Interventions to promote local-level planning and coordination of essential health and family planning services: a review
Background: Significant variations in the coverage and availability of comprehensive quality health and family planning services still exist in Bangladesh. Evidence shows that the current lack of planning and coordination among the providers at the local-level contributes to the inadequate distribution of services, to inefficient management of resources and perhaps to differential quality of care. There is a need, particularly in low performing areas, to develop capability at rural and urban areas so that managers are able to identify problems, and plan and act locally to solve them in a cost-effective manner. Objectives: This review was undertaken to examine current local-level planning and coordination interventions and experiences of government and NGO agencies in urban and rural settings. This exercise was carried out to identify ways of increasing the effctiveness of interventions to improve local-level planning and coordination. Methodology: Data on the existing local-level planning process, in both rural and urban settings, were collected through discussions with programme managers and supervisors, observation of field activities, analysis of organized meetings, and review of literature. Findings: There was no systematic local-level planning process in the government programme. Managers distribute targets issued by the national level among field workers. The government has established committees at the district and thana levels and below which are supposed to meet every month to plan programme activities and review performance. The available evidence showed that the majority of these committees were inactive. Local-level planning interventions, undertaken by the MCH-FP Extention Project of ICDDR,B, revealed that the systematic introduction of the process of performance review helped managers and supervision to diagnose problems and find solutions in rural areas. However, the success of the interventions was largely based on the commitment and skills of thana managers. Interventions in urban areas were effective in establishing a forum for service providers to discuss and resolve common health issues and problems. In both urban and rural settings, the role of external facilities was critical. Other interventions conducted by ICDDR,B projects, national NGOs and special projects to suppor the government health and family planning programs at district and thana level, have shown promising results in small areas. The effects of these interventions are still being monitored. Among others, these local-level planning interventions have been introduced by the Thana Functional Improvement Pilot Project, BRAC, Swanivar Bangladesh, Pathfinder International, Population Services and Training Cectre, CARE and Concerned Women for Family Planning. The replicability of these interventions is yet to be established. Conclusion: Interventions to promote local-level planning and coordination of health services in Bangladesh need to identify mechanisms to motivate and train local managers and supervisors. Up to now, most interventions seem to require external facilition. New interventions must recognize the transition to the full fange of ESP services and the shift in emphasis from doorstep to static clinics. Realistic ways of obtaining a meaningful involvement of community representatives could enhance the availablility of additional local recources.