সংযোগ

Universal Health Coverage (UHC): in pursuit of equity to access in health care services

Universal health coverage (UHC) means that all people receive the health services they need, including health initiatives designed to promote better health, prevent illness, and to provide the treatment, rehabilitation and palliative care of sufficient quality to be effective while at the same time ensuring that the use of these services does not expose the user to financial hardship. Universal health care (also called UHC) is a health care system that provides health care and financial protection to all citizens of a particular country. Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.

Definition of UHC by WHO
Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. Currently, at least half of the people in the world do not receive the health services they need. About 100 million people around the world are pushed into extreme poverty each year because of out-of-pocket spending on health. To make health for all a reality, we need: individuals and communities who have access to high quality health services so that they take care of their own health and the health of their families; skilled health workers providing quality, people-centred care; and policy-makers committed to investing in universal health coverage. Universal health coverage should be based on strong, people-centred primary health care.

What countries have UHC?
Countries with universal health care include Austria, Belarus, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, Malta, Moldova, Netherlands, Norway, Portugal, Romania, Russia, Sweden, Switzerland, Turkey, Ukraine, Serbia, Spain, United Kingdom and India .

Is Universal health care free?
Universal health care is a system that provides quality medical services to all citizens. The federal government offers it to everyone regardless of their ability to pay. Most universal health care is funded by general income taxes or payroll taxes. Some countries mandate that everyone buy health insurance

Components of UHC
The key elements which are needed to achieve UHC are:
• Strong political leadership and long-term commitment to achieve Universal Health Coverage.
• Generate multi stakeholder support for Health Care Financing Strategy; and
• Implementation of UHC in country’s health care system.

Why does UHC work?
Single-payer health-care (in which the government pays for universal coverage, typically through taxes) helps keep costs down for two reasons: It means that the government can regulate and negotiate the price of drugs and medical services, and it eliminates the need for a vast private health-insurance bureaucracy. Universal health care is a system that provides quality medical services to all citizens. The federal government offers it to everyone regardless of their ability to pay. Despite some similarities, Obamacare is not universal health care. Most universal health care is funded by general income taxes or payroll taxes.

Who pays for Universal health care?
Single-payer health-care (in which the government pays for universal coverage, typically through taxes) helps keep costs down for two reasons: It means that the government can regulate and negotiate the price of drugs and medical services, and it eliminates the need for a vast private health-insurance bureaucracy.

Universal Health Coverage: Bangladesh situation
UHC is to be a top priority for Bangladesh health care system. Under UHC people are expected to have access to quality health care services without any financial hardship. Although Bangladesh has been moving ahead in extending health care services to its citizens, there is still disparities in accessing services by various social groups. Financial barrier is still a very important barrier in accessing health care. As we know that annual per capita health expenditure is $ 27. Of this, 67% comes from individual pocket which is one of the highest and has a serious impoverishing effect on household economy. Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters.

Health Care Financing Strategy

At the strategy level, Bangladesh has adopted the health care financing strategy 2012-2032. It also worked on health workforce strategy 2013-2033. At the action level the government has increased the manpower for hospitals and health centers to provide better health care services. The government has already established and revitalized 13,000 community health clinics. The policy environment in Bangladesh is primed for an all-out progress towards UHC, especially owing to the commitment from the highest political level within the country. Bangladesh requires a customized and context-specific policy adjustments need to be incorporated for progress towards UHC and subsequently achieving the pertinent SDGs. The challenges posed by health financing in Bangladesh are many and can be summarized under three broad categories. These are:
(i) inadequate health financing;
(ii) inequity in health financing and utilization; and
(iii) inefficient use of existing resources.

The goal of the national health financing strategy is to strengthen financial protection and extend health services and population coverage especially to the poor and vulnerable segments of the population, with the long-term aim to achieve universal coverage. The role of health financing is to:

(i) provide all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality to be effective; and
(ii) ensure that the use of these services does not expose the user to financial hardship.

To cope with the challenges and increase financial protection for the entire population and decrease out-of-pocket payments at point of service, the following three strategic objectives are proposed:
• Generate more resources for effective health services
• Improve equity and increase health care access especially for the poor and vulnerable
• Enhance efficiency in resource allocation and utilization.

Health Equity
Health equity aims at people’s health service opportunities based on their needs and ability to pay for it. This means that the same health center is charging people based on their level of ability to pay for the service charges.
A person who cannot afford service charges for health care may receive it for free while another person may pay for the same care. Equity in provision of the health services is one of the central pillars for promoting UHC. According to the International Society for Equity in Health, “Equity is the absence of systematic and potentially remediable differences in one or more aspects of health across populations or population groups defined socially, economically, demographically, or geographically”. Unfortunately, Bangladesh’s out of pocket (OOP) contributions to health expenditure becomes one of the most inequitable sources of healthcare financing which is among the highest in the world with 67%. On the other hand, the Quality of care, another important aspect of UHC, still remains as highly questionable in the public sector. This encourages people to opt for private sector healthcare, which is more expensive and increases the OOP at further level that accounts at 93% for the health expenditure in private health facilities exclusively from OOP payments.

Government’s health expenditures and budget allocations does not correspond with health equity
Government’s health expenditures and budget allocation appears as mere conventional. The following two diagrams are clearly indicating that the government health care expenditure in proportion to the total public spending remains static in between 5% to 6% in the past several years.

Moreover, there are quite frequent curtailment of allocation in revised budget than that of the proposed one happens almost in every year. In addition, the National Health Policy (NHP) underscored the increment of health care spending as share of gross domestic product (GDP) in Bangladesh. But in previous few years, the trend follows a downward stream. At present, the country spends only 2.8% of its total GDP in health sector, whereas neighboring countries like Bhutan, India, and Nepal spend 3.6%, 4.7%, and 5.8%, respectively. Most surprisingly, the maximum portion of health care expenditure as a share of GDP is private, which means being paid by the individual’s own pocket.

The National Health Accounts that OOP payment in Bangladesh is 67%, compare to the global standard which is less than 32%. However, almost two third (61%) of the OOP is costs for buying drugs and medicine. Because government spends only 23%, the health care need that magnifies the poverty and leads to financial hardship in Bangladesh. Studies reported that nearly 15.8% of the households face financial catastrophe in Bangladesh, leading them to hardship, asset diminution, and increases inability to consume the essential services.

Equity seems inherent to the pursuance of UHC
In accessing to health care, the equity is inherent to the health system objective of universal health coverage (UHC). Policies aimed at UHC, from wider health systems approaches to focalized programs and interventions, must be assessed in terms of their effect on equity of access, which requires that their design and management specifically facilitate and enable access across the social arena, particularly by disadvantaged groups.

The World Health Organization defines universal coverage reforms as “reforms that ensure health systems contribute to health equity, social justice and the end of exclusion, primarily by moving towards universal access and social health protection”. The World Health Organization (WHO) believes that equity is an intermediate objective of UHC; and the WHO Consultative Group on Equity and Universal Health Coverage urges countries to commit to fairness, equity and rights to health in policymaking. However, equity is not a natural consequence of the implementation of UHC policies. The UHC infers balances which may not necessarily favorable to vulnerable people, and some policies pursued in the name of UHC may worsen inequalities. Hence the acknowledged importance of measuring inequity, and tracking progress is necessary when implementing UHC policies.

The role of Strategic Communication in promotion of UHC and Health Equity
Effective strategic communication is essential to apprehend UHC and that for health equity. Progress toward UHC requires community ownership and tailored strategies for specific contexts. Diverse stakeholders must be engaged that includes political leaders, health care recipients, providers, suppliers, and civil society groups while each audience requires customized communication approaches to change their knowledge, attitudes, and behaviors. Communication is the two-way exchange of information while the strategic communication is deliberate and coordinated actions intended to inform, influence, or persuade key stakeholders. These actions may engage stakeholders in information sharing, dialogue, and/or collective learning, with the aim of making decisions or influencing human behaviors.
All actors to understand their rights, responsibilities, and opportunities to maximize the benefits of UHC and to act in the best interest of realizing those rights, responsibilities, and opportunities. This is often a first step for many in the complex, long-term endeavor of realizing UHC. In other policy dominions, strategic communication provides the information exchange, modeling, and reinforcement necessary to influence behavior change. Whether through building allies, establishing partnership and advocacy for resource mobilization, promotion and implementation of new health system processes, or other strategic communication efforts; policymakers and implementers are constantly working to achieve incremental progress toward UHC.

“Digital resources will make a difference regarding quality counselling of the clients in HPN” Sector – LD, NNS, DGHS

Virtual eToolkit training for field workers (HA, AHI, HI and CHCP) of Sunamgonj Sadar, Biswambharpur Upazila of Sunamgonj District and Ukhia Upazila of Cox’s Bazar held through April 29, 2021 to May 11, 2021 in seven batches. This training was organized from the operational plan budget of NNS under 4th Health, Population and Nutrition Sector Programme (2017–2022) with the technical support from USAID-Ujjiban project. A total of 126 field workers were present in total 6 batches. Batchwise training was inaugurated by Dr. S. M Mustafizur Rahman, Line Director, NNS, DGHS and Dr. Fatema Nawaz, Program Manager, NNS, DGHS from Central level and Civil Surgeon from respective districts.

In the inauguration session both the guest from central and district level reiterated that this virtual training is very essential when country is stepping to digitalization. Now a days most of the health-related data has been sending to central MIS virtually. By using these digital resources filed works will be able to make a difference particularly in regards to better counselling of the clients in HPN sector. The whole training program was divided into: objective of the training, Introduction to digital resources pre and post, installation of eToolkit and eLearning course step by step and practice session to run eToolkit and eLearning course. As this is a technical training hence a pre-training orientation session was organized just day before the actual training to acquire technical know-how for smooth running of the training by using the Zoom Platform comfortably.

Sensitized Journalist and Quality Reporting can Contribute to Improved Public Procurement Environment in the Country

BCCP, DIMAPPP team successfully conducted an Orientation Program for Media Representatives on Public procurement and e-GP on March 24, 2021 in Rajshahi at Hotel Warisan. The objectives of the orientation program were to:
• Provide knowledge on Digitizing Implementation Monitoring and Public Procurement
• Explain the participants act, rules and digitizing on public procurement.
• Discuss how to prepare investigative report, feature, and analyze information on public procurement; and
• Explain the importance & main activities on social awareness, citizen portal and citizen engagement in public procurement

A total of 30 participants attended the orientation program from seventeen (17) national and local print media, thirteen (13) electronic media including Bangladesh Television and Bangladesh Betar.

Mr. Md. Aziz Taher Khan, Director, (Joint Secretary), CPTU, IMED, Ministry of Planning was present at the event as Chief Guest and inaugurated the Orientation Program. Ms. Khadija Bilkis, Team Leader, BCC component of DIMAPPP and Sr. Deputy Director, BCCP was present as the Special Guest. Mr. Md. Saifur Rahman, Senior Assistant Commissioner, Rajshahi presided over the orientation program.
The orientation program was explorative, reflective, analytical and was based on participatory principles through multimedia presentation and online display.

The media professionals found very much interested and enthusiastic in the discourse of public procurement and e-GP issues in the country. The participants were provided with useful reference materials on public procurement and e-GP system in the country. “The workshop will enable our local journalists to prepare quality, authentic and investigative reporting which can ultimately benefit a transparent public procurement environment in the community” mentioned the participants at the end of the workshop.

The orientation program got a good news coverage in different print newspapers/online newsportal like Bangladesh Sangbad Sangstha (BSS), The Daily Sunshine, Sonardesh etc.

Guidebook on community mobilization could become a resource book for planning of local level mobilization in the HPN fields

In the one-day orientation for the Health, Population and Nutrition (HPN) field’s unit level officials, the participants found very enthusiastic to apply the learning of the guidebook in planning community mobilizations interventions in their respective field of operation. One of their major comment expressed as that “Guidebook on community mobilization could become a resource book for planning local level mobilization in the HPN fields”.
This orientation program was held on April 28, 2021 in the Zoom virtual platform that participated by 19 officials from the Health and Family Planning directorates includes; Line Director-L&HEP, Chief-BHE, PM-IEM and the DPMs from the BHE, IEM, NNS, CBHC, CCSDP and FP-FSD units. Ujjiban-SBCC project officials from the CSS and CM team also attended this day-long orientation. The participants were keen about the topics and found proactive in raising issues over the discussions in the orientation of CM Guidebook that developed and organized with the technical assistance from the Ujjiban SBCC project.
The guidebook had a total of 8 sessions titled as; - Community Mobilization: differences between community and social mobilization - Understanding of the Community: strategic communication and communication and perception - Implementing Community Mobilization: developing a strategic plan - Community Engagement: process, type, principle and challenges - Community Participation: motivational factors, obstacles, stakeholder analysis and capacity development - Analyzing target audience: target audience for community mobilization, analyzing message specific target audience - Inter Personal Communication: process of behavior changes, elements and skill development - Group Meeting: steps and skills of the organizer.
In the concluding session the Line Director, L&HEP termed this orientation as a good source of learning on community mobilization and contributory for the program planners. He thanked Ujjiban for developing the CM Guidebook and conduction of this orientation course.

Leading for a Better Tomorrow

For a better life one needs to have better decision making and problem-solving skills. Successful leaders are able to transform organizations, enhance value creation, create efficiencies and engage their co-colleagues to help deliver better results. To acquire a better personality and securing the future, the upcoming generation needs to have a strong base of skillset. In order to encourage leadership and capacity building of the university students as well as strengthening the connection among the students and law enforcement agencies, the Student Leadership Development Workshop (SLDW) came into application. The road to SLDW initiated with a vision to guide the youths coming into the spotlight and devise the qualities to be the leaders of tomorrow.

The successful completion of the Rajshahi SLD Workshop made the students realize how they can utilize their fullest potential to benefit themselves and the society around them. The recent trend in Bangladesh is displaying a scenario where youths are engaging themselves in many militant groups along with involving in various extreme and violent activities. By attending the Student Leadership Development workshops student along with the police participants have gained knowledge regarding issues like patriotism, leadership, extremism, inter-faith dialogue, radicalization and counter radicalization, community resiliency, policing in Bangladesh, reporting crime, social network, life skills and so on.

It is worth mentioning that, BCCP with the help of Information Support Team (IST) of U.S. Embassy have successfully conducted 15 theme-based workshops in 5 batches. Participants from University of Rajshahi, Rajshahi University of Engineering and Technology (RUET), Rajshahi College & nominated police members from Rajshahi Metropolitan Police (RMP) have attended the workshop titled "Student Leadership Development Workshops" under the project of “Rajshahi Student & Police Engagement ̶ Student Leadership Development Workshops”. The Student Leadership Development Workshops in Rajshahi started in last week of January 2021 and continued till the 2nd week of March 2021.

To demonstrate the deviation of the student participants after the workshop, they were asked by the educators to perform and practice various activities which were relevant to the topic covered in the workshop. Moreover, to utilize the leadership experience and preserve the takeaway of the workshop, a Knowledge Management Database (KMD) have been developed.

Most of the students have shared their experience with the team about how they were able to materialize their learnings amidst this pandemic period. The global Covid-19 pandemic initially came as a horror to the mankind and being confined for a substantial amount of time a lot of people had suffered from mental anxiety and other cognitive traumas. Many students have discussed and shared their learnings with their family members, close relatives, neighbors, peers who were depressed or indulged with other mental complications about various aspects of the workshop using their life skills to assist them in overcoming their difficulties. They have encouraged themselves after the workshop and consciously putting these concepts into practice and got some great results.

Unified and integrated school health, population and nutrition education package: a milestone system changes for the GoB completed the journey through a validation workshop

An effort was initiated in 2019 for an integrated and unified school health education package bringing the health, population and nutrition (HPN) together in one single curriculum as were being used by the DGHS and DGFP focusing on different HPN issues. This effort was originated following DGFP’s school education program who introduced the comprehensive issues of HPN in their School Education Program replacing the existing curriculum which had mostly concentrated on the population issues. Ujjiban provided TA to the DGFP for developing such an integrated School Health, Population and Nutrition Education curriculum.

This curriculum was developed at the end of 2017 and after having vetted by the HPN units and also validation of the DGFP level decision makers, it was introduced in the program through ToT to 174 headquarter and district level trainers for making up a resource pool by mid-2018. This resource pool provided training to the upazila/union level Sub-Assistant Community Medical Officer (SACMO), who were responsible to provide health education at the schools, to cover the entire 2200 SACMOs of 64 districts.

After seeing the success in DGFP, Ujjiban planned to continue its effort for a unified, integrated and comprehensive school health education curriculum to be commonly used by the entire GoB level HPN units under the MoHFW in order to bring out a comprehensive curriculum and making it as uniform, univocal and integrated messaging for the school students on the HPN issues.

Development phase:
Pursuing to these objectives Ujjiban undertaken several initiatives includes; mobilizing ministry level policy makers, directorate level HPN unit heads and program stakeholders. Simultaneously the different school health education curriculums as have currently been using by the different units started collecting to see the differences between these and conceptualize how a uniform curriculum could have been better contributed to the school health education program. This conceptualization also reviewed the current provision for organizing, imparting and geographical covering of the school health education program. The expedition found four different types of curriculums being used by different units having singly focused at either on health, population or nutrition.

In continuation of this pursuance this issue was discussed in the BCC Working Group meeting which was held on December 27, 2018 having the Additional Secretary, HSD, MoHFW as Chair and Additional Secretary, ME&FWD, MoHFW as co-chair. This meeting decided that the school health education program have to be implemented in an integrated way. An SBCC OP Coordination workshop will have to be organized by mid-January 2019 with the OP Line Directors and the DPs to discuss and decide this integration process.

Finally, the MoHFW convened an OP Coordination Workshop for developing a unified and integrated school health education program bringing the health, population and nutrition program comprehensively covered together in one single curriculum. In addition to the MoHFW and HPN unit OPs, this workshop was also participated by the representatives from the ministry of education, ministry of religious affairs, ministry of women and child affairs, ministry of local government and ministry of information held on January 14, 2020. This workshop brought all available school health education program curriculum into consideration. After a day-long discussion followed by group work activity this workshop came-up with specific recommendations that all existing curriculums will be replaced with one single package for an integrated and unified school health education program which will be used by entire HPN units. This workshop also recommended forming a 15-member national level committee had been formed comprised of MoHFW, MoE, MoWCA, MoI, MoLGRD&C including 7 of the HPN unit includes; IEM, NNS, L&HEP, MCRAH, CBHC, CDC and MNCAH. This committee will be chaired by the Additional Secretary (Pop., law and FW), MW&FWD, MoHFW while Deputy Secretary (PH-2), HSD, MoHFW will be the member-secretary of this committee. Ujjiban will also be a member of this committee to provide TA.

Scaling up and consolidate the development phase by developing a package:
In the consolidation phase of the package this national committee hold three meetings for development of contents and get the package consolidated for the final version of the package with the contents and lesson plans. The first meeting held on September 15, 2020 that finalized the content topic titles to a total number of 17 with the detailed sub-topic heads. This meeting decided to detail out contents to be developed by respective program units.

The second meeting of this committee was held on October 28, 2020 to review the detailed contents along with the lesson plan outlined under a comprehensive package. This meeting finalized the contents, lesson plan and package outline and finalized the contents on 23 subject issues that brought under 23 sessions. These sessions will be grouped under 7 chapters. The meeting also chalked out a package finalization and production schedule to carry on activities that brought down the package into implementation level.

In its third meeting on January 18, 2021 this package was presented before the HPN OP Line Directors with package production and implementation plan. This meeting approved the package with the provision of laying-out the contents in formal package format, inserting illustrations, OP level initiative for package production and ToT cost allocation and get the final version validated in an inter-OP, inter-unit and inter-ministerial workshop.

Package validation Workshop
The package validation workshop was held on June 22, 2021 attended by 48 ministry and HPN unit level officials held in the virtual platform. The ministry level officials represent Education, Information, Local Government and Rural Development, Religious Affairs including the Health and Family Welfare; while unit level officials include IEM, FPFSD, MNCAH, CBHC, CDC, L&HEP, BHE and NNS. This validation workshop was graced as special guest by Mr. Md. Ali Noor, Sr. Secretary, ME&FWD, MoHFW and Chaired by Mr. Nitish Chandra Sarker, Additional Secretary (Pop., Law & FW), ME&FWD, MoHFW.

This workshop was initiated with the address of welcome made by Mr. Syed Mojibul Huq, Additional Secretary, HSD, MoHFW and he provided a brief outline of the package which is having 23 HPN issue-based sessions grouped under 7 chapters. He thanked ministry and HPN unit level contributors along with Ujjiban for contribution and their support to the development of this package.

The objective of this package was presented by the Member-Secretary of the School HPN Education Package Development & implementation Coordination Committee and Deputy Secretary, PH-2, HSD, MoHFW. He specifically mentioned 3 key objectives as; - Provide knowledge on the comprehensive HPN issues - Unification and integration of HPN school education program and ensure univocal messaging - Avoid duplication and maximize geographical coverage of schools by field level integration.

At this stage, the contributors of developing this package from the units of DGHS and DGFP presented by key issues as have been delineated in 23 topics of the package by 7 chapters. This was made by seven officials respectively from the NNS, MNCAH, IEM, TMED (MoE), L&HEP, CDC and NCDC. The presenters also described about the key methodologies that will have adopted in conduction and delivering of the topics and related messages by the field level trainers.

An open discussion took place immediate after the unit’s presentation on package topics. In this discussion Ms. Liza Talukder, SBCC Program Management Specialist, USAID emphasized the need of HPN information to provide for the adolescent through school-based education. She told that USAID is happy to be part of this initiative and thanked MoHFW for developing the SHPN Education package.

Taking part in the discussion Dr. Nizamul Karim, Secretary, NCTB pointed out that the HPN issues have already been introduced in the formal school education curriculum. The classroom hours for providing textbook lessons also have been determined to uniformly maintain in the high schools. He suggested to consider how this SHPN Education package will be imparted in view of the existing formal school education system. He also referred a law as were passed in 2018 on the school education system that need to be considered while implementation of this SHPN Education package.

Mr. Helaluddin, Additional Secretary, Planning, MoHFW opined to include school health clinics with the provision of SHPN Education package messaging. He termed this curriculum comprehensively covered the HPN issues will hopefully be able to increase knowledge of the school students. We should be careful about any intrusion of further new curriculum with any donor or NGO support as a huge effort have been invested in developing the current package. He thanked USAID-Ujjiban project for their technical support in developing this SHPN Education package.

In his speech Mr. Md. Ali Noor, Secretary, ME&FWD, MoHFW termed this SHPN Education package as very comprehensive and right step towards addressing a critical group of the population. He suggested to plan for a well-designed ToT on this package to make field level trainers proficient in conducting orientation and delivering messages. He hoped that this program will bring success while on implementation.

Mr. Nitish Chandra Sarker, Additional Secretary (Pop., Law & FW), ME&FWD, MoHFW made concluding remarks in the validation event and thanked all members of the School HPN Education Package Development & implementation Coordination Committee on development of SHPN Education package for their great contribution. He commented that the said law as were referred by the Secretary-NCTB will be duly considered before the implementation of SHPN Education package. He also thanked USAID-Ujjiban SBCC project for their TA support to this intervention.

It is expected that the SHPN Education package book production followed by the ToT will soon be initiated by the respective units. The scale-up phase in the field will be supplemented with a guideline for field level training program implementation and integration of covering of schools by avoiding duplication and maximizing geographical coverage by the front-line supervisors and workers of the DGHS and DGFP.

Story of Rube ….

Rube (fictional name) was a worker in the dried fish industry of southern district of Bangladesh Cox’s Bazar. She has two children. Her husband has died while fishing in the sea. To earn her livelihood, she had to fight constantly against the rough sea but still her income was very minimal. Poverty was an integral part of her family. So, she had stopped the education of her two children and involved them in the dried fish establishment, but still passed the days by hardship.

Let’s hear her story of life battling:
“Poverty is a challenge. I stopped my children’s education and got them involved in dried fish processing firm for income. How will they continue study while they are hungry?”

Not only Rube, this is a common story of many families of this dried fish sector. Currently, like Rube, about 15,000 male and female workers are working in the dried fish sector of Cox's Bazar among which 20% are children. A huge number of children are working in the dried fish processing establishments in an unhealthy and hazardous environment just to earn two meals a day. But still the numbers of worker is getting increased alarmingly day by day.

CLIMB, a project of Winrock International has contributed in this area to ensure the Rights of these children working in the dried fish sector though it’s diversified interventions. BCCP as a media partner of CLIMB, is also contributed in this area to reduce the risky child labor by strengthening and promoting the importance and overall success of the project through mobilizing and sensitizing the media and civil society, thus providing a safe and protected life to these children.

Inspired by these activities of CLIMB and BCCP, some NGOs and volunteer organizations are working in collaboration with local Govt. and civil society to ensure education and alternative livelihood opportunities for the children and their families. As a part of these initiatives, they are providing various skill development trainings such as handicrafts, computer learning, tailoring, electronics, block batik etc. which are changing their life significantly.

Rube’s life changing story:

“On the way while returning from my job, I met with the representative of a volunteer organization and came to know about the poultry rearing training available at their organization. Considering my interest, she enrolled and trained me on poultry rearing.

This training has benefitted me to increase my family income. I also enrolled my son to the computer training organized by CSO. These opportunities have created earning scope for me to send my daughter to school. They no longer work in the dried fish farm. They live a healthy and happy life now”

There are continuous advocacy efforts in the national level to eliminate child labor from the dried fish sector. Getting motivated by the interventions of BCCP, different news media at national and local level played an important role by publishing appropriate news and articles on this hazardous occupation. More than 80 news/articles so far published in the print media as a part of this advocacy.

Today’s children are the future of tomorrow. Therefore, children’s education is of paramount importance and our responsibility is to protect them from hazardous occupation. Let the risky child labor be stopped. Let the dreams of these children spread in the wide blue sky. Let the world be filled with the smiles of these thousands of mothers like Rube.

Conceptualizing SBCC process and methods for planning of effective SBCC intervention is important as the Family Planning program deals with human behavior

Strategic approaches of the SBCC followed by a widespread discussion and interaction took place in the 4-day workshop held for the DGFP officials. The objective of this workshop was to strengthen capacity to plan and implement SBCC programs aligning with Comprehensive SBCC Strategy. Under the auspices of the IEM unit of DGFP, this workshop was held on June 14-17, 2021 that participated by other unit officials of DGFP along with the field level officials which totals the participation to 28 officials.

USAID-Ujjiban SBCC project provided technical assistance in planning, designing, processing and conduction of this training that followed the Reflection, Discussion and Synthesis (RDS) method combined with the didactic and practical approaches. The didactic approach had provided a good opportunity for the participants to learn the process, methods and steps of strategic communication while the practical approach had individual work along with group work and discussion in prescribed formats followed by individual and group presentations.

The key issues of the didactic sessions covered following topics of communication:
- Framework, principles and components of the Comprehensive SBCC Strategy
- Leadership: concept, principles and leadership versus management
- Introducing Learning Style Inventory for an individual and get it practiced

- Individual findings synchronized with certain style and about its explanation
- Management of Change, understand the process of managing change and its relationship with the learning styles
- Importance and effectiveness of the coordination in SBCC program
- HPN SBCC Coordination Committee at different levels
- Introducing Leadership & Coordination training module
- SBCC Capacity Strengthening needs and tools
- Community mobilization, implementation process, participation and resource mobilization
- SBCC monitoring; process and data for decision making.

At the last stages of the 4-day training the participants worked on developing individual action plan that described their plan and commitment for increasing SBCC knowledge and skills of fellow colleagues to better serve community with appropriate knowledge and information on Family Planning. Training participant took part in it and identified activities in their individual Action Plan. Few of these activities are:
- Introducing mental health awareness among colleagues and office staff of different units of DGFP
- Provide training to the field level staff on certain SBCC concept to understand their client’s perspective and undertake appropriate measures
- Organize topic-based orientation with the fellow colleagues on appropriate elements of SBCC issues
- Increase individual efficiency to understand fellow colleagues and get interacted with them following the understanding and learnings from the SBCC training
- Mobilize field level staff to emphasize and increase community mobilization effort and activities.

The participants found very proactive to take part in various courses of the training. They interacted with fellow participants while work in group, raising question into the discussions and made responses to the facilitator while there was discussion in the plenary. Their inquisitiveness over various issues of discussion also found at excellent level.

In the concluding session the Director-IEM and Director General Family Planning attended and spoke on the occasion. This session initiated with few comments of the participants about their feelings on receipt of this training. Ms. Mahbuba Khatun, UFPO, Gaibandha termed this training as very useful in increasing their SBCC knowledge and skills. She hoped that these skills will help them to transfer it into their field level staff. Mr. Faruk Abdullah, AD-FP, Laxmipur found this training as very effective and becomes a source of good learning. He told that the discussion, presentation and interactions of this training were simply very good.

In his speech Mr. Amir Hossain, Director-IEM underscored the need for and importance of such a training. He described this training will immensely contribute enhancing DGFP and IEM’s SBCC planning and implementation efficiency. He thanked Ujjiban for their technical assistance in designing, planning and conduction of the training.

Ms. Shahan Ara Banu, Director General, Family Planning appreciated the effective role of IEM they are playing to mobilize community and the stakeholders to response for Family Planning program issues. She mentioned that “Conceptualizing SBCC process and methods for planning of effective SBCC intervention is very important as the Family Planning program deals with human behavior and this training program has been a perfect response to that requirement.” She also thanked Ujjiban for their continuous support provided to DGFP on SBCC activities.

Electronic-Government Procurement (e-GP): Maintains the progress of government procurement despite COVID pandemic.

The Electronic Government Procurement (e-GP) system has been established in the country by the Central Procurement Technical Unit (CPTU) under the Implementation, Monitoring and Evaluation Division (IMED) of the Ministry of Planning. The e-GP system has been introduced in 2011 has enabled government procuring entities to invite, process, and award tenders online. Procuring entities are greatly relieved of all hassles regarding tender processing and contract awards through the e-GP system.

BCCP has been implementing a four-year BCC program under DIMAPP project of CPTU and established and managing a Digital Billboard for showcasing the progress of e-GP in the country. The Digital Billboard is placed at a point of Farmgate area in Dhaka and being operated where live data of e-GP tender is being displayed 7/24 hours. Being active persistently, the Digital Billboard shares multiple information including the total number of tenders completed through e-GP and total monetary value of the e-GP tenders round off.

The procurement of Bangladesh Government has been benefitted in the pandemic as e-GP system has continued its normal functioning amid this COVID crisis. When compared to the same month a year ago, the number of contracts awarded to winning tenderers increased by 4% to 11,413 in June 2020. In the same month, the value of contract awards increased by 32%, bringing total spending to $959 million, up from $725 million the previous year. Tender invitations increased by 175% in June 2020 compared to the previous year, with a total value of $790 million, nearly six times larger. Tender evaluation was also 11% higher in both number than that of the same time in previous year.

In June 2020, all e-tender-related operations saw a significant increase in order to make up for the lapses of the previous few months. Although the pandemic caused some inconveniences for most of the projects but this period was utilized in processing and submitting tenders remotely through e-GP by tenderers across the country. This is a significant step forward in the government's plan to create a Digital Bangladesh. The salient live data about e-GP was displayed in the Digital Billboard.

HPN Coordination Committee meeting will contribute to the effective inter-unit coordination and will maximize utilization of resources

The HPN Coordination Committee met for its 30th episode meeting to discuss about the activities, challenges and results of SBCC and necessities of inter-unit coordination in maximizing the program outcome. This meeting on virtual platform was held on June 15, 2021 held under the auspices of the IEM Unit having Director-IEM in the chair. Mr. Rezaul Karim, Director-MIS, Dr. Sarwar Bari, Line Director-FPFSD and Dr. S M Mustafizur Rahman, Line Director-NNS also attended the meeting. A total of 21 unit level officials represent IEM and MCH from DGFP; and BHE, IPHN, NNS, BNNC and CBHC units were from the DGHS.

There was presentation made by the BHE, IEM and NNS took place at the beginning on their successful implementation of SBCC activities done in last six months includes the upcoming activities that the respective units planned for next three months. The presentations were initiated by the BHE with current status and upcoming SBCC program plans.

BHE (Mr. Muklesur Rahman, Asstt. Chief, BHE) Current implementation status:
• District and Upazila level workshops in 35 districts and 111 upazillas for the frontline worker and supervisor on communicable and non-communicable disease
• Adopting SBCC monitoring tools by the Upazila level supervisors of DGHS to track/monitor the use of SBCC activities to conduct in 12 upazila
• Support/facilitated for using L&HEP, BHE, DHHS vertical LED advertising machine established in 64 districts and 11 health Institutes for mass awareness through different TVCs, Drama, Songs on HPN issues developed both by the Ujjiban and BHE, DGHS.
• Identifying issues/messages to be scrolled in different TV channel and print media as advertisement specially on COVID 19.

Upcoming activities:
• Organize training on environmental and occupational health awareness for Sr. and Jr. HEO, a 5-day long training on effective health communication and on SBCC activity monitoring apps
• Awareness building campaign at the Division and District level on to adverse effects of dietary salt intake to reduce health risk behavior.

IEM (Ms. Israt Zabin, PCO, IEM)
Current implementation status:
• Six batches of TOT held on eToolkit and eLearning course at five districts (Chattogram, Cox’s Bazar, Bandarban, Khagracherri and Rangamati) for the district and upazila level managers and for 120 frontline worker and supervisors
• Hold a Message Design Workshop and developed messages on key thematic area
• Organize community level orientation for different audience groups on planned family, child marriage, ARH, Safe Motherhood and nutrition
• Media campaign on short acting FP method, call center and institutional delivery through airing of TVC for 1200 times in 8 TV channels
• Media campaign on covid-19, long-acting FP method, call center, danger sign and ANC, PNC through airing of TVC for 1200 times in 8 TV channels.

NNS (Presented by Mr. Aman Ullah, DPM, NNS)
Current implementation status:
• 22 live TV talk show on BTV broadcast on different aspect of Nutrition in the name of “Pusti Sommridhy” and 22 episodes of nutrition phone-in program in Bangladesh Betar
• Developed and distributed three posters for the SAM corner in collaboration with UNICEF, 5000 SBCC folder developed containing nutrition message, 500 BFHI & BFC board printed and 15000 posters on nutrition printed
• Observed National Nutrition Week and program includes; sermon on nutrition after Jumma prayer, GMP card fill up, counselling on nutrition for pregnant mother, health check-up for freedom fighter/people above 60 yrs., Facebook posting and quiz competition
• Awareness campaign on maternal nutrition held in 1807 community clinics by involving community groups and community support groups
• Orientation for the Sanitary Inspectors on “Risk Based Food Inspection” held in 13 batches participated by 260 Inspectors
• Conducted training on eToolkit and eLearning course for 127 HI, AHI & CHCPs of Sunamganj Sadar, Biswambharpur of Sunamganj District and Ukhia Upazila of Cox’s bazar.

Upcoming Activities:
• A dedicated campaign through Social Media like; Facebook, YouTube, Tweeter etc. has been in the developing stage
• The contents will be prioritized over the wrong conceptions and superstitions about nutrition in our country focusing on maternal nutrition.

In the open discussion part of the meeting, Mr. Aman Ullah, DPM, NNS raised an issue about the display of NNS developed nutrition related promotional videos through AV vans under the DGFP. Ms. Israt Zabin instantly responded it and replied that this will be very much possible and requested Mr. Aman Ullah to send those videos to IEM.

Dr. S M Mustafizur Rahman, Line Director-NNS pointed out that this meeting of HPN Coordination Committee is being held after about six months than the last meeting held. He mentioned that these meetings should have been held in every quarter which will make this inter-unit coordination more effective and will bring about a good result.

In his concluding remarks Mr. Amir Hossain, Director-IEM emphasized the need of inter-unit coordination. He particularly mentioned that “HPN Coordination Committee meetings will contribute to the effective inter-unit coordination, avoid duplication and will maximize utilization of resources. He thanked all members of the committee for their presence in the meeting and acknowledged USAID-Ujjiban SBCC project for their continuous support to the HPN Units.

Message Design Workshop for the DGFP officials

A multi-variant participation of different units of DGFP along with their field level officials went through a well-designed process made the Message Design Workshop came out as a repository of the messages to help designing and production of the message and materials. Under the auspices of the IEM unit of DGFP the USAID-Ujjiban SBCC Project provided technical assistance in planning, designing, processing and conduction of the Message Design Workshop.
This 3-day Message Design Workshop was held on June 03-06, 2021 through virtual platform in Zoom and 36 participants from different units of DGFP and field level officials from different district and upazila participated it. The Reflection, Discussion and Synthesis (RDS) method combined with the didactic and practical approach were followed in this workshop. The didactic approach had provided a good opportunity for the participants to learn the process and methods of message design and development while the practical approach had group discussion, work in group in prescribed formats followed by group presentations. This group work was also made through virtual mediums and 5 groups worked jointly in the google drive. The group work on the new message development was designed on the basis of a survey conducted during the workshop through a ‘survey monkey’ format that determined the thematic area and audiences for whom the messages will have designed.

The workshop methodology brought participants and the facilitators gets interacted and participatory that generated a broad level of enthusiasm which has brought a learning environment in course of the workshop. At the end of the workshop the participants came up with a big list of messages targeting to certain audience group for targeted services. This work has contributed to finally came up with a message repository for IEM unit in particular and DGFP as a whole.

The 3-day workshop was ended up with a brief concluding session attended by the Director General of Family Planning along with the Director-Admn., Joint Secretary-Planning, MoHFW, Director-FPFSD and the Director-IEM. In the concluding session two participants spoke on their understanding and feelings over the 3-day workshop. Ms. Reshma Khatoon Munni, UFPO Burichong termed this virtual workshop as no less effective than an on-site workshop. She also found this workshop facilitation and methodologies as unique and useful which has been ended up with a big list of selected messages will help headquarter and the field offices with effective and appropriate messages to develop materials and conduct service promotional campaigns.

In his speech Mr. Abdus Salam Khan, Joint Secretary, Planning, MoHFW found this workshop as very effectively and appropriately designed for the virtual mediums. He strongly recommended the virtual format of the workshop, as have been designed by Ujjiban, be replicated in other virtual training and workshop of the DGFP. Mr. Amir Hossain, Director-IEM expressed his satisfaction over the successful completion of the Message Design Workshop which will immensely benefitted IEM in establishing a message bank. He thanked Ujjiban for their technical support in organizing and conduction of this workshop.

In her concluding remarks Ms. Shahan Ara Banu, Director General of Family Planning described this workshop as very successful in designing and developing effective messages through certain processes designed and facilitated by Ujjiban team. She expressed hopes that Ujjiban will continue their technical assistance for DGFP in the field of SBCC.

BCCP STAR OF THE MONTH

As a strategic communication organization, BCCP evaluates each staff by 360-degree approach annually. In order to encourage staff for their good work BCCP also initiated recognizing the best performer in each month that started from July 2020 to select as “BCCP Star of the Month”. In this row BCCP acknowledges 3 Star of the Month during last April to June, 2021 period.

Md. Romiz Uddin, Driver (BCCP Star of the month April 2021)
Mr. Romiz is serving BCCP as Driver for last about18 years. He was conferred with the ‘Safe Driving’ awards for several times. He is a dependable and honest staff member with the quality to perform multifarious activities in addition to routine maintenance and driving of the assigned vehicle. He makes correspondences with various offices and provide support to program people during training/event management. He always keen to satisfy the organization.
Mr. Kazi Jamal Hasan, Assistant Director (Admn. & Corp.) (BCCP Star of the month May 2021)

Mr. Jamal is the Assistant Director (Admn. & Corp.) of BCCP is serving in this organization for around two decades. He is known to all as ‘Sokol Kajer Kazee’ (An expert to perform any work). Apart from his regular responsibility related to Admn. & Corporate he proved himself to be very capable person in maintaining liaison with government offices and BCCP clients. He also proved his efficiency in organizing and managing office events. He can intervene and manages the critical office management situations. Overall, he appeared as a dependable staff member of this organization in administration and management issues.


Mr. A. K. M. Marzanul Islam Joy, Market and Business Development Specialist (BCCP Star of the month June 2021)

Mr. Marzanul Islam Joy is serving this organization as the Market and Business Development Specialist. He performs in excellence in developing business development proposals, communication with new clients aiming to build a better image of BCCP in the development field. He has completed his MBA from Independent University, Bangladesh (IUB) and MDS from East West University (EWU). He has achieved a fellowship on Corporate Social Responsibility (CSR) from DANIDA Fellowship Center (DFC), Copenhagen, Denmark. Personally, he is a very pious person

Towards Universal Health Coverage and Covid-19 challenges

The world celebrated the International Universal Health Coverage Day on December 12, 2020. Like many other countries around the world, Bangladesh adopts Universal Health Coverage (UHC) as a national aspiration. According to the commitment of the Prime Minister of Bangladesh in the 64th World Health Assembly held in May 2011, the country committed to gain UHC by 2032. The central theme of it was providing quality and affordable health services which is a significant element of social protection. Universal Health Coverage (UHC) is a target within the third goal of the SDGs and has appeared to be an issue of developing nations. More importantly UHC includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course that brings about a equtable and sustainable health system.

In such a situation, Covid-19 created challenges to the journey towards UHC. Since the outbreak of Covid-19, the government of Bangladesh initiated to work with preventive measures includes; promote practicing different health measures, diagnostic tests and imposing movement restrictions/lockdown. But there are little impact over the community and individual practice level in maintaining health mesures those are very necessary to prevent Covid-19. As a result the number of infections and death remains increasing and currently reaches at high of all time. This situation is reminded us that our health system is massively requires Risk Communication and Community Engagement through Universal Health Coverage for a sustainable health system which can response in Pandemic situations like Covid-19 for undertaking prevention measures.

On the other hand discriminatory access due to shortage of vaccine for Covid-19 becomes another challenges to the developing nations including Bangladesh towards achieving UHC as ‘service coverage’ to entire population remains as a key components. If we look into the other indicators of UHC, ‘financial risk protection’ meaning that no one faces financial hardship for utilizing health care in need, represents a picture where general people are paying a good amount of money for Covid-19 treatments. A Covid-19 test costs Tk. 3,000 to 5,000 and the hospitalization in the private hospitals costs vary across hospitals but it is too high for a large population of the country. This scenario comes as inequitable health services when health equity describes as “the absence of systematic and potentially remediable differences in one or more aspects of health across populations or population groups defined socially, economically, demographically, or geographically”. Furthermore, Bangladesh’s out of pocket (OOP) contributions to health expenditure is one of the most inequitable sources of healthcare financing and are among the highest in the world with 67% while comparatively low budget allocation in the health sector is bringing further challenges achieving UHC and Health Equity.

The current pandemic brings a lesson for us that Bangladesh requires individual health practice and community preparedness for encountering any pandemic including Covid-19 and establishing universal access in the health services for a sustainable health system. In addition to the GoB’s coordinated and effective planning, the effective strategic communication is essential to realize UHC and that for health equity. Progress toward UHC requires local ownership and customized strategies for specific contexts. Diverse stakeholders must be engaged— including political leaders, health care purchasers, providers, patients, suppliers, and civil society groups—and each audience requires tailored communication approaches to change their knowledge, attitudes, and behaviors.

These actions may engage stakeholders in information sharing, dialogue, and/or collective learning, with the aim of making decisions or influencing human behaviors. All actors to understand their rights, responsibilities, and opportunities to maximize the benefits of UHC and to act in the best interest of realizing those rights, responsibilities, and opportunities. This is often a firhttps://mcusercontent.com/965693778884ead2c2005f747/images/8ad24026-0979-2592-dc45-a4bdb764bdd3.pngst step for many in the complex, long-term endeavor of realizing UHC. >