Objectives of the study

Study TitleUtilization of CSBA Training of the FWAs in reduction of maternal and child mortality and morbidityConducted by : Center for Development Studies

Objectives of the study The general objective of the study is to assess the utilization status of the CSBA training of the FWAs in the reduction of the maternal and child mortality and morbidity.

Specific objectives of the study • The specific objectives of the study • To investigate the effectiveness of the CSBA services in the reduction of morbidity of the pregnant women. • To investigate effective utilization of CSBA. • To investigate the opinions of the community about their services; and • To investigate the opinions of the mothers about the services of CSBA.

Methodology • Study uses both quantitative and qualitative method to collect data from the field. • The quantitative data include survey of 400 trained FWAs on CSBA course from 10 districts covering all administrative Divisions. • The qualitative method includes focus group discussion (FGD) of clients, community members and social elites. • Five survey teams, comprising three members each interviewed 400 trained FWAs to collect quantitative data and conducted 6 FGDs for qualitative data.

Key Findings (Basic characteristics, CSBA) Characteristics Percentage Education Secondary 56.3 Secondary Plus 43.7 Length of Services (Yrs) 21-25 82.3 Avg. Services length 21.6 In service Training : Basic Training 73.5 Arsenic contamination 43.5 EPI 35.8 Early childhood dev. 11.8 Refreshers Training 14.8 HIV/AIDS 10.5

Key Findings (Recall of training contents) • Out of 41 training sessions, CSBAs remembered those sessions more which are related to different stages of pregnancy and its related action, home delivery, new born child care and session related with emergency care; and • Remembered less which related to those organized for creating community awareness and related issues.

Key Findings: Knowledge

Key Findings : Utilization • Most of the CSBA (80% and above) clearly state that they utilized their training and performed their assigned 30 types of responsibilities completely which they performed partially before the CSBA training. • All CSBA maintained record of pregnant mother and 83 percent CSBA maintained record of high-risk mother. • Services receiving clients and community leaders are satisfied with the CSBA’s present performance .

Key Findings : Utilization • Analyzing the whole utilization pattern of all CSBA activities it is clearly appeared that • CSBA have performed their duties in the fields of services related to • ANC, PNC and delivery period, • Timely visitation of pregnant women and referral of high-risk women • Counseling for breastfeeding & baby care • Community counseling. • Finally, CSBA have successfully maintained record of pregnant mother and high-risk mother .

Lessons learned • A considerable progress has been made in the recruitment of CSBA for services at the community level and their training afterwards. • A significant number of the CSBA have shown to have knowledge about their services, which patient they have to refer and to where. • That they have knowledge and sincerity in providing services has also been reflected from FGD of clients and community leaders. • Community has satisfaction over the performance of the CSBA

Lessons learned • CSBA have utilized the training and handled the visiting patients efficiently in the field of • Dealing pregnant mothers • Referral for emergency patient • Visited pregnant mothers at their homes. • But have a little lacking in dealing with the family and the community. • Burdened with work. This study has found an improvement in the knowledge and utilization of knowledge in the performance of CSBA after the training

Challenges • A few obstacles were reported from the CSBA related with supply management. Example, lack of weighing and blood pressure machine and the supply of medicine. • In reporting these problems the CSBA, Clients and community leaders are in agreement with little variation in their statements. • CSBA still feel hesitant to give treatment to incoming pregnant women with complication,

Recommendations • Only a handful of 6000 CSBA have undergone training on skilled birth attendance against 3.25 million births taking place each year. • Recruitment of more CSBAs and their training on skilled birth attendance program should continue. • Culturally, women and the community do not feel the necessity for skilled care at delivery. A small number of women visit Community Clinic. Therefore: • There should be undertaken a two dimension program

Recommendations • First, there should be recruitment of more CSBA and be deployed after proper CSBA training; • Regular refresher courses should be organized. • Second, mechanism should be developed to make the community aware of the need to seek skilled birth attendance, • Determine why the messages and information about various healthcare services have failed to attract community to get access to those services • There should be a review of BCC materials, and the communication campaign mechanism

Recommendations • Finally. An in-depth socio-economic study can be undertaken in order to identify the community perception and its related culture. Solution should be sought from community perspectives.

Thank you

Objectives of the study