Affiliate Safe Community Support Centre
Centre for Injury Prevention and Research, Bangladesh (CIPRB) replacing
(Institute of Child and Mother Health)
Country: Bangladesh
Population:
Bangladesh 2001 -130 million,
Sherepur Sadar Upazila 2001 – 400,000
Program started: the Sherpur Safe Community Programme started
in 1999
Affiliate Safe Community Support Centre: Designation year: 2002
More information: www.icmhbd.org
Identity: The Institute of Child and Mother Health
(ICMH), Matuail, Dhaka, Bangladesh is an unique Institute
works not only for the welfare of the children and mothers
of Bangladesh but also for all children and mothers the world
over.
Mission: To respond to the needs of children and mothers
in the country particularly in the field of health and nutrition.
Vision: ICMH is a unique institution to guide and
lead the country in child and mother health and a model of
combined community and hospital based services on preventive
promotive and curative care.
Objectives:
Health and Nutrition research in child and mother health;
Human resources development through training in child and
mother health;
Provision of health care in the community, out patients and
inpatients.
Strategies:
Combining community and hospital based care for children
and mothers;
Combining care of children and mothers health;
Emphasizing on nutrition of children and mothers;
Equal emphasis on need based research, training and patient
care.
Special Characteristics of ICMH:
The institute is characterised by having very clear mission,
vision, goal, objectives, strategies and action plan. Research,
training on child and mother health and nutrition as well
as patient care are all organised under the umbrella of a
single institute. It has highly trained, skilled, motivated
and committed faculty members. This community based Institute
hosts a Faculty of Epidemiology and Biostatistics, Centre
for Training and Communication with excellent training facilities,
Department of Energy and Biomedical Engineering. Of special
note is the excellent Auditorium, conference rooms for national,
regional and international conferences as well as arrangements
for residential training. ICMH has a community-based branch
at Jalkuri. In this institute, we are planning to provide
quality patient care through protocol based patient management
as well as efficient hospital management supported by computer
networking, high quality medical record system and up to date
library facility. The location of the institute is also favourable
to keep contact with the rural community. The institute has
a strong commitment to promote safety among all population
of Bangladesh.
Manpower:
Among the total 255 approved posts, currently there are 230
staff members of whom 45% are female. Out of 230 members,
51 are class I, 12 are class II, 105 are class III and 62
are class IV staff.
Sherpur Safe Community Programme:
The Sherepur Safe Community Projgramme was lunched in December
1999 based on the WHO Safe Community model. It is also based
on the injury surveillance system that had been on operation
for four years. This is a research as well as developmental
programme with an over all goal of safety promotion, injury
prevention and social development in the area.
Sherpur Safe Community Programme is a collaborative programme
of Institute of Child and Mother Health (ICMH), Matuail, Dhaka,
Bangladesh and Karolinska Institutet, Norrbacka, Stockholm,
Sweden on injury prevention. The Swedish International Development
Cooperation Agency (SIDA) has made available fund for this
programme.
The Program area, Sherpur Sadar Upazila, (Upazila is a sub-
district), having around 400,000 population in 380 Sq. Km.
and it is located about 200 km away from Dhaka, the capital
Bangaldesh, and situated at the mid northern Bangladesh-India
border. Sherpur district headquarters, which is a municipal
town, is housed in this Upazila. Geographically the area is
featured by plain land, traversed by a big river and many
other small rivers and canals and a lot of other natural surface
water reservoirs like ponds and ditches. Socio- economically
people are poor in general, around 70% live below poverty
level. The main professions of the inhabitants are agriculture
,Business, Service, Share Cropping, Day laborer, Rickshaw
puller, Rice mills worker, Carpentry, Mud culling, Pottering
etc.
For intervention programs the project has also identified
its control area at Netrokona (another sub district or upazila)
which is very similar in all respects having around 300,000
population. It has also a district headquarters and the municipality
of the same size like Sherepur. The control area is about
110 km away from program area.
An employed set-up, comprising Nine people, governs administrative
functions of this program. This body is primarily responsible
for coordinating community organization participation in safe
community initiatives, for program management and for implementation
of interventions.
As mentioned earlier an injury surveillance system ( hospital
based ) had been developed in Sherpur since 1997 which has
provided epidemiological features and information for initiating
intervention program.
This intervention program hoped to act as countermeasures
to lowdown occurrence of injury events (intentional and unintentional)
as well as will serve as an experimental research in suburban-rural
setting in Bangladesh. The interventions would be based on
intersectoral approach ensuring community participation. Educational,
engineering, environmental, legislative, mass media, and improved
case management are the mainstays of interventions local condition.
By principle the program allows a greater degree flexibility
to absorb suggestions from community in the course of program
implementation and the practical experiences provide the action
guide in many situations.
The main program efforts are exerted in primary health care
level but it also uses secondary level health care arrangements.
VISION, AIM, GOAL, TARGET
Vision: To develop an ideal injury prevention and
safety promotion program for demonstrating other parts of
Bangladesh and also for the whole developing world.
Aim: To attain WHO safe community recognition for
the study area.
Goals:
1. Creating national level Govt. authority & opinion leaders
to take national injury prevention plan through presenting
success stories of this program.
2. Creating a favorable state which might stimulate conscience
of national Govt. in recognizing injury as a major public
health problem and thereby motivating them to incorporate
injury prevention program in current " Five year plan
for Health and population sector programs".
Strategies:
Prevention of all types of injuries among all age groups;
Behavior change communication;
Education and safety measures;
Modification of risk environments potential for injuries;
Improving injury case management;
Gaining commitment from government, political and social leaders.
CURRENT ACTIVITIES
1. Establishing injury Surveillance system:
The program has established an injury surveillance system
in it’s program area and also in the control area.
At Sherpur, surveillance data are being collected from: Hospital,
Police report, Postmortem report, from Volunteers (Community
level).
Hospital data: Hospital data are collected from admitted
patients using a standard format. An inbuilt data collection
and entry into the computer has been arranged by setting a
computer corner and training two persons who themselves collect
data.
Police report and post mortem report: These report is collected
from local police station’s record.
From volunteers (Community level): The program is collecting
data from village volunteers.
Initially community health centers ( Govt. & NGOs ) &
clinics were in the list of surveillance data sources but
after one year effort it is concluded that data collected
from these points are insignificant and it does not contribute
anything to surveillance. This dismaying observation then
compelled us to drop these sources from surveillance purview.
In the control area data are collected from: Hospital, Police
report and Postmortem report.
In addition to this, surveillance system is supplemented
by household surveys. In both the program and control area
the surveillance system is computerized.
Local networking: The very initial step of mobilizing
local community was to local networking arranging personal
appointments and discussing aims & objectives of the program
and thereby securing commitment of cooperation .
The sectors covered are:
Existing health system (CS, THFPO)
Public administration (DC, SP, TNO)
Other relevant Govt. departments like police (including village
police setup), engineering etc.
Elected public representatives (MP, Municipal Chairman, UP
Chairmen);
Various Association leaders;
Local elite;
Local NGO,s.
3. Household survey: The program has conducted two
household surveys, one at Sherpur and the other at Netrakona.
Each covered around 16000 households in an average. Both Sherpur
and Netrokona survey surfaced drowning, RTA, fall, suicide
as priority injury problems.
4. School training: In order to produce a conscious
future generation regarding injury issues and also to change
risky behavior of school children and youngsters, the program
has started a school training program. Initially 5 schools
of Sherpur town have been selected involving school administration
in planning and implementing. Two manuals, other audio-video
materials have been developed as training materials.
The said 5 schools are reputed high schools in the town where
manual based very structured training courses are offered.
In rest of the schools situated in program area (high, junior
high and primary schools) nearly 250 in numbers are offered
one day orientation. By now, these schools have been covered
for once and will be repeated for second time.
Module based school training (in 5 schools) is conducted
by the schools themselves. Two teachers from each school have
been trained on how to conduct sessions. Teachers and students
are given modules. Modules are self explained means how to
present sections of the module is stated there and also the
ways to make sessions attractive and complete is also mentioned
there. For each session logistic support is given from the
program and a field coordinator remain present there to watch
and finally the field coordinator take an instant examination
using a question sheet where two / three questions on the
presented session are asked. Field coordinator then collect
the answer sheets and mark on those and gives back to the
students to communicate their last days performance. The mechanism
gave schools self control and articulated teachers –
students on being concentrated on the subject matter.
5. Behavior Change Communications:
To communicate injury prevention messages to the target community,
the following means of communication are being used like:
Distributing leaflet: A leaflet have prepared describing
programs objectives and activities in short. In three occasions
12000 were printed and distributed.
Erecting bill board: Four bill boards are made depicting RTA
and dog bite/snake bite picture and messages and posted in
road side.
Wall writings: 20 wall writings with picture and messages
have been done in different places of the town and 14 in selected
places of villages. Some of the prototype of these bounded
in small board which are pretty portable, are being used in
social mobilization meetings/ gatherings.
Video presentation: Recording the statements of the victim’s
families we have prepared a video. This is being used in social
mobilization meetings, especially in rural area.
Calendar distribution: On the occasion of New Bengali year
we prepared a Calendar which comprised some messages.
Advertisement in various publications: We have managed to
publish five advertisements / publications in various magazines
/ newspapers. We speculate that this will give a good publicity.
Cinema slide presentation: The program has produced six prototypes
of posters / pictures which will be showing in cinema halls
before starting movies. There are six cinema halls in the
town.
Album: We are creating two albums. One by pasting newspaper
cuttings on injury, both from local and national newspaper.
The other is by the pictures of our activities.
6. Social mobilization meetings:
General: We have done 97 general social mobilization meetings.
One with Government departmental officers, One with Officers
of Non- Government organizations, Professionals, Associations,
local elite, One with Health providers, Two with sub-district
administrative body, Two with municipal body and 14 with village
union council bodies.
Parallel to these general meetings we have completed 70 village
meetings. These village meetings are organized with the help
of local elected Union Council Members, volunteers and other
local leaders who has strong social influence on social life.
We have created a set of logistics to support these meetings
so that the session can be offered in a very organized and
attractive way.
As we were advancing and looking for effective ways for ensuring
community participation our experience identified community
volunteers very useful. We followed a methodology to find
them out instead of asking village authorities to give a list.
We asked household members some specific questions (i.e To
whom you consult first when you are in medical problem ? )
and based on their answers we could find names. They are all
times friends in need of community people. They can be told
as natural leaders of villagers. From each Union we selected
27 such persons and called them in meetings. In meeting we
made them understood what role we expect them to play for
our program. We could complete 8 volunteers meetings.
Special: We have designed some special type of social mobilization
meeting arrangement like for drowning / Snake bite / dog bite
- we have created a mechanism to get fresh injury death news.
As soon as we get a news we move there and have a social mobilization
meeting with local people on the spot, so that people can
see the justification of our words. We have done 71 such meetings
so far.
7. Community coalition: As the program now know the
priority injury problems for the program area, it has now
started dialogue to form community coalition to secure community
participation. Separating the community into two sections,
Urban and Rural, we have formed two community coalitions.
One, for rural community under the chairmanship of Sub-district
administrator and 14 elected public representatives. The other
one, formed for urban community under Municipal Chairman and
9 elected municipal commissioners.
8. Volunteer support group: Driven by the experiences
from rural community we have marked that some people do welfare
work for the people of his / her locality out of their natural
instinct. Usually these people are local social leaders, school
teachers, religious leaders etc. they serve people, guide
people without any personal interest. The program considered
these volunteers suitable for reaching people and as a means
of successful intervention. With this thinking, we have started
a process of finding out them asking household heads and listing
up them to create a volunteer support group. We 14 Unions
and selected 27 volunteers from each Union whom we planned
to train for preparing as support group. Asd we mentioned
earlier 8 such groups are trained already.
9. Specific measures: The program was continuously
studying the local situation to know the injury sources, factors
and trying to find out specific measures to reduce injuries.
One specific measure that we developed is a tube-well handle
guard which prevents injury produced by the handle of tube
well which is the universal source of drinking water in the
program area. Tube-well users acceptance was very encouraging.
The program had a plan take a wide scale promotion on this
for the program area but due to resource and time scarcity
we had to be limited.
The project activities include local networking, establishing
injury surveillance system, household survey on drowning,
road traffic accidents, suicide and injury due to fall and
injury education program for community people including school
children. Among the specific measures the project has developed
a tube-well handle guard which prevents injury due to tube-well
handles. Research, consultancy, advocacy, and lobbying for
legislative change are also important activities of the Sherpur
project.
Other involvement of ICMH in Safety promotion
International commitments:
The institute is committed to develop an ideal injury prevention
and safety promotion programme for demonstrating other parts
of Bangladesh and also for the whole developing world.
Conference organisation and participation:
The project is actively involved in local, national and international
conferences as organisers and presenters. The institute organised
the Safe Comm-9, Dhaka, February 2000. A good number of staff
of the project presented their work in the conference. Staff
have received scholarships to present their work at the Sixth
World Conference on Injury Prevention and Control, Montreal,
Canada, May 2002. Three staff will also participate and present
their work in the First Asian Regional Conference in Injury
Prevention, Suwon City, South Korea. The project has presented
work at the 4th, 6th and 7th, 8th, & 10th SafeComm conferences
as both presenter and key note speaker during 1994-2001.
Educational activities:
The institute has extensive teaching commitments with undergraduate
teaching in community safety, undergraduate and postgraduate
teaching of medical students, MPH and Graduate Diploma in
Child Health students, stakeholder of injury prevention, and
a range of secondary and tertiary students.
Staff:
Number: 20 staff, 2 full-time, 16 part-time and 2 temporary.
Disciplines: Public health, Epidemiology, information technology,
Statistics, social sciences, community development and teaching.
Application Report:
Institute of Child and Mother Health
For further information please contact:
Dr. AKM Fazlur Rahman PhD
Executive Director
Centre for Injury Prevention and Research, Bangladesh (CIPRB)
House 226, Lake Road 15, New DOHS
Mohakhali, Dhaka 1206
Bangladesh
Tel. +880-2-8861258 Ext. 102
Fax. +880-2-8861499
Email: fazlur@ciprb.org , fazlur@citechco.net
Web: www.ciprb.org
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