UNFPA Midwifery 2017-2021 UNFPA Mödrahälsa 2017-2021 UNFPA has submitted a project proposal for financial support to the implementation of the program “Strengthening Midwifery – led continuum of care in Bangladesh”. Over a four year period (2017-2021) Sweden will provide SEK 61 500 000 to support the introduction of the Midwifery profession in Bangladesh by UNFPA in cooperation with the Ministry of Health (MOHFW). The funding allocation covers three specific outcomes: i) increased number and capacity of midwives, ii) increased availability of quality of Emergency Obstetric Care (EmONC), and iii) Increased access to family planning and services with a particular focus on adolescents. SEK 500 000 are earmarked for an external evaluation that will be carried out at the end of the programme. SEK 15 000 000 are specifically earmarked for expanding sexual and reproductive health care to girls, women and adolescents living in areas affected by the Rohingya crisis. 

The intervention will complement the work of the Government of Bangladesh in developing midwifery workforce in which UNFPA has comparative advantage, and will positively impact on result area four (4) on improved basic health in the Swedish Result Strategy with Bangladesh 2014-2020. In particular, the intervention will be targeting   the sub-results i) more women with access to good maternal health care, ii) more people with access to sexual and reproductive health and rights and iii) reduced child mortality. In addition, the proposed contribution gives continuity to existing interventions in the health sector financed by Sweden. UNFPA har inkommit med ett projektförslag för ekonomiskt stöd till genomförandet av programmet “Strengthening Midwifery – led continuum of care in Bangladesh”. Under en fyraårsperiod (2017-2021) kommer Sverige att bidra med 61 500 000 kronor för att stödja UNFPAs, i samarbete med hälsoministeriet (MOHFW), etablering av barnmorskeyrket i Bangladesh. 500 000 kronor kommer att öronmärkas för en extern utvärdering, som kommer att genomföras vid slutet av programmet. 

Projektet förväntas påverka hälsosystemets interna funktioner och organisation, och därmed stärka systemets resiliens, d.v.s. systemets förmåga att anpassa sig till förändrade villkor i omgivningen. Programmet omfattar tre specifika resultat: i) ökat antal av och kapacitet för barnmorskor, ii) ökad tillgänglighet av kvalitativ akut obstetrisk vård (EmONC), och iii) ökad tillgång till familjeplanering och tjänster med särskilt fokus på ungdomar. 15 000 000 SEK kommer att öronmärkas för expandering av tjänster inom sexuell och reproduktiv hälsa till flickor, kvinnor och ungdomar i särskilt drabbade krisområden.  

Insatsen kompletterar Bangladesh regerings arbete med att bygga upp arbetsstyrkan av barnmorskor, där UNFPA bedöms ha jämförande fördelar. Programmet bedöms vara relevant för att uppfylla resultaten inom området fyra (4) om förbättrad grundläggande hälsa i den svenska resultatstrategin för Bangladesh 2014-2020. Insatsen kommer särskilt att inriktas på delresultaten i) fler kvinnor med tillgång till bra mödrahälsovård, ii) fler personer med tillgång till sexuell och reproduktiv hälsa och rättigheter och iii) minskad barndödlighet. Dessutom ger den föreslagna insatsen kontinuitet i befintliga insatser inom hälsosektorn, som finansieras av Sverige. The main goal is to improve the health of mothers and adolescents in selected districts of Bangladesh.

The main outcomes are: 1) Increased number and capacity of midwives; 2) Increased availability and quality of Emergency Obstetric Care; 3) Increased access to family planning information and services with a particular focus on adolescents.

The outputs that the project will achieve are identified as follows:
Output 1.1: Midwives well educated and trained to international standards.
Output 1.2: Midwives regulated to international standards.
Output 1.3: Midwives are represented by a national recognized professional association.
Output 1.4: Midwives contribute to assuring greater equity in health systems.

Output 2.1: Models for district level Emergency Obstetric Care improvement established.
Output 2.2: Increased coverage and quality of Basic Emergency Obstetric Care services in supported locations.
Output 2.3: Improved quality of Comprehensive Obstetric Care.

Output 3.1: Improve availability of modern contraceptives in the community and health facilities.
Output 3.2: Improved capacity of service providers on adolescents sexual and reproductive health.
Output 3.3: Increased awareness and demand for family planning.

A third amendment with 4,6 MSEK additional covid19 support and a costed programme extension of 23 MSEK April 2021 - March 2022 was assessed in July 2020.

UNFPA requested in March 2020 to reprogramme 230 000 usd funds from 2020 that could not be spent due to the present pandemicas well as 500 000 USD additional covid19 funding.  The reprogrammed and additional funds for covid19 were directed to the activities at Upazila Health Clinics, UHC, and clinical facilities for midwives in the Swedish supported districts and Dhaka cc. All the activities within the Covid-19 response fall under Case Management and Infection Prevention Control (IPC) Pillars and Risk communication/awareness and community engagement pillars of the CPRP including the continues use of roving midwives to reach pregnant mothers during the pandemic.

With the Covid pandemic reaching record number of infection and deaths during march-april 2021 and with the risk of a longer lock down UNFPA requested new support in the form of 700,000 USD.

The goals of the Covid response will be:

Outcome 1. Increased utilisation of quality of SRHR services in the context of COVID-19.

Outcome 2. Continuation of RMNCH services (ANC, PNC, delivery care, FP and GBV), through telemedicine and emergency hotlines to be in compliance with global COVID maternity guidelines.

Outcome 3. Infection prevention and control (IPC) and effective triaging system established for separate maternity areas.

Outcome 4. Transport for midwives supervisors, health care providers and pregnant women for referral.