Making childbirth safer in the big city

During an antenatal check up that is set up in a village home, Jhorna Akther (30 years old), a BRAC Community Health Worker (CHW) measures Khatidja Akther’s blood pressure, who is pregnant for the first time. (Credit: BRAC/Shehzad Noorani)

Nearly 9 million children under-five are dying every year largely due to inadequate maternal, neonatal and child health care; that’s 24,000 children a day. Around 70 percent of these early child deaths are due to conditions that could be prevented or treated with access to affordable solutions. Childbirth is dangerous for mothers too, with 1,000 mothers dying every day because of complications during pregnancy, nearly all in developing countries. For the first time GlaxoSmithKline and Save the Children have joined together to create a $1 million Healthcare Innovation Award, aiming to deliver a new model for corporate-charity working to help save the lives of a million children. BRAC has won $300,000 of this award for our innovative Manoshi programme which is dramatically changing the face of maternal, neonatal and child health in urban slums of Bangladesh. Manoshi is a cost-effective innovation, rooted in communities that maximises the use of cutting edge technology and increases access to services for families living in informal settlements. Manoshi works on three basic innovations:

• Delivery centres – simple, clean rooms in the heart of the slums that enable safe delivery

• Active referral system – local emergency health services engaged by BRAC ensure the poorest slum dwellers get seen by a professional at a fixed price as soon as possible if there is a problem

• M-health – a digital solution for streamlining BRAC’s data collection procedures in Manoshi. Data is collected in a real time virtual database which equips the community health workers with mobile phone based data enabling them to prioritise patients.

In five years since its inception Manoshi has been extremely successful. In response to Manoshi’s work, home deliveries have reduced from 86 per cent to 16 per cent and the maternal mortality ratio from 294 per 100,000 to 135. Additionally, the neonatal mortality rate has dramatically decreased from 43 per 1,000 to 17. Both of these accomplishments reach and exceed the Millennium Development Goal targets which call for reducing the under-five and maternal mortality rates by two-thirds between 1990 and 2015. Additionally Manoshi has triggered behavioural change with many more deliveries happening at safe facilities and perception change with pregnant women preferring to give birth in a delivery centre. Lastly Manoshi has bridged key stakeholders; slum populations, BRAC health workers, government and private healthcare providers to reach a shared goal. The prize money will be used to pilot Manoshi in the slums of Freetown, Sierra Leone where under-five and maternal mortality rates are amongst the highest in the world at 185/1,000 and 890/100,000 respectively. The pilot will involve consulting, scoping, planning and implementing a Manoshi style programme, with the same innovative components, adapted to the Freetown slum context. Azizul Huq, Bangladesh Country Manager at GSK, said “This remarkable project shows what can be achieved through south-led innovation and we are delighted to be able to recognise the hard work of all involved. It has saved lives of mothers and children in Bangladesh and can make a difference for the people of Sierra Leone.” For more about BRAC’s Manoshi programme, watch the video below or visit http://health.brac.net/manoshi.