Community based skilled birth attendants programme in Bangladesh; intervention towards improving maternal health

Aim: To review the strength and weakness of a community based skilled birth attendant (CSBA) program in Bangladesh.Specific Objective: To explore perceptions of the providers, decision makers and community regarding newly trained community based skilled birth attendants.To understand challenges, gaps and obstacles and recommend potential solutions for programme improvement.Design: A descriptive study, using a qualitative approach was chosen to elicit the views and experiences of different stakeholders and the beneficiaries of the program was undertaken. The study intended to enhance understanding on gaps and challenges during program implementation by getting insight into different views. The data were captured through different methods including in-depth interviews (IDIs) and Focus Group Discussions (FGDs). In addition, the initial review of the existing literature and other related policies and documents were also employed.Participants: Nine in-depth interviews were conducted with graduate CSBAs, 10 with Key informants including government, donor agencies and CSBAs’ trainers. Three FGDs were conducted with two groups of community women and a group of CSBAs trainees.Finding: In general, the role and scope of work of CSBAs found to be uncertain; with no clear consensus on their job description or clarity of their role. Most of the respondents appreciated the role of the CSBAs in reducing maternal mortality; however, the real impact was still uncertain due to many barriers. The main barriers was low job satisfaction, lack of supportive work environment, supportive policies and low acceptability at the community which had led to the provider being demoralised and resulted in low productivity.Conclusion: To achieve the MDG’s targets related to maternal and child health, the health systems cannot function without competent and well trained skilled providers who can provide quality services. The CSBA program may not be the best solution in the long term but it could be a temporary option for emergency response to the crisis of human resources in health system but in long term government of Bangladesh needs to revise their policies and strategies to train more qualified health providers