Skilled Birth Attendant (SBA) Training Program in Bangladesh

1
Skilled Birth Attendant (SBA) Training Program
in Bangladesh
Prof. A B Bhuiyan President , OGSB and Focal
point SBA Training Program
2
Bangladesh Situation

• 26,00,000 delivery per year
• High Maternal Mortality Ratio 3.2/1000 live
  births in spite of decades of TBA training
• 90 delivery occurs at home attended by TBAs and
  relatives
• 80 deaths occur at home mostly during and
  immediately after child birth.
• For each maternal death another 40 suffer from
  morbidity
• Delivery by skilled attendants only 13
• Neonatal mortality 45 /1000 live birth
• All this deaths are preventable

3
Need Assessment of SBA

• Initiated by WHO, OGSB conducted the Need
  assessment Study to assess the feasibility of
  training of FWA and FeHA as skilled attendants
  (2001)
• Findings were positive
• Family Welfare Visitors (FWAs) and Female Health
  Assistant (FeHA) are ready to become SBA on being
  trained for 6 months
• Majority faced a demand from the community to
  conduct home delivery
• FWA and FeHA are already exposed or involved to
  community health services

4
Need Assessment of SBA

• Need assessment findings were presented to
  Honble Minister, Ministry of Health Family
  Welfare
• Approval for Piloting of the SBA training was
  obtained
• WHO and UNFPA agreed to provide support
• OGSB provided the technical support

5
A Memorandum of Understanding was signed between
MOHFW, WHO and UNFPA

• Implementing Organizations are
• Obstetrical Gynaeclogical Society of
• Bangladesh (OGSB)
• Institute of Child Mother Health,
• Dhaka (ICMH)
• Maternal Child Health Training
• Institute (MCHTI), Dhaka

6
A Curriculum is developed based on

• Job description analysis and based on the
• level of health infrastructure they work
• Findings of need assessment
• Reviewing existing literature curriculum
• Formation of Curriculum task force
• Technical appropriateness by Experts

National Curriculum Steering Committee approved
Trainees Curriculum on Oct. 2002
7
Overview

• 90 District Trainers were selected by personal
  interview and TOT was given (15 trainers per
  district)
• MOHFW implemented SBA Training Pilot program in 6
  districts started from 1st March 2003 to 31st
  August 2003.
• Comilla, Tangail, Barisal (supported by WHO)
• Joypurhat, Jessore, Habiganj (by UNFPA)

8
Criteria of SBA Trainees

• Family Welfare Assistant (FWA) and Female Health
  Assistant (FeHA)
• Education Minimum SSC (standard X)
• Age 35-45 Years
• with positive aptitude
• Willingness to participate 6 month training at
  district level
• Should reside in their place of posting
• Committed to serve the local community

9
SBA Training Course

• It is a Competency Based Training
• Training Period 6 months
• Post training evaluation After 6 months
• Total 26 Weeks (6 Months) Training
• 4 Weeks-Class Room Lecture, Demonstration
• 13 Weeks-Clinical Practice in Hospital
• 8 Weeks-Community Practice
• 1 Week- Final Evaluation

10

• 90 FWA FeHA completed the SBA Training
• Final examination was conducted Certificate
  was provided by Bangladesh Nursing Council (BNC)
• Registration was given by BNC as SBA
• Quality Assurance (QA) of the training by QA
  Team, National Consultants National team
• Supervision Monitoring is being provided by
  DGHS, DGFP, MCHTI, ICMH, NIPORT, OGSB, WHO,
  UNFPA

11
Final Evaluation

• Bangladesh Nursing Council conducted Final
• Examination at district level
• Written Test
• - Paper I 26th August 2003
• - Paper 2 27th August 2003
• Practical and Oral 28th August 2003
• Total mark for written examination 200(100100)
• Total mark for oral and practical 100(5050)
• Pass mark for both Written oral Practical was
  50

12
Registration and Certification

• The Honorable Minister, MOHFW, distributed
  certificates on 4th September, 2003 in a program
  at Hotel Sonargaon, Dhaka
• Registration was given by Bangladesh Nursing
  Council (BNC)

13
Visible Changes in SBAs after Piloting (result
of evaluation)

• SBAs are well accepted by the community
• They look more confident
• Community people are satisfied and happy with
  their services
• Referral has increased in the Referral Centre

14
Achievement in Piloting

• Strong Commitment from GOB
• Strong partnership at all level
• Registration and Certification through BNC as
  special category SBA
• Approval of Accreditation Guidelines

15
Accreditation of SBA Training

• To ensure quality of all the SBA Training
  components, Accreditation guidelines has been
  prepared and approved by the Government.

16
Conclusion

• After completing the training, SBAs conducting
  2-7 deliveries per month in their community
• Other FWA and FeHA wanted to become Skilled Birth
  Attendant at community level as early as
  possible.
• FWAs and FeHAs are the most suitable candidates
  in GOB and equivalent paramedics in NGO for SBA
  training.
• NGO worker shown interest in this type of
  training
• Continuous and intensive monitoring and
  supervision of training services is required
  for the success of the program.

17
New Development

• UNFPA is supporting SBA training in 19 Districts
  taking 33 Upazillas
• It is expected that 18 more upazilla will be
  taken soon. A total of 850 SBAs will be in the
  field after training by the end of the year 2004.

18
Thank you