Awarded in 2009, the Integrated Safe Motherhood, Newborn Care, and Family Planning Project (MaMoni) was an associate award under USAID’s global flagship maternal, newborn, and child health program, MCHIP. MaMoni works in the Habiganj and Sylhet districts of Bangladesh, reaching a population of more than 3.5 million. Focused on supporting the Government of Bangladesh’s (GOB’s) Ministry of Health and Family Welfare (MOH&FW) Health Population and Nutrition Sector Development Program strategy to reduce maternal and neonatal mortality, the project sought the attainment of Millennium Development Goals 4 and 5 in Bangladesh.
MaMoni began working in Sylhet in December 2009, building on the work of the ACCESS project (2006–2009) and Projahmo (2001–2006). ACCESS focused on improving demand for MNH behaviors and services in 7 of the 12 upazilas of Sylhet, largely through NGO-supported community health workers (CHWs) who provided home-based counseling and services and community action groups (CAGs) with linkages to MOH&FW services. ACCESS results showed a rise in demand but limited change in service use, so strengthening systems to improve access to MNH/FP services is a key MaMoni strategy. MaMoni added interventions to increase CAG knowledge about FP and hand washing. The CHWs were also trained on these messages, as well as in counseling and resupplying pills and condoms.
As the project progressed, USAID decided that the health systems strengthening activities would have to go beyond traditional support to address critical issues, such as high vacancy rates of health workers. Since many of the efforts in Sylhet had been in place since 2006 and were largely led by the NGOs, USAID began to phase out these activities and focus the health systems strengthening efforts in Habiganj. Activities in Habiganj began in June 2010 with the same two local NGOs utilizing a different approach than previously. From the outset, MaMoni focused on an integrated approach that would address critical health systems issues, mobilize communities, and engage the Union Parishad (UP) in a coordinated way to improve MNH/FP outcomes. The project conducted an extensive mapping exercise and a health facility assessment (HFA) to understand all the issues. While the project design outlined some areas that MaMoni would address, many of the interventions undertaken, such as facility renovation or hiring temporary staff, were not anticipated at the project’s outset.