Table 2 Characteristics of antenatal care service provision in community settings in Gaibandha district
Type of setting | Community Level (Satellite clinics) | ||
|---|---|---|---|
Government Family Welfare Assistant/Visitors (FWA, FWV) | BRAC Shyastho Kormis (SK), Shyastho Shebikas (SS) | Smiling Sun Community Service Promotors (CSP) | |
Service capacity for target population | - 1 FWA covers 1 ward (population 5000-6000) and is responsible for 800-1000 HHs (eligible couple with reproductive age women) for pregnancy surveillance/family planning; 1 FWA/FWV identifies about 6-7 pregnancies per month in her catchment area. - 1 FWA visits about 30 HHs for routine surveillance per day in her catchment area - 60-70 pregnant women per month were reported in 1 union | -1 Shyastho Kormis (SK) covers 360 HH for pregnancy surveillance/family planning ; 1 SK identifies about 9 pregnancies a month in her catchment area -1 SK visits about 15 HHs for routine surveillance activities per day in her catchment area. | -1 Community Service Promoters (CSP) covers 421-430 HH for pregnancy surveillance/family planning; 1 CSP identifies about 9 pregnancies a month in her catchment area -1 CSP visits about 20 HH for routine surveillance activities per day in her catchment area |
Service provision and costs | -Clinical history, Examination, Counseling -All free | -Clinical history, Examination, Counseling -Lab service (hemoglobin, Urine tests) -Treatment (iron and folate) ($0.6/50 taka) | -Clinical history, Examination, Counseling ($0.24/20 taka) |
Staffing | -In Gaibandha district (Population: 2.6 million) there are family planning inspectors (53), Sub-Assistant Community Medical Officers (SACMO) (49), Family welfare visitors (FWV) (72), Family welfare assistants (FWA) (421), Community health care providers (291) -1 union (population 18,000) has 3 community clinics and 8 satellite clinics including 1 SACMO, 1 FPI, 1 FWV, 5 FWAs | -1 upazila (10~15 unions) has 1 manager, 10 program officers and 35 Shyastho Kormis (SK), and 399 Shyastho Shebikas (SS) -BRAC only provides satellite clinics by SK/SS and there are no static clinics in the Gaibandha district. | -In Gaibandha, there are total 36 satellite clinics in 3 unions. 1 union has 18 satellite clinics including 1 Paramedics, 18 CSPs. The paramdics are service providers, CSPs provide surveillance, family planning, community mobilization support. |
Drugs and supplies | -Family planning (male condoms, oral contraceptive pills, intrauterine devices (IUDs), implants, injectable contraception) which are all free. -Maternal care (iron tablets, folic acid, misoprostol tablet, oxytocin injection, paracetamol) | -Family planning (male condom, oral contraceptive pill which are free cost) -Maternal care (iron and folic acid, misoprostol, paracetamol, oral rehydration) | -Family planning (male condom, oral contraceptive pill, emergent contraceptive pills, IUDs, implants, injectable contraception, sterilization surgery which are free from government support) -Maternal care (iron and folic acid, misoprostol, Azithromycin, Cefixime, Betamethasone, Dexamethasone, Nifedipine, methyldopa) |
Referral practice | Referral was most frequent during labor and delivery. During the pregnancy period, ANC visits during the first (8-12 weeks base on the guideline but actual first visit timing of some pregnant women may be beyond 12 weeks) and fourth (36-38 weeks). Reasons for referral are varied (e.g. vaginal bleeding, fever, headache or blurred vision, cough or difficulty breathing, fetal movement, convulsion, high blood pressure). Referrals are often made by verbally advising the client to be hospitalized urgently, explaining the reason for referral, occasionally giving a referral slip to the caretaker, or explaining where and when to go with a health professional’s contact information. | ||