Affiliate Safe Community Support Centre-Institute of Child and Mother Health

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Name of the support centre: 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
"WHO 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 :

1. Prevention of all types of injuries among all age groups;
2. Behavior change communication;
3. Education and safety measures;
4. Modification of risk environments potential for injuries;
5. Improving injury case management;
6. 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.

To communicate injury prevention messages to the target community, the following means of communication are being used like:

1. Distributing leaflet: A leaflet have prepared describing programs objectives and activities in short. In three occasions 12000 were printed and distributed.
2. Erecting bill board: Four bill boards are made depicting RTA and dog bite/snake bite picture and messages and posted in road side.
3. 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.
4. 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.
5. Calendar distribution: On the occasion of New Bengali year we prepared a Calendar which comprised some messages.
6. 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.
7. 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.
8. 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 7^th, 8^th, & 10^th 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.

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Institute of Child and Mother Health, Bangladesh- Application as an Affiliate Safe Community Support Centre.

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Updated by Moa Sundström, 2002-10-29 14:39.