anr_institutional_2010-2011

BWHC Program & Projects
Reproductive and Sexual Health Program at rural and semi urban area
HIV and HIV and STI Intervention(Modhumita)Project for Hotel based Female Sex
workers
Expanding Provision of Essential Services to Street, Hotel and Residence Based
Female Sex Workers
Reduction of Unsafe Abortion in Rural Bangladesh funded by SAAF
Women’s Health Rights Advocacy Partnership Project (WHRAP)
Fistula Patients Treatment Recovery and Rehabilitation (FPTRRP) Project
International Activities
Acknowledgement to Our Development Partners
Message from CE
Message from C
Reproductive and Sexual Health Program at rural, semi urban and
urban area (RSHP)
In our society context where there are strict limits on the social role and physical mobility of most girls and
women, BWHC has set an exemplary goal of enabling women.
No matter what their income or education, to learn how to manage their own reproductive health and the
health of their children in a way that enhances their sense of strength and competence. BWHC is
unconventional in its philosophy, spirit, and commitment to serving women in need. BWHC clinics are
welcoming places where clients feel comfortable, respected and understood. Although the lives and
opportunity of Bangladeshi girls and women differ tremendously but they all have a common need for
reproductive health services. With this belief, BWHC health clinics renders Essential Service Package
covering reproductive health , child health, adolescent health, limited curative care in the same setting and
BCC in the community.
The Overall Objective of the program is; “Improved health and social status of women in BWHC working
areas”.
Immediate Objectives:
Objective 1: Improve reproductive & health of target population in BWHC working areas
Objective 2: Strengthen the operational management of BWHC
Objective 3: Improve Knowledge management system
Objective 4: Strategic partnerships improved with evidence base results
Objective 5: Sustainability of BWHC improved
1
Profile of Reproductive and Sexual Health Program
Intervention Areas
: Narayangonj, Tangail, Palash(Norsingdi), Lohagora, Shaghata(Gaibandha),
Chauddagram( Comilla) and Zokiganj(Sylhet) and Jatrabari (Dhaka)
Target Population
Population coverage
: Women, Children & Adolescent
: 4,17,245
Total no. of Service centers
: 116
Static Reproductive & Sexual Health centers
:
Satellite health centers
BWHC GFATM 908 consortium Health Centers
(48 DICs, 4 Outlets)
HSPP Integrated Health center (IHC -01+ Hotels 38))
The
Health
Service
Delivery Centre
model
Fistula
Patient
Réhabilitation
08
: 16
: 52
:39
: 01
The
two-prong health service
delivery model of BWHC covers
Coverage
Division
: 06both curative & preventive dimensions of
District
:
28Clinic-based activities are responsible to
health through Clinic-based & Community-based frame work.
Upazilla
: 28
deliver the major components of ESP like Safe Motherhood, Child Survival Safe MR, services & training,
Family Planning, RTI/STI/HIV/AIDS& LimitedCurative care. Community based activities are responsible to
ensure Behavior Change Communication (BCC) and women
development initiatives through mass community participation. Both the approaches complements each
other to reinforce the improvement of women health in the community
Antenatal Care
Disitribution of FP m ethods
10000
Distribution of T.T Service
2500
9000
8000
7000
1200
1000
2000
6000
5000
1000
0
1500
600
1000
400
200
500
0
Prengnant
Women
0
1st Tri 2nd Tri 3rd Tri
PNC
Non-Pregnant Adolescents
Women
Polio
EPI
1800
1840
1850
1750
1800
1700
848
800
4000
3000
2000
1750
1040
890
1700
1721
1650
1600
1636
1650
1550
1600
1500
1550
1450
1400
1500
Pant avalent -1 Pant avalent -2 Pant avalent -3
1350
Polio-1
Polio-2
Polio-3
Polio-4
2
Distribution of RTI/STI Cases
Child Disease(0-14 years)
N=2239
571
545
263
327
340
RTI/ STI Case
STI Par tner mgt
RTI F-up
RTI Counsel i ng
Gynae case
193
ARI
Dirrohea
Helment hesis
Skin Disease
Pyrexia
ot hers
Joint Advocacy & monitoring meeting
Community based advocacy meeting on Fistula
Pregnant mother & Guardian meeting
Speech given by THFPO in media campaign
Advocacy meeting & media campaign
3
Observed World AIDS day, 2010
4
BWHC: HIV & STI Prevention Project (Modhumita)
Goal: To reduce the risk of STI/HIV/AIDS transmission among hotel based female sex workers & their clients
in 30 hotels involved in the sex trade within Dhaka city
Objective:
1. Create a supportive environment for HIV and STI prevention through social mobilization
2. Increase competency of project staff on project management and behavior change
3. Promote risk elimination and risk reduction practices among hotel –based female sex workers
and their clients through outreach activities and centers
4. Provide quality sexual and reproductive health services including STI management and family
planning information and referral for hotel- based female sex workers and their partners/clients
5. Create a structured Quality Assurance and Quality Improvement (QA/QI) system
6. Provide high quality HIV counseling and testing services options for hotel-based female sex
workers
7. Create awareness for TB diagnosis and directly observed treatment services among hotel –
based female sex workers and their clients
8. Strengthen referral networks of services for hotel- based female sex workers and their clients
9. Increase knowledge, skills and access to products for correct and consistent use of condoms in
high –risk sexual encounters
Target Vs. Achievement:
Events
Individual female SW
Individual Clients
No. of Contact with Sex workers
No. of Contact with client
No. of STI patient treated
No. of VCT done
No. of condom Dist.
Advocacy with Law Enforcing
Agencies
Advocacy with religious leaders
Project Facilitation Team (PFT)
meeting
Volunteer Recognition Ceremony
Awareness
raising
with
hotel
authority, students, rickshaw pullers,
truckers
Community sensitization on TB
Day observation (World AIDS Day &
World TB day)
Capacity building activity
Collaborative activity (with MACCA,
SMC, CWFD)
Reward giving ceremony
Target
60,000
6,000
46,800
1,00,000
2,304
48,00000
02
Achievement
1,20,246
11151
55426
125181
2,344
484
49,04,400
02
% of Achievement
200
186
118
125
102
100
102
100
02
03
02
03
100
100
01
12
01
12
100
100
12
02
12
02
100
100
02
Need based
02
Done
100
Done
04
04
100
Challenges:
• Repeated hotel raid by law enforcement agencies & joint forces
• Frequent changes/turn over of police authority
• New Peer Educator recruitment
5
•
•
•
Hotel coverage - long distance
Syphilis screening integration
Keeping condom in hotels due to administrative operation of LEA
Project Facilitation Team Meeting
Volunteer Recognition Ceremony
Advocacy with Police
6
Advocacy with religious leaders
Observed World TB day, 2010
Awareness raising with students
7
Expanding Provision of Essential Services to Street, Hotel and
Residence Based Female Sex Workers
The project titled “Provision of Essential Services to Street-Based and Hotel/Residence-Based Female Sex
Workers in Selected Districts of Bangladesh”, a collaborative project between the Ministry of Health and
Family Welfare and Save the Children-USA funded by the Global Fund to fight AIDS, Tuberculosis and
Malaria (GFATM) started from April 2007. From December 1st 2009, this project merged with Rolling
Continuation Channel (RCC) Program with its title “Expanding Provision of Essential Services to Street,
Hotel and Residence Based Female Sex Workers (FSWs)”. The program aims to ensure essential health
services for 13,550 uncovered street, hotel and residence based female sex workers in four divisions of
Bangladesh through 48 drop in centers and 4 Outlets under 4 divisions and 25 districts in different locations
of the country through peer based outreach services.
FSWs received essential HIV prevention services which include BCC activities, access to condom and STI
services, and other DIC-based recreational services. It aims to provide capacity building of relevant staff.
DICs links to local VCT, RH, MCH, EPI and FP existing services required by SWs. It also aims to provide
alternative ways for sustainable income generation building on proven methods and experiences to FSWs
with links to micro credit and marketing programs.
No. of Sex Workers Receiving Monthly Peer Education
4000
3500
3000
2500
2000
1500
1000
500
0
Jan
'10
Feb
'10
BWHC
Mar
'10
Apr
'10
AVAS
May
'10
HELP
Jun
'10
Jul '10
Aug
'10
Padakhep
Sep
'10
Oct
'10
Nov
'10
RPDO
Dec
'10
SJA
It uses a model to create an enabling environment within local communities for legal support, child support
and basic rights through partnerships and community level advocacy meetings. Printing and distribution of
updated IEC and advocacy materials are also be carried out. Adequate community involvement in all
program sites is ensured.
BWHC has firmly believed that it is critical to remain responsive to the “most at risk population” in order to
contain the spread of HIV. The global fund gave an opportunity to serve underprivileged marginalized sex
workers with BWHC as lead agency, hand in hand with other esteemed organizations like Association of
Voluntary Action for Society (AVAS), Rural Poor Development Organization (RPDO), Health and Education
for the Less-Privileged People (HELP), Padakhep Manabik Unnayan Kendra (PADAKHEP) and Sylhet Jubo
Academy (SJA). This consortium has drawn expertise from each other and has worked with a strong
consolidation of sincere efforts overcoming multiple challenges.
Achievements:

Reached 14878 sex workers through peer education and condom distribution
8
No. of Sex Workers Reached
2307
2750
1430
2689
3470
955
BWHC

AVAS
HELP
Padakhep
RPDO
SJA
Distributed 6430686 free male condoms to the sex workers.
Condom Distribution
3,000,000
16 5 0
237
STI Cacses
1494
VD
1138
2,500,000
LAP
2,000,000
GU
3040
1,500,000
UD
SS
1,000,000
IB
500,000
NC
0
13407
BWHC
AVAS
HELP
Target
Padakhep
RPDO
others
SJA
Achievement

Provided 19337 sexually transmitted infection services and 6167 primary health care services to sex
workers and also provided 1508 health care services to their children.

370 outreach workers, 52 outreach supervisors, 48 DIC Coordinators and 52 Master Trainers
received training on essential services for female sex workers.
520 local level advocacy meeting held with 9409 participants.

Discussion on peer education

Advocacy Meeting at Barguna DIC
600 sex workers received training on Income Generating Activities in different items like tailoring, jute
bag making, block printing, sanitary napkin making etc.
9
BWHC stall Bangabandhu International Conference Center
IGA training on Tailoring at Pallobi
Candle Light Ceremony on WAD 2010
South Surma DIC
Shahjalal Upashahar DIC
Case Story of Soniya
Soniya lives under the care of her father & mother in a small village - Shipbari Gussogram in
Jhalokhathi District, She schools at Shipbari Scondary school and is a senior pupil being in
standard primary. Soniya's father is a vegetable seller. When Soniya was 14, her father
thought Soniya has grown up. So he wanted to arrange a marriage for Soniya. After that
Soniya's school was stopped & she was married. Her husband was small a businessman & a
drug addict. Every day her husband beat her up. Her husband also expected money from her
father’s house. After 4 years of married life Soniya's husband left her. During this time her father and mother had
passed away and she had a daughter. Sonia felt alone and helpless. There was no person who could help her. Soniya
was beautiful and young. Local youth, mastans, hoodlums continuously harassed her mentally and then physically.
When Soniya's husband left her, she was living with her daughter only. Her earning source was working as a sex
worker at a residence. Some times she moved between hotels. She felt that she was sick. In the beginning Soniya felt
ashamed to see a doctor. When Outreach Worker of Barisal DIC enlisted Soniya, she felt very comfortable to discuss
her problem with the paramedic. Paramedic diagnosed her with STI. After treatment she became free of STI.
Last year we arranged a training course on tailoring in Barisal DIC. Sonia was a participant of that course. After the
course, Sonia bought a sewing machine and collected orders. Day by day she improved with her small business. Now,
she is a famous female tailor in her locality and earns enough money from this.
Soniya live in a Guchchogram which is land given from Govt. Those living around her are not friendly to her and people
do not appreciate her, because she is a sex worker. She now knows some basic information about HIV, AIDS & STI
through awareness by educational group & one to one sessions. Sonia wants to be a proud mother with her daughter.
Her dream is that one day her daughter will be well educated and rich. She is trying to get school admission for her
daughter with the help of DIC Advisory Committee and Self Help group-Barisal.
Soniya says- "I try to take care of myself, I am feeling better than before. The training course has changed my life.
Some day I will stop working as a sex worker”.
This project gave her training on HIV AIDS, STI and IGA. She is now independent. She has more confidence in life.
10
Reduction of Unsafe Abortion in Rural Bangladesh
The project titled “Reduction of Unsafe Abortion in Rural Bangladesh” funded by Safe Abortion Action Fund
(SAAF), IPPF started from July 2007 with a consortium approach with two other partners where BWHC was
lead. From March 2010, BWHC is implementing this project with a view to promote reproductive health
services and prevention of unsafe abortions of disadvantaged and deprived rural women. The program aims
to ensure reproductive health services for women & Adolescent girls focusing on Safe abortion services and
post abortion care in five divisions of Bangladesh through 08 static reproductive health facilities and 16
satellite health centers, under 25 districts in different locations of the country through two-prong approach –
Community based awareness raising and clinic based health care service delivery.
Women and Adolescent girls received reproductive health care services, which includes Safe abortion (MR),
post MR contraception (Family planning methods), post abortion care, gynecological service and pregnancy
test. Community based activities includes;
Behavioral change communication (BCC), Advocacy with media people on safe abortion, capacity building of
the Providers /staffs and relevant stake holders like government machineries, local support group, and
community based organization. It also provides training/ workshop for the capacity building of the local
support group, BCC leaders aiming to program sustatainability,
Goal of the Project
Contribute to the health policy framework of the Government of Bangladesh in relevance to maternal
health and National Poverty Reduction Strategy for reduction of unsafe abortion
Project Objectives:

To determine whether the project increased knowledge of safe abortion among rural women, which
may lead to reduce maternal morbidity & mortality

Increase access to safe abortion and abortion related services to hard to reach and marginalized
women
 Address quality aspect of safe abortion service and practices
 Increase awareness and attitudinal change on safe abortion issues among key stakeholders
 Capacity building of the project staff to ensure safe abortion care
 To determine the means of sustainability of the project in any form.
11
Achievement
During this reporting period a total of -3432--safe abortion (MR) were performed where 90% accepted post
MR contraception. A total of 1201 MR accepted clients came for follow up among them 129 clients came for
PAC services. Following figure shows the clinical performance.
Post abortion Care Services
Post MR Contraceptives Services
Distribution of Safe Abortion (MR)
Services under SAAF Project
38
688
25
793
2744
3432
3918
52
1201
1997
1201
MR Deferred Rejected Follow -up
Quality Service by the Provider
Treatement
19
counsnseling
Referred
90
200
MR Counseling
PAC (F-up)
33
PMR counseling
Pill
Condom
IUD
Injection
Ligation ensure
Client seeking service
Capacity development training
Our connectedness with Community
Community based awareness through behavioral change communication is to generate interest among the
target population aiming at changing of attitude and behavior to bring about positive changes in their lives ,
thus improving their health status and well being . The basic principle is, each woman should be provided
with sufficient information to make her own choices about her reproductive health.
In the year-2010, total 16 community support group were formed at different communities of BWHC who
provided active guidance and support at the community level for improving the health seeking behavior and
strengthening the access to client centered quality health care services.
Focused Activities of Community based program :







BCC
Group leaders Development from the BCC group
Partnership with the local Community based Organization
Development of Peer educator
Facilitate the role of Community health volunteers to reach their full potential for community
development
Skill enhancement and coordination with the local Support groups
Partnership developed with the local media Persons
12
Involvement of Community Health Volunteers & BCC Group leaders in the programs
Potential women candidates are selected & trained from the community as well as from the BCC groups and
are made responsible for intensive communication to generate awareness on specific health & social issues.
During the reporting period a total of 32 CHV and 278 group leaders were formed who remain actively
involved in the program. The initiative is to keep the dynamism within the respective BCC groups through
participation of the community mothers in BCC sessions, in observing the national/international days
including rallies, workshops, mass gathering and cultural activities. Group leaders are responsible to work in
absence of CHV’s , hold BCC session and provide feedback to CHV ‘s. CHV’s are the community
representatives and by involving them it is desired that a trust will be built in the community for effective
community mobilization .
During this reporting period the following activities were performed;
Activities & Achievements

Orientation workshop on SAAF Projects goal, Objectives & Implementation strategy among the clinical
and community based program Providers.

Conducted Need Assessment & KAP survey on Safe Abortion and dissemination the findings among the
stake holders.

Capacity building training on infection prevention & quality reproductive health services of among the
technical staffs.

MOU for partnership with 8 Community based local Organization at eight different locations of Project
implementing areas and conduct 16 Advocacy campaign on safe abortion care which covers about
10,000 populations.

Conducted 8 media advocacy campaign at eight different locations of Project implementing areas with
local journalist, reporters and media involved persons. A total of 16 paper clippings published in the local
printing media.

A total of 8 local Support group meeting and 8 capacity building workshop conducted on prevention of
unsafe abortion aiming to sustainable of the project and to reduce the Donor dependency.

Conducted eight Mass advocacy programs through public Drama at eight different locations of Project
implementing areas.

A total of 8 training was conducted for BCC leader on reproductive health and prevention of unsafe
abortion during the reporting period.

Developed IEC materials and updated Pocket Information Booklet

A total of 12 Coordination meeting hold with the Program & Finance staffs.
13
Fistula Patients Treatment Recovery & Rehabilitation Project
Objectives:
 To render through counseling for confidence building, decision making and mental recovery
to ensure reproductive health and right.
 To impart need based customized skilled based training on Income Generating Activity (IGA)
for economical solvency & self reliance .
 To assist cured fistula patients in restoring their social acceptance and respect thereby
reintegrating in their own community.
 Create awareness in the community on Campaign to end Obstetric Fistula in Bangladesh by
Community Fistula Advocates
3) Major achivements:
a) Total number of admitted fistula patients in the rehab centre(2010): 151
b)251 patients’s received investigation services, 49 bag of blood Provided to 41 Patients.(included
DMCH )
c)198 patients’s received both way travel Payment.
d)Number of Fistula Patient Completed IGA Training Session: (2010)
Sl No
Tailoring
Agriculture
& Animal
husbandry
Bakery
Total
33
49
25
107
e) Cured Fistula Patients Rehabilitated in the Community from ( 2010)
Sl No
01
Tailoring
Agriculture
& Animal
husbandry
Bakery
Total
33
37
15
85
14
f)
Basic and refresher training for
CFA
35 old CFA & 15 New CFA
has been received basic & Refresher training.
g)
New CFA development
15 new CFA is developed and received refresher
training
h) Awareness creation program through community group meeting ( 2010 )
Awareness creation program through community group meeting has been done in the six
reproductive health centre of BWHC located in the six district of the country for create awareness
among pregnant women, adolescent, CSBA, health service provider, imam and local influential
about obstetric fistula.
i) Community level advocacy meeting by CSBAs and CFAs (2010)
50 BCC Meeting & 50 Advocacy Meeting is conducted by the FPTRRP staffs. Obstetric fistula
message is delivered to almost 2000 people including pregnant women, adolescent, CSBA, imam,
general people and local influential. Two grand advocacy meeting is done by FPTRRP in two different
location ( Lalmonirhat & moulovibazar) of the country.
j) Follow – Up & BCC Information (2010 ):
Items
Number
Monitoring & Follow-up
154
BCC meeting conducted
285
Persons
2337
4306
Photographs: Distribution of rehabilitation items
Distribution of cow
Distribution of sewing machine
15
Distribution of
signboard for bakery
Distribution of seeds for vegetables
Distribution of cloth
Distribution of agriculture signboard
Distribution of sprayer
Distribution of bakery materials
Y
16
Distribution of bakery materials
Distribution of bakery materials
Photographs on community level activity
Yard meeting
Activity observation of patient
Advocacy meeting
Activity observation of patient
17
Activity observation of patient
Activity observation of patient
Brochure giving to Officer of social welfare - Gazipur
Brochure & booklet giving to veterinary surgeon
-Jamalpur
Brochure & booklet giving to social
welfare office
18
Photograph on CFA training/workshop
Brochure & booklet giving to Female &
Children affairs officer
Mobile phone giving to CFA by DG – FP
Brochure & booklet giving to youth
& development officer -Rajshahi
Mobile phone giving to CFA by DD
planning & program Manager
19
Capacity building activity
Certificate distribution
Photograph on CFA activity
Cow milk selling- Comilla
Poultry
Sewing- Rajshahi
Sewing
Working at own bakery
20
Working at own bakery
Photograph on Advocacy
Speech given by UP chairman- Baralekha,
Mogolhat, Moulvibazar
Speech given by UP chairmanLalmonirhat
21
22