Bringing Health Services Closer to Home:

Community Skilled Birth Attendants in the

MaMoni Project, Bangladesh
by: Jebun Rahman1, Imteaz Mannan2, Marufa Aziz Khan2, and Sabbir Ahmed2
affiliation: 1Jhpiego, an affiliate of Johns Hopkins University; 2Save the Children

Objective
This analysis aimed to understand the
performance of private community skilled
birth attendant (pCSBAs) supported by
the MaMoni Project in Habiganj district
in northeastern Bangladesh.

Background

Reaching mothers
with critical health
services is challenging
where home delivery is
the norm. The MaMoni
Health Systems
Strengthening
Project, funded by the
United States Agency
for International
Development, trained
48 local women from
hard-to-reach areas
in a six-month course
for community skilled birth attendant (CSBA),
accredited by the Bangladesh Nursing Council,
to increase coverage of skilled birth attendants
(SBAs) in hard to reach areas. This complements
the coverage of government-supported CSBAs.

Methodology

Findings, (Continued)

Source of data: Secondary analysis of pCSBAs

monthly project Management Information System
forms

Comparison of deliveries conducted by pCSBA

and GoB CSBA against projected number of
deliveries* in respective working areas

Area: Three sub-districts of Habiganj (Ajmiriganj,

Baniachong, Nabiganj)
Analysis period: April 2013March 2014
(12 months)
Comparisons: Performance of pCSBAs and CSBAs
supported by the Government of Bangladesh (GoB)

nnIn order to practice, CSBA must fulfill the

criteria to receive registration and/or
licensure from the government-approved legal
authority.
nnLocal women in their respective communities
were selected as pCSBAs by a team consisting
of the Ministry of Health and Family Welfare,
MaMoni and the Obstetric and Gynecology
Society of Bangladesh. Other selection criteria
were as per national guideline, including:
Female, age 20 to 45 years
Minimum Secondary School Certificate
Preferably married
Local resident
Willing to stay for 6 months in the district for
training
nn Acceptable to the community
nn Previous experience working for community
is an added advantage
nn
nn
nn
nn
nn

BC

NG

Total

pCSBA

14

27

48

CSBA

13

28

21

62

16%

Working areas of CSBAs, Habiganj District,

Bangladesh

19%

17%

16%
9%

Nabiganj

7 pCSBA

Ajmiriganj

14 pCSBA

Ajmiriganj

Baniachong

Lakhai

Baniachong

Nabiganj

Delivery by pCSBA
Delivery by CSBA

27 pCSBA

Sadar Bahubal
Percentage of deliveries conducted by pCSBAs
and SBAs in respective working areas

Chunarughat

CSBA in Bangladesh:
nnDefinition of CSBA: An accredited health
professional, such as midwife or nurse, who
has been educated and trained to proficiency
in the skills needed to manage normal
(uncomplicated) pregnancy, childbirth and
the postnatal period and in the indication,
management and referral of complications in
women and newborns (WHO, ICM, FIGO; 2014).

26%

AG

48%

Madhabpur
Working areas of pCSBAs
Working areas of GoB CSBA

26%
19%

Findings

23%

51% to 65% of pregnant women were identified by

pCSBAs in their working areas.

Pregnant women who received one antenatal

care visit from pCSBAs and other medically
trained providers in respective working areas

30%

29%

17.6%

16.9%

Ajmiriganj

Baniachong

20%
14.4%

Nabiganj

pCSBA
Other medically trained providers

Ajmiriganj

Baniachong

16% 16%

Nabiganj

% delivery by pCSBA in clusters

% delivery by SBA in working areas

Conclusions

nnpCSBAs increased coverage of skilled care

at the community level, particularly in areas
where health facilities were inadequate
nnTo maximize use of pCSBAs at the community
level, community resources are needed for
offsetting operating costs and ensuring skills
retention with supportive supervision on site
nnProper allocation of working areas and an
incentive and recognition mechanism from the
community need special attention

USAIDs MaMoni HSS Project was made posssible with the support of the American People through the U.S. Agency for International Development (USAID) in collaboration with the
Ministry of Health and Family Welfare in Bangladesh. The contents of this particulat material are the responsibility of the authors and do no neccessarily reflect the opinion of USAID or
the U.S. Government.