Around 500 participants attended an "end of project" conference in Dhaka on May 23 for the Nongovernmental Organization Service Delivery Program (NSDP) in Bangladesh. IntraHealth has provided technical assistance and training expertise to NSDP since 2002. The five-year USAID-funded program, led by Pathfinder International, has worked to advance the health of Bangladeshis through improving the delivery and quality of essential public health services, training health care providers and assisting NGOs with institutional development. 

The conference featured seminars on key program areas. Dr. Mahbubur Rahman, acting director of IntraHealth's Clinical Services Team, presented a seminar highlighting the addition of safe delivery and emergency obstetric care services to 28 of NSDP's network of "Smiling Sun" clinics and development of a home delivery program in 61 clinics. Save the Children's Dr. Mohammed Islam Helal, a member of the Clinical Services Team, presented a seminar on scaling-up integrated management of childhood illnesses (IMCI) at all Smiling Sun clinics and community IMCI in rural areas. IntraHealth's Beth Fischer presented results and lessons learned and served as a panelist on Dr. Helal's seminar.

Assisting Home-Based Births
IntraHealth contributed to the home delivery program by training paramedics—nurses, midwives and other non-physician health care workers—as skilled birth attendants for home-based childbirth, which accounts for 90% of deliveries in Bangladesh. Training included normal delivery, use of the partograph, neonatal resuscitation and active management of the third stage of labor to prevent postpartum hemorrhage. From July 2005—May 2006, 27 NSDP-trained paramedics in ten pilot clinic areas assisted in 421 home deliveries. In a follow-up survey most service recipients rated the paramedics' performance quality as good (78%) or excellent (17%). To increase maternal and child survival rates NSDP also added maternal health community outreach activities, including community emergency obstetric care, referrals, birth preparedness plans and a community support system.

Managing Childhood Illnesses
IMCI is an integrated approach to organizing, managing and implementing child health programs that encompasses curative care, disease prevention and health promotion interventions. Using this approach NSDP has addressed Bangladesh's rate of child mortality and morbidity by improving health worker skills; strengthening the health system, including provision of essential drugs; and optimizing family and community child health practices, particularly care-seeking behavior. Correct management of sick children increased from 15% in 2000 to 69% in 2003 at IMCI facilities. In the same time period the correct management of all priority illnesses at IMCI facilities increased from 8% to 79%. As of May 2007, 92% of NSDP's Smiling Sun facilities have 60% or more of their health care providers trained in IMCI. The Program has also trained 6,450 Depot Holders—people within local communities who can provide oral rehydrating salts for diarrhea and cotrimoxozole for pneumonia, conduct home visits for health education and refer severely ill children to clinics.

Detecting and Treating TB
In 2003 the Government of Bangladesh asked NSDP to join the National Tuberculosis Control Program to increase health care workers' TB control capacity. Approximately half of the adults in Bangladesh are infected with tuberculosis bacilli, and 300,000 develop the disease every year. IntraHealth assisted with training 129 doctors, 92 paramedics, 38 lab technologists and 185 service promoters/counselors to provide quality TB services. The detection rate of TB at Smiling Sun clinics has steadily increased, doubling between 2003 and 2006. The treatment success rate among Smiling Sun clinics started high at 83% in 2003 and increased to 88% in 2005

Enhancing Family Planning Training
IntraHealth also trained NSDP paramedics in family planning counseling, infection prevention, contraceptive methods and clinical skills using the "Learning for Performance" methodology. Introduced in Bangladesh in 2004, "Learning for Performance" focuses training on the essential content needed to improve performance on-the-job. NSDP piloted this methodology with three NGOs for on-the-job training in infection prevention and basic counseling skills. All of the trainees scored at or above acceptable levels on post-training knowledge and skills tests. NSDP staff determined that on-the-job training in infection prevention and counseling could be widely applied in NGO clinics, and that NGOs that have implemented these courses can orient other NGOs in these areas. The "Learning for Performance" guide and toolkit can be downloaded for free, in our Resource section.