Yeung, Wan Hua
School of Public Health
Bangladesh - Case Studies of the Scale Up of Maternal and Newborn Health Interventions in Bangladesh
The MaMoni Program of Save the Children is a large USAID-funded health systems strengthening program with a goal to improve utilization of integrated maternal, newborn, and child health, family planning, and nutrition (MNCH/FP/N) services in Bangladesh. The projectâ€™s objective is to increase availability and quality of high-impact interventions through strengthening district-level local management and health systems. The project is currently supporting the scale up of two national initiatives: 1) universal cleansing of the umbilical cord with chlorhexidine; 2) upgrading lower-level health facilities to provide 24/7 delivery services.
As a part of MaMoni's program learning efforts, the evaluation team is conducting implementation case studies of these two initiatives, as well as other program components. The case studies will employ both qualitative and quantitative qualitative methods to: a) evaluate the outcomes achieved under these two initiatives; b) identify the challenges encountered by the program; c) document program adaptations and successful strategies.
Globa Health PI/Mentor: Jennifer Callaghan-Koru
I had originally expected to be in Bangladesh for 4 months from August-December 2016, but due to delays for security reasons, this was reduced to 2 months from December 2016- January 2017. Hence, when I first arrived in Bangladesh, I was excited to hit the ground running in order to make up for lost time. I had planned my accommodations and transportation in advanced, and my workplace was a convenient .5 miles away from my housing. Having this set up allowed me to start my field placement off smoothly and relatively stress-free.
My research experience while in Bangladesh gave me a much more realistic perspective of global health work in LMICs under financial and human resource restrictions. Although my supervisors had gently commented that my travel plan was “ambitious,” I soon realized that they meant I had tried to fit into a 2 month plan what would realistically take 6 months to achieve, based on available resources.
I had a mixed experience living and working in Dhaka, Bangladesh. One of the most unique experiences I had was visiting the city 5 months after a terrorist attack. Because of these circumstances, my movement was very restricted; I could only travel by car, and avoided going out in public. It was the first time I had lived in a heightened security situation. Even though this meant I did not have much of a social life while I was there, I appreciated the insight into precautions that are sometimes necessary in order to continue important work in the field of global health. A very positive work environment and good relationships with my coworkers provided a kind of escape from these restrictions. Rather than going out, I spent time indoors with my coworkers, either at my guesthouse or their homes, and found alternate ways to socialize that way. However, these visits were far and few in between, and I did go through periods of social isolation, especially because there were no other Hopkins-affiliated students in-country at the time, and because most of my coworkers were older and wanted to spend their free time with their families.
One thing that defied my expectations in the best way possible was the ease and productivity with which I was able to complete tasks in the field. Although I had expected things to flow faster now that I was working from the country office, I was surprised by the willingness and quick turnaround time with which my coworkers responded to my requests for help or information. Although there was a strong sense of hierarchy, and I was technically an intern and an outsider, I did not feel like one. I attribute this to a mix of 2 potential factors: 1. my on-site supervisor, who supported me with his authority and led the team I was working with in a way that facilitated great teamwork; and 2. My affiliation with Hopkins, which is seen as an elite institution in the field of global health.
I was pushed out of my comfort zone through the in-depth interviews I conducted with national stakeholders, which included high-ranking officials at the ministry of health, national newborn health champions seated at the head of academia and professional bodies, and program managers at NGOs. It was intimidating to sit across from them, and was sometimes tricky navigating the interview to get rich information, especially since it was my first practical experience conducting in-depth interviews. However, I found all of them to be gracious, and also found my interviewing skills growing with each interview, which was very rewarding.
I think one of the biggest takeaways from this field experience is the importance of relationships and choosing the right person for the job. From just scheduling interviews to the actual interviews themselves, we always did it with a contact person who had a relationship with the interviewee. This opened doors for us to people with extremely selective schedules. Additionally, in my final presentation to the program implementers, I learned from my supervisors the importance of not only presenting key findings, but to balance that with recognition of all the work everyone had put in already. I think in school we are so focused on producing a high quality final product that sometimes we can lose sight of the fact that in the real world, we can’t and didn’t do it alone. This field experience reminded me that improving global health is a team effort, and building good relationship is the foundation for that