Evaluating the Impact: From Promise to Evidence

Improved Maternal Health for Haor Dwellers Dhaka, Bangladesh

April 27-29, 2014

Priyanka Chowdhury (Team Leader) Masud Khan Abu Hanif Sabuj Kanti Mistry Saiful Islam Sruthi Chandrasekaran (Moderator)

1. Intervention Summary

Brief description of program activities and outputs:

• The Haor basin Bangladesh is one of the most vulnerable regions and are viewed as poverty pocket. People of these area are facing multi-dimensional problems—deprivation from mainstream service provisions and development opportunities and because of inaccessibility exclusions, they are becoming increasingly marginalized and isolated

• BRAC is implementing Integrated development program since 2011 based on its strategic plan and priorities (2011-2015) to boom development of these socio-economically depressed regions which are falling behind on MDG achievement.

1. Intervention Summary (continued)

• IDP is ensuring basic services (education, health, nutrition & population, and WASH) promoting sustainable livelihoods (Agriculture, fisheries, poultry, livestock, TUP, Migration & MF)), Social Mobilization (CEP, GJD and HRLS)

• For this particular exercise, we are focusing specifically on improving maternal health by providing awareness, ANC/PNC, effective referral systems and skill training to health workers

Where is it conducted?

• Derai in Sunamganj and Baniachong Sub-district in Habiganj

• IDP-Haor is being implemented for 0.6 million people through it’s 10 offices in Baniachong Upazila and 5 offices in Derai Upazila

Who is targeted?

• Pregnant women

• Targeting 50,000 pregnant women over course of 3 years

• When is it conducted? January 2013 to December 2015

Name of implementing organization

• BRAC

2. Results Chain PROGRAM

INTERMEDIATE OUTCOME IMPACT

Inputs • Training to CSBA, NHW SK SS • Subsidy for complicated

pregnancy cases • Kitboxes, communication

materials Activities • Antenatal and postnatal

care checkups • Establish an effective

referral system • Delivery through trained

and skilled work attendants

Outputs • Receiving regular checkups • Access an effective referral

system • Receiving deliveries through

trained and skilled attendants

• Reduced complicated pregnancy cases (PPH)

• Increase of safe deliveries

• Reduction of maternal mortality rate and hence improve maternal health

3. Research Questions

Will an improvement in maternal healthcare facilities lead to a decrease in maternal mortality rate?

Will offering a package of services – antenatal and postnatal care, effective referral systems and access to skilled attendants – lead to a decrease in maternal mortality?

4. Impact Evaluation Design

A. Describe the intervention in the (add treatment arms, if applicable):

Treatment: provide maternal health services

ANC & PNC check ups

Effective referral system

Number of skill development training to birth attendants

Control: No service

B. Describe the sample size

Treatment: 341 villages

Control: 341 villages (will be served on the next phase)

C. Describe the program assignment rule:

Random selection of Villages

64 Districts

Habiganj (Districts) Sunamganj (Districts)

Baniachong (Sub-districts) Derai (Sub-districts)

15 Union 10 Union

441 Villages 241 Villages

220 Villages (T) 221 Villages (C) 121 Villages (T) 120 Villages (C)

341 Villages (C) 341 Villages (T)

Describing the sample size

5. Data Collection A. List program indicators to be collected:

• Maternal Mortality Rate

• Access to (maternal) healthcare services

– Level of awareness of facilities, care options

– Level of health care (maternal) knowledge

– Level of expertise, comfort level with participants

– Received ANC, SBA services

– Status of care for complications

– Referral

• Access to skilled workers, healthcare workers

• Frequency of referring to health centre

• Resolution of cases (place, provider)

• Health status

– Frequency of pregnancies

– Frequency of complications

B. Method of data collection:

• HH survey

• Process monitoring data

C. Frequency of data collection:

• HH Survey: Baseline, Midline (1.5 years), Endline (3 years)

• Process monitoring: Monthly

D. Who will collect the data: Research Assistants

Thank You!