Manoshi

Bangladesh is a country of 140 million people, of whom nearly a quarter live in urban settlements. A third of the urban residents are slum-dwellers. UNICEF has forecasted that the urban poor population might rise to 30 million by 2020. Although, Bangladesh has witnessed remarkable progress in the health of its population over the last few decades, the maternal mortality ratio (MMR) is still high at 320 per 100,000 live births (Bangladesh Maternal Mortality Survey 2001), under-five child mortality is 65 per 1000 live births and the neonatal mortality rate is 37 per 1000 live births (Bangladesh Demographic Health Survey 2007). It is reported that the health indicators are even worse for the urban poor than the rural poor (Ministry of Health and family Welfare 2001). Despite being in close proximity to skilled care, nearly 80 percent of the deliveries in slums are conducted by neighbors/relatives at home (Pragatir Pathey 2003). Antenatal coverage of 55% in urban slums is much lower than the 74% of urban non-slum areas. Given this scenario of maternal care utilization, it is not surprising that newborn care utilization is virtually absent. Immunization coverage is 63% in urban slums, much lower than national and non-slum averages of 73%.
 
In this context, the Manoshi project was developed by BRAC to establish a community- based health programme targeted at reducing maternal and child mortality in the urban slums of Bangladesh. It addresses the Bill and Melinda Gates Foundation’s Community Health Solutions (CHS) initiative that aims at strengthening and leveraging community organizations and participants to scale up proven interventions in community settings. Manoshi will be implemented in the urban slums of six city corporations (Dhaka, Chittagong, Sylhet, Rajshahi, Barisal and Khulna) and in 15 statistical metropolitan areas of Dhaka to provide services to 8 million population.  
 
This five-year project (January 2007 to December 2011) is led and implemented by BRAC. ICDDR,B, in collaboration with the Research and Evaluation Division (RED) of BRAC, provides technical assistance to the project through two means:

• Chair and participate in the Technical/Management Committee that leads the research of the project. This Committee, formed of six BRAC members and six ICDDR,B staff, meets monthly to review research topics, objectives, research design, sampling, tools, operations and timeline. Results are reviewed and fed to programme staff through meetings and briefs.
• Development of tools and protocols for specific research topics to be fielded by ICDDR,B and RED of BRAC.