Community Skilled Birth Attendants: Strengthening health systems in ensuring safe motherhood in rural Bangladesh

Presenter: Judy Phuong, BRAC

Background: Whilst Bangladesh is on track to achieving Millennium Development Goals 4 and 5, 77% deliveries still take place at home, with only 32% deliveries currently being attended by skilled birth attendants. Challenges in accessing skilled delivery care stem from cultural barriers around traditional home births and access to institutional care. Since 2001, the Bangladesh Government has trained a new cadre of workers known as Community Skilled Birth Attendants (CSBA) for every 5000 population, in order to increase skilled birth attendance to 50%. CSBAs act to strengthen the health system through bridging the gaps between demand and supply of skilled care at delivery, improving MNCH outcomes in rural Bangladesh. Safe delivery is a pre-requisite to reducing maternal and neonatal morbidity and mortality, which BRAC seeks to achieve through developing CSBAs.

Methodology: CSBAs are selected and trained from all 14 IMNCS intervention districts namely Nilphamari, Rangpur, Gaibandha, Mymensingh, Lalmonirhat, Kurigram, Rajbari, Faridpur, Magura, Madaripur, Joypurhat, Pirojpur, Sherpur and Shariatpur.

Results: In 2014, the rate of skilled birth attendance increased to 65% in BRAC catchment areas with CSBAs contributing to 11%.  MMR and NMR dropped significantly to 32 per 100,000 live births and 10 per 1000 live births respectively, among the deliveries conducted by BRAC CSBAs.

Conclusion: The role of CSBAs in increasing skilled delivery through delivery of quality service and early referral plays a crucial role in improving maternal and newborn care and health. Investing time and resources to enable these CBAs to be competent enough to serve confidently, will provide a sustainable resource for strengthening health systems in improving maternal health outcomes in rural Bangladesh.