Transferring health and family planning service innovations to the public sector: an experiment in organization development in Bangladesh

Abstract

The International Centre for Diarrhoeal Disease Research, Bangladesh, has launched a field experiment in two rural thanas of Bangladesh to test the transferability of its successful health and family planning experiment in Matlab to the Ministry of Health and Population Control service system. This paper reviews the Matlab experiment with particular attention to its organization and identifies elements for transfer. The intervention strategy and operations research design of the new experiment are discussed. The proposed design follows an organization development strategy in which collaborative diagnostic research is used to foster institutional change.

The International Center for Diarrheal Disease Research, Bangladesh has launched a field experiment in 2 rural thanas of Bangladesh to test the transferability of its successful health and family planning experiment in Matlab to the Ministry of Health and Population Control service system. The 1st family planning experiment began in 1975 and concentrated on the household distribution of contraceptives. It was further designed to provide a broad range of contraceptive and immunization services and oral rehydration therapy. Strong management control is vested in the non-medical, male supervisory staff. Maternal and child health services were later combined with the family planning project. This extension project has 2 components: an intervention strategy and a research strategy to assess the efficacy of the program. The analysis of the effects of this extension program is achieved through the longitudinal observation of households with a sample registration system. The proposed design follows an organization development strategy in which collaborative diagnostic research is used to foster institutional change. The original Matlab experiment posited that a significant proportion of clients desire to limit or space childbearing, but lack contraceptive services for doing so. The experiment demonstrated that there is a set of conditions under which a significant proportion of a rural Bangladeshi population will use contraception, and thereby reduce fertility. In transferring the programs to the supervision of the Ministry of Health, a number of modes were used: 1) use of a team appraoch, especially on household distribution; 2) train more community workers, especially females, and use teams of both males and females; 3) develop a Tertiary Health Center referral system, especially for sterilization; 4) enlarge training of present workers to include better preventive and MCH care; and 5) arrange monthly meetings of union-level workers at the field centers. No change in salary structure or administrative structure was planned