**_The_** _Matdab_ **_Project_**

_5_ CHS but earn no income. About 1250 bari-mothers have been trained to promote and educate mothers on oral rehydration solution (ORS) preparation and use. They keep records of their communities' ORS needs and act as depots for distributing ORS packets. Since 1982 there have been about 500 traditional birth attendants (TBAs) who have been trained to educate mothers about safe delivery of babies and utilization of sal. birth/delivery kits.

Once every two weeks each block subcenter holds a staff meeting which is attended by the CHWs, LFPVs, SHAs and, usually, more than one managerial staff members of the Project located at Matlab Bazar. Necessary contraceptive and medical supplies are distributed in these meetings. The CHWs report on their fortnightly activities and discuss their field problems. The supervisors present block performance reports to the CHWs and give information about changes, training sessions, and other relevant matters. These meetings provide opportunities to the CHS for continuous orientation on various aspects of their work. Data management personnel attend those meetings to collect and disseminate biweekly information.

The Matlab Project does not provide any service other than ORS distribution in the Comparison Area. But its Demographic Surveillance System (DSS) staff members regularly collect demographic data from the Comparison Area through periodic visits to the households. They are also responsible for distribution of ORS packets and imparting education regarding their proper use.

# _Service_ **_Structw_** _of the_ **_Bangldesh_** _National Program_

The family planning wing of the Ministry of Health and Family Planning (MOHFP) provides family planning and MCH services throughout the country (for details see Balk 1986 and Balk et al. 1988). The union-level health and family welfare centers (one H&FWC for approximately 20,000 people) constitute the institutional cornerstone of the rural family planning and MCH outreach service. These serve as the first referral points for village-level service providers. In 1991, there were about 2700 such centers. There were about 350 upazila-level health complexes (UHCs). As recent extension of facilities, two satellite clinics are organized twice a week within the jurisdiction of union-level H&FWCs and two sterilization camps are organized every month by each health complex (Choudhuri and Akhter 1989).

Pills, condoms, and foam tablets are distributed at home by Family Welfare Assistants (FWAs)-the key field-level female workers. There is provision of IUD insertion and other health services at the union-level health and family welfare centre which is staffed by a lady paramedic designated as Lady Family Welfare Visitor (LFWV). Sterilization and menstrual regulation services are available at the family planning unit of the health complex, which at the minimum has a doctor designated as MO (MCH), two lady paramedics, and two male assistants. Injectable (depo-piovera), introduced in the program since 1978 and still accounting for a minuscule part of contraceptive prevalence, is administered in any health facility.

The density of Family Welfare Assistants (FWAs) located at the union-level centers was one per 7500 population until recently. They were scheduled to visit each household once every three months. With the addition of ongoing recruits, the FWA-population ratio by the end of the Third Five Year Plan (1985-90) is expected to be of the order of 1:4000 or roughly 1:800 couples (about four times less than in the Matlab Treatment Area). Family Planning Assistants (FPAs), who are males, have the responsibility of supervising FWAs (females) and also