Bangladesh has made significant progress in lowering maternal and child mortality over the last decade, particularly in improving maternal and child health. Despite these impressive achievements, the results have not been uniform across the country. Due to weaknesses in the health system, lack of human resources and technical capacities, the most vulnerable sectors of the population are not yet reached by quality healthcare which contributes to high levels of inequity. Hence, there are large segments of the population who are still deprived of basic human rights such as healthcare. The harder to reach districts are left behind, poorer populations left behind richer ones and women left behind men when it comes to access to quality health services.
Save the Children in Bangladesh, together with their partners have been advocating for differentiated programming in health services, meaning health responses designed for each region according to their needs instead of a one-size-fits-all solution. For the past five years or more, Save the Children’s health team has been working to incorporate their strategies, model demonstrations and learnings into the health sector programme of the Government. After years of persistent, continuous and sustained advocacy, developing and implementing equity enhancing approaches, presenting numerous evidence-based arguments- the Government of Bangladesh has adopted differentiated programming in the Bangladesh Health, Population and Nutrition Sector Programme 2017-2022. Not only that, the Project Implementation Plan with all activities and associated budget has been approved, and 31 operational plans which will guide implementation have been developed. This is a big advocacy win for Bangladesh and can be modelled for other countries as well.
How did Save the Children contribute to this achievement?
Save the Children demonstrated equity enhancing approaches on the ground through programmes which was the foundation of the advocacy work. They advocated with the Government and supported the Government in strengthening the national health system. Later, they used evidence based data driven results from the projects as proof of the success of differentiated programming in improving health access and quality to the most vulnerable children and mothers. Save the Children presented this evidences at various national, international forums to place their advocacy asks.
While Save the Children increasingly shifted towards national level interventions it has always had a footing rooted firmly in its community level work. It worked directly and through the local government institutions with the community to engage and mobilize them. For instance the projects developed a large army of community volunteers to directly reach the community members, engage them into discussions and impart knowledge through community action group meetings and motivate them to shift attitude by exposing them to information and knowledge regarding maternal and child health. Local government engagement was an effective method of ensuring a two way accountability mechanism within the community, leading to increased coordination and long-term sustainability.
Save the Children used a multi-dimensional, continuous and sustainable advocacy stance of influencing the state and non-state actors with sway on the policy making process in various discussions relating to semi-formal smaller settings to much more formal environments. Furthermore, Save the Children promoted the national-level dialogues on health services that aimed to further enhance the capacity of the Ministry of Health and Family Welfare to change policies at national and local level. They partnered with multiple professional bodies in building capacity of public health staff and increasing the provision of technical.
Respected as a pioneer in public health programming in Bangladesh, Save the Children continues to maintain a good relationship with the Government which elevated the entire advocacy process. Members of Save the Children have co-authored and contributed to the development of various policy briefs which integrated the inclusion of health equity and pressed on the urgent need for health facility functionality in the lowest performing divisions by a differential budgeting approach. Save the Children presented this evidence based approach as recommendations in national and international policy documents. They provided technical support in several other policy pieces such as the Bangladesh’s Maternal Mortality Survey, Bangladesh Maternal Health Standard Operating Procedure, Bangladesh Demographic Health Survey, 2011 & 2014 and so on.
Results and Evidence
The inclusion of differentiated programming in the national health sector programme means that the underserved and left behind areas will have specialised strategies to address the needs of their population, particularly the children who are the most marginalized and deprived. Therefore, if implemented at scale by the Government the potential impact for children is high. This milestone is a result of a combined effort by different agencies and individuals. Save the Children was a critical actor in this process and led a number of initiatives which indicates that without their contribution this success would not have happened as quickly as it did. The programmes were the different stages of proof of concept, from which we translated the projects into real life situations and engaged with the government through national level advocacy. Our recommendations were included in key documents. By engaging national level ministers, we demonstrated our data and work on the ground. This evidence was used for primary policy advocacy and for policy buy in. Through these meetings, we presented our theoretical approach to the ministers and followed up with evidence showing the actual results from our programmes.
Save the Children in Bangladesh has developed an advocacy impact story which documents the entire advocacy journey and captures the important milestones.