Family Health Research Project (FHRP)

The year 2002 marked the completion of the first full year of the Family Health Research Project (FHRP). The mission of FHRP is to improve the health of the people of Bangladesh by improving effectiveness of the Essential Services Package (ESP) that provides basic medical services to families with emphasis on improving services to vulnerable populations, and on developing new, more cost-effective methods for using resources.

We have been working closely with the Population, Health and Nutrition team of USAID in developing proposals and on their implementation and dissemination. During the year, 11 research projects were approved by USAID/Dhaka. The studies spanned many disciplines and subject areas to include research into the introduction and evaluation of new tools to promote healthcare delivery and management, effectiveness of community-based strategies, effectiveness and cost-effectiveness of protocols, and vaccines strategies in a community setting. These covered the areas of population sciences, emergency obstetric care, neonatal care, general health, family planning, and EPI. Research especially targets the poor, women, and children.

A second component of FHRP is the core support unit. During 2002, the unit was involved in building supporting foundations on which to conduct research across the Centre. These include: continuation of field-site surveillance to provide an area rich in information to conduct interventions and measure their impact; recruitment of two scientists to provide guidance to the scientists across the Centre on operations research; and a logistics unit to provide support to scientists working on USAID-funded projects.

 
Studies funded by the Family Health Research ProjecT

Meeting additional family health needs of clients by addressing missed opportunities at the ESP clinics
 
Use of ESP services at established NGO and GoB facilities is very low in Bangladesh. One strategy to improve the uptake of services is to identify the needs of clients who visit the health facilities for any one of the services provided and to ensure that the opportunity is taken to offer and provide additional required services. The information obtained from this study will provide ESP service providers with the tools required to take advantage of these otherwise missed opportunities more efficiently.

The objectives of the study are to address: (a) the extent of unmet need for ESP services among clients (or their family members) visiting the NIPHP and GoB clinics and (b) whether unmet need is translated into met-need when the provider detects unmet need through the provision of services, information, counselling, and referrals.
 
At the end of 2002, the baseline qualitative and quantitative data collection had been completed. From this data it has been verified that in both NSDP and MoHFW clinics there existed a poor understanding of unmet needs. With the exception of a few NSDP sites, health workers were not screening clients for unmet needs. As a result, missed opportunities are uniformly occurring in the provision of reproductive and child health services. Nearly 100% of unmet needs are not being detected and, therefore, remain not served. The research team was also able to complete the preparation of a screening tool, following input from experts in the MoHFW, NGOs, and international organizations. This tool is now being evaluated.
    
Programmatic and non-programmatic determinants of low immunization coverage

While Bangladesh has improved the vaccination coverage of the five childhood immunizations, there is still room for further improvement. It is of particular concern that a large proportion of those who receive initial doses do not continue to become fully vaccinated. The findings of this study will provide information required to recommend, design, and test interventions to increase the proportion of fully-vaccinated children.

The objectives of the study are to: (a) have an in-depth understanding of the programmatic and behavioural (non-programmatic) factors associated with high drop-out and non-use of immunization and (b) identify the underlying programmatic and non-programmatic determinants of low-coverage factors, thereby increasing the full coverage of EPI by reducing left-outs and drop-outs.

Data collection for both quantitative and qualitative components has been completed in six selected upazilas. A survey of immunization coverage was done in all the upazilas among 2,702 randomly-selected children aged 12-23 months, ranging from 259 to 614 children in different upazilas. In-depth interviews of mothers of 79 fully-immunized children, 97 drop-out, 84 left-out, and 37 receiving invalid dosage were conducted. At least one session of each of the health assistants of these selected upazilas was conducted. In-depth interviews of service providers and managers were also conducted. Reporting and record-keeping systems were examined. The data are being analyzed for report writing and dissemination.

Reproductive health services for adolescents

Adolescents in Bangladesh are exposed to the same reproductive health risks as adolescents in other developing countries. These adolescents do not have accurate knowledge about reproductive health issues and have limited access to accurate health information and services while still being at a stage in life associated with an increased likelihood of sexual activity. This intervention provided a holistic approach, in collaboration with the Government of Bangladesh and the Concerned Women for Family Development, in three different settings (school, community, and worksite) to improve knowledge on reproductive health among adolescents.

The hypotheses of the study are as follows:

• Development and distribution of easy-to-read information materi -  als on reproductive health can lead to significant improvement in knowledge on reproductive health and use of related services among adolescents attending schools.
• Introduction of adolescent-friendly clinics increases the use of reproductive services by school-going adolescents.

Community-based protocolized management of severe child malnutrition: cost and cost-effectiveness analyses of PSKP services

The protocolized management of severe child malnutrition is an effective way to help malnourished children to recover in a controlled setting. The appropriateness of this approach as a model for child nutrition services in Bangladesh depends on its efficacy and cost-effectiveness.

The objectives of the study are to: (a) assess the costs of the intervention with consideration of the service providers and client costs, (b) assess the effects/impact generated by the intervention, and (c) execute a costing and cost-effectiveness analysis of the intervention.
 
Translation of research findings into policy and practice

The FHRP and the USAID Population, Health and Nutrition team have a strong focus on facilitating and encouraging the results of its research projects being translated into policy and practice. The mechanisms in place are: (1) setting the agenda, including partnerships in the proposal development, (2) interest groups, and (3) as the studies are completed, the inclusion of programmes in the dissemination of findings to demonstrate the implications to practice.