rohingya respondents, overcoming language barriers in order to get quality information, and the limited availability of local research collaborators were additional challenges. Working with researchers or research institutes that are familiar with the context and have experience in conducting implementation and health systems research can help with collection of quality data, identifying key stakeholders and bringing them on board to ensure the execution of the project, and ensuring utilization of the research findings. Study limitations include possible constraints in generalizing our conclusions to other humanitarian settings. Implementation research conducted in additional humanitarian settings can contribute to the evidence on this topic. Conclusions Findings indicate that embedded IR can be done effectively in humanitarian settings if the challenges are anticipated, and appropriate strategies ...

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Effective maternal, newborn and child health programming among Rohingya refugees in Cox’s Bazar, Bangladesh: Implementation challenges and potential solutions

Cited by 18 publications

References 12 publications

Feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in Bangladesh

Feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in Bangladesh

Immediate Postpartum Long-Acting Reversible Contraception: A Comparison Across Six Humanitarian Country Contexts

Carrying out embedded implementation research in humanitarian settings: A qualitative study in Cox's Bazar, Bangladesh

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