Dr. Ferdousi Begum - NGO Service Delivery Program, Bangladesh
September 2007
Dr. Begum is the Head of Program Operations in Bangladesh for Pathfinder International's NGO Service Delivery Program (NSDP). Dr. Begum and her team provide technical assistance to national and local NGOs implementing health and population programming. Dr. Begum has more than 16 years of experience working for different cooperating agencies of USAID-Bangladesh, both in service provision and program management.
Prior to working with NSDP, Dr. Begum worked in a variety of other positions within Pathfinder International. She served as the Senior Technical Officer for Pathfinder's Rural Service Delivery Project and as a Medical Program Officer in Dhaka. Dr. Begum has conducted training throughout the country on issues such as program management, family planning service delivery, Reproductive Tract Infections(RTIs)/Sexually Transmitted Infections (STIs), and infection prevention.
She attended the Executive Program in Health and Population for Developing Countries, Department of Health Policy and Administration, at the University of North Carolina’s School of Public Health; further supplemented by a 15-day workshop from February 25 to March 09, 2007 in Uganda on Population and Health Program Designing and Monitoring. Her dissertation paper for her MPH, was “Strengthening Reproductive Tract Infections (RTIs) Service Delivery Program in Pathfinder Supported NGO Projects in Bangladesh”, 1997.
The HIV/AIDS Integration site interviewed Dr. Begum about her experience with providing integrated services in Bangladesh.
Please tell us about a project or program experience integrating HIV/AIDS and sexual and reproductive health services.
In Bangladesh, Pathfinder International, initially through the Rural Service Delivery Project (RSDP) and later through the NSDP, offered integrated HIV/AIDS, sexual and reproductive health services along with an essential service delivery package. However, before RSDP, Pathfinder International piloted this integration of services on a smaller scale in the latter part of the Family Health Service Project (FHSP)1, which ran from July 1987 to June 1997). The focus of RSDP was:
- Awareness-building activities for the general population
- Targeted intervention for high-risk and at-risk populations (intervention consisting of diagnosis and treatment of cases)
- Syndromic management of RTI/STI cases (reproductive tract infections/sexually transmitted infections)
What were the dates of the project?
In Bangladesh, the RSDP was conducted from July 1997 to June 2002.
Who was the target audience of the project?
The target audience was adolescents, eligible couples, local leaders (teachers and religious leaders), and high-risk populations (e.g., sex workers, truckers, and migrant populations).
What was the problem you were responding to when you developed the program?
In Bangladesh, integration of reproductive health (RH) with general health services helped to solve a major problem in effective health care delivery: the stigma associated with seeking reproductive health care, particularly for high-risk sub-populations. Stigma associated with high-risk clients and types of treatment led to low up-take levels. Programmers slowly found that the best way to target RH services in high-risk populations was to provide integrated primary health care, including RH, to all segments of the population. To support this approach, clinics were opened in locations close to brothels, migrant areas, and other high-risk locales. But to reach these distinct populations successfully, key changes in programming were necessary. These changes included offering additional provider training on handling high-risk groups and a cost-effective approach to managing RTIs and STIs.
Please tell us more about the provider training.
All health care providers in Bangladesh, especially those assigned to high-risk populations, received counseling training with a main focus on sensitivity. The training began with an overview of general health issues, and went on to cover the particular concerns of stigmatized populations. This training helped enable service providers to deliver health care in a more open manner.
How else was stigma addressed?
In order to decrease stigma, people could be treated anonymously. For sex workers diagnosed with an infection, coded cards were provided for her sex partners; these individuals could return to the clinic with the card, which would indicate the health concern for which the individual needed treatment, without providing personal, identifying information. Still, however, some clients would not come to clinics that were clearly marked for RH. The successful result of addressing this challenge was that clinics were expanded to provide more comprehensive general health services, while still maintaining complete services for RH. In this service delivery paradigm, stigma was reduced on all sides, leading to greater provision and uptake of services.
You mentioned a cost-effective approach to managing RTIs and STIs. Please tell us about this change in approach.
A key programmatic change involved the introduction of syndromic management of RTIs and STIs; in a situation with limited clinical resources, testing to confirm every infection was not a possibility. Instead, syndromic diagnosis on site with the help of flow charts enabled more direct curative action.
Were there systems you developed to manage integrated services?
Integrating services meant that we did not use a vertical system for HIV/AIDS, sexual and reproductive health clients. As we have seen, vertical systems create stigma. However, a new component of services involved ensuring more coverage in terms of client follow-up or complicated case management, and also ensuring proper referral of potential HIV-positive cases.
How were you able to maintain the necessary program focus—on integrating services?
We developed missed-opportunity flow charts for use as a job aid for the service providers, so that providers can easily identify the HIV and SRH issues to address with clients.
How do the providers and clients feel about the integrated activity?
Nothing unusual. Services had been integrated before: the Bangladesh family planning program integrated maternal and child health services in the early 1990s, and then gradually added safe delivery, emergency obstetric care, RTIs, STIs, and other services.
Who was involved in the discussion and decision-making on the approach to take in the program?
Senior management staff of RSDP, implementing partners—the NGOs—and stakeholders of Family Health International (FHI).
Did Family Health International (FHI) provide the funding for the program? Were there any other funders for this integration program?
Since 2002, FHI-supported NGOs have worked with NSDP-supported NGOs for this intervention and provided some money (but not as a grant) for technical assistance, facility upgrades, medicine, procurement of furniture, and free cards for the poor. There are also funds from GFTAM, DFID, Swedish Cida, UNAIDS, UNFPA and UNICEF.
What are some elements for success of an integration program such as this?
Collaboration is key. The collaborative nature of RSDP was important for successful health outreach. Funded internationally by USAID, and implemented by both international organizations and local NGOs, all partners would meet when it became clear that there were concerns or solutions that needed to be addressed for better service delivery. Routine data management and evaluation enabled programming to be adjusted as needed. The flexibility and willingness to modify the programmatic paradigm enabled RSDP to evolve into a program relying on integration in order to best achieve high-quality health care delivery.
For more information about NSDP in Bangladesh, see http://www.nsdp.org.
Contact Information
Dr. Ferdousi Begum
Head, Program Operations
NGO Service Delivery Program (NSDP)
House No. NE (N) 5, Road No. 88
Gulshan-2, Dhaka-1212,Bangladesh
Phone: 880-2-988-6994-95; 880-2-885-3815-17; 880-2-988-3639-40
House No. NE (N) 5, Road No. 88
Gulshan-2, Dhaka-1212,Bangladesh
Phone: 880-2-988-6994-95; 880-2-885-3815-17; 880-2-988-3639-40
E-mail :fbegum@nsdp.org
Web: www.nsdp.org
[1] The USAID-funded Family Health Services Project began in 1987 to improve family health of the Bangladeshi population through a community-based distribution program of NGOs. It subsequently became the Rural Service Delivery Project.