Skip to main content

Advertisement

SpringerLink
Log in

First Steps in Initiating an Effective Maternal, Neonatal, and Child Health Program in Urban Slums: the BRAC Manoshi Project’s Experience with Community Engagement, Social Mapping, and Census Taking in Bangladesh

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

The processes for implementing effective programs at scale in low-income countries have not been well-documented in the peer-reviewed literature. This article describes the initial steps taken by one such program—the BRAC Manoshi Project, which now reaches a population of 6.9 million. The project has achieved notable increases in facility births and reductions in maternal and neonatal mortality. The focus of the paper is on the initial steps—community engagement, social mapping, and census taking. Community engagement began with (1) engaging local leaders, (2) creating Maternal, Neonatal, and Child Health Committees for populations of approximately 10,000 people, (3) responding to advice from the community, (4) social mapping of the community, and (5) census taking. Social mapping involved community members working with BRAC staff to map all important physical features that affect how the community carries out its daily functions—such as alleys, lanes and roads, schools, mosques, markets, pharmacies, health facilities, latrine sites, and ponds. As the social mapping progressed, it became possible to conduct household censuses with maps identifying every household and listing family members by household. Again, this was a process of collaboration between BRAC staff and community members. Thus, social mapping and census taking were also instrumental for advancing community engagement. These three processes—community engagement, social mapping, and census taking—can be valuable strategies for strengthening health programs in urban slum settings of low-income countries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1

Similar content being viewed by others

Abbreviations

BRAC:

Formerly Bangladesh Rural Advancement Committee

CHWs:

Community health workers

NGO:

Non-governmental organization

SSs:

Shasthya Shebikas

SKs:

Shasthya Kormis

UBAs:

Urban birth attendants

References

  1. UN. World Urbanization Prospects: the 2014 Revision, (ST/ESA/SER.A/366). 2015. Available at http://esa.un.org/unpd/wup/FinalReport/WUP2014-Report.pdf. Accessed Dec 20 2015.

  2. United Nations. The Millennium Development Goals Report 2014. 2014. Available at http://www.un.org/millenniumgoals/2014%20MDG%20report/MDG%202014%20English%20web.pdf. Accessed Dec 20 2015.

  3. UN-Habitat. The Challenge of Slums: Global Report on Human Settlements 2003. 2003. http://www.unhabitat.org.jo/pdf/GRHS.2003.pdf. Accessed Dec 20 2015.

  4. UN. Population Distribution, Urbanization, Internal Migration and Development: an International Perspective. 2011. Available at http://www.un.org/esa/population/publications/PopDistribUrbanization/PopulationDistributionUrbanization.pdf. Accessed Dec 20 2015.

  5. UN. End Poverty: Millennium Development Goals and Beyond 2015. Goal 7. Environmental Sustainability 2014. Available at http://www.un.org/millenniumgoals/environ.shtml. Accessed Dec 20 2015.

  6. Prakash R, Kumar A. Urban poverty and utilization of maternal and child health care services in India. J Biosoc Sci. 2013; 45(4): 433–49.

    Article  PubMed  Google Scholar 

  7. Yuan B, Qian X, Thomsen S. Disadvantaged populations in maternal health in China who and why? Global Health Action. 2013; 6: 19542.

    Article  PubMed  Google Scholar 

  8. Vasquez F, Paraje G, Estay M. Income-related inequality in health and health care utilization in Chile, 2000–2009. Rev Panam Salud Publica. 2013; 33(2): 98–106.

    Article  PubMed  Google Scholar 

  9. Zhao Q, Huang ZJ, Yang S, Pan J, Smith B, Xu B. The utilization of antenatal care among rural-to-urban migrant women in Shanghai: a hospital-based cross-sectional study. BMC Public Health. 2012; 12: 1012.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zyaambo C, Siziya S, Fylkesnes K. Health status and socio-economic factors associated with health facility utilization in rural and urban areas in Zambia. BMC Health Serv Res. 2012; 12: 389.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Emina J, Beguy D, Zulu EM, et al. Monitoring of health and demographic outcomes in poor urban settlements: evidence from the Nairobi Urban Health and Demographic Surveillance System. J Urban Health: Bull New York Acad Med. 2011; 88(Suppl 2): S200–18.

    Article  Google Scholar 

  12. Islam MM, Azad KM. Rural–urban migration and child survival in urban Bangladesh: are the urban migrants and poor disadvantaged? J Biosoc Sci. 2008; 40(1): 83–96.

    Article  PubMed  Google Scholar 

  13. Hazarika I. Women’s reproductive health in slum populations in India: evidence from NFHS-3. J Urban Health: Bull New York Acad Med. 2010; 87(2): 264–77.

    Article  Google Scholar 

  14. Moran AC, Choudhury N, Uz Zaman Khan N, et al. Newborn care practices among slum dwellers in Dhaka, Bangladesh: a quantitative and qualitative exploratory study. BMC Pregnancy Childbirth. 2009; 9: 54.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Khatun F, Rasheed S, Moran AC, et al. Causes of neonatal and maternal deaths in Dhaka slums: implications for service delivery. BMC Public Health. 2012; 12: 84.

    Article  PubMed  PubMed Central  Google Scholar 

  16. More NS, Bapat U, Das S, et al. Community mobilization in Mumbai slums to improve perinatal care and outcomes: a cluster randomized controlled trial. PLoS Med. 2012; 9(7), e1001257.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zulu EM, Beguy D, Ezeh AC, et al. Overview of migration, poverty and health dynamics in Nairobi City’s slum settlements. J Urban Health: Bull New York Acad Med. 2011; 88(Suppl 2): S185–99.

    Article  Google Scholar 

  18. BRAC. BRAC Annual Report, 2014. 2014. Available at http://www.brac.net/sites/default/files/ar2014/BRAC-annual-report-14.pdf. Accessed Dec 20 2015.

  19. Manoshi Project. Manoshi Internal Data Report, 2012. Dhaka, Bangladesh: BRAC; 2013.

    Google Scholar 

  20. Manoshi Project. Manoshi Internal Data Report, 2013. Dhaka, Bangladesh: BRAC; 2014.

    Google Scholar 

  21. National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International. Bangladesh Demographic and Health Survey 2014: Key Indicators. Dhaka, Bangladesh, and Rockville, Maryland, USA: NIPORT, Mitra and Associates, and ICF International; 2015.

  22. Streatfield P, Arifeen S. Bangladesh Maternal Mortality and Health Survey 2010. Dhaka, Bangladesh: icddr,b; 2010.

    Google Scholar 

  23. Quayyum Z, Khan MN, Quayyum T, Nasreen HE, Chowdhury M, Ensor T. “Can community level interventions have an impact on equity and utilization of maternal health care”—evidence from rural Bangladesh. Int J Equity Health. 2013; 12: 22.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Darmstadt GL, Lee AC, Cousens S, et al. 60 Million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths? Int J Gynaecol Obstet. 2009; 107(Suppl 1): S89–112.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Littrell M, Moukam LV, Libite R, Youmba JC, Baugh G. Narrowing the treatment gap with equitable access: mid-term outcomes of a community case management program in Cameroon. Health Policy Plan. 2013; 28(7): 705–16.

    Article  PubMed  Google Scholar 

  26. le Roux IM, Tomlinson M, Harwood JM, et al. Outcomes of home visits for pregnant mothers and their infants: a cluster randomized controlled trial. AIDS. 2013; 27(9): 1461–71.

    Article  PubMed  Google Scholar 

  27. Nsona H, Mtimuni A, Daelmans B, et al. Scaling up integrated community case management of childhood illness: update from Malawi. Am J Trop Med Hyg. 2012; 87(5 Suppl): 54–60.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kisia J, Nelima F, Otieno DO, et al. Factors associated with utilization of community health workers in improving access to malaria treatment among children in Kenya. Malar J. 2012; 11: 248.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Smith JM, Gubin R, Holston MM, Fullerton J, Prata N. Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date. BMC Pregnancy Childbirth. 2013; 13: 44.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Farmer PE, Nutt CT, Wagner CM, et al. Reduced premature mortality in Rwanda: lessons from success. BMJ. 2013; 346: f65.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mugeni C, Levine AC, Munyaneza RM, et al. Nationwide implementation of integrated community case management of childhood illness in Rwanda. Global Health, Sci Pract. 2014; 2(3): 328–41.

    Article  Google Scholar 

  32. Bang AT, Bang RA. Background of the field trial of home-based neonatal care in Gadchiroli, India. J Perinatol. 2005; 25(Suppl 1): S3–10.

    Article  PubMed  Google Scholar 

  33. Mridha MK, Hossain A, Alam B, et al. The Perceptions of Community Groups to Improve MNCH in Urban Slums: an Exploratory Case Study of Korail Slum in Dhaka. Dhaka, Bangladesh: icddr,b and BRAC; 2009.

    Google Scholar 

  34. Ahmed SM, Hossain A, Khan MA, et al. Using formative research to develop MNCH programme in urban slums in Bangladesh: experiences from MANOSHI, BRAC. BMC Public Health. 2010; 10: 663.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Khan M, Ahmed S. The “Birthing Hut” Facilities of Manoshi: a two-part paper exploring the inception and post-inception phases of urban delivery centers. Dhaka, Bangladesh: icddr,b and BRAC; 2009.

    Google Scholar 

  36. Banu M, Nahar S, Nasreen H. Assessing the MANOSHI Referral System: addressing delays in seeking emergency obstetric care in Dhaka’s slums. Dhaka, Bangladesh: icddr,b and BRAC; 2010.

    Google Scholar 

  37. Story WT, Burgard SA, Lori JR, Taleb F, Ali NA, Hoque DM. Husbands’ involvement in delivery care utilization in rural Bangladesh: a qualitative study. BMC Pregnancy Childbirth. 2012; 12: 28.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Aronson RE, Wallis AB, O’Campo PJ, Schafer P. Neighborhood mapping and evaluation: a methodology for participatory community health initiatives. Matern Child Health J. 2007; 11(4): 373–83.

    Article  PubMed  Google Scholar 

  39. Roy T, Marcil L, Chowdhury R, Afsana K, Perry H. The BRAC Manoshi Approach to Initiating a Maternal, Neonatal and Child Health Project in Urban Slums with Social Mapping, Census Taking, and Community Engagement2014. Available at http://www.brac.net/sites/default/files/portals/Manoshi-book-v3-1.pdf. Accessed Dec 20 2015.

Download references

Acknowledgments

We thank the people of slum communities in Bangladesh and the staff of the BRAC Manoshi Project for their assistance in gathering the information used for this article. We also thank the Lipitz Public Health Policy Fund for its support of Dr. Marcil’s participation in this study. The Bill & Melinda Gates Foundation provided funding from 2007 to 2011 for the BRAC Manoshi Project.

Author information

Authors and Affiliations

  1. Boston Combined Residency Program—Urban Health and Advocacy Track, Boston Children’s and Boston Medical Center, Boston, MA, USA

    Lucy Marcil

  2. Health, Nutrition and Population Program, BRAC, Dhaka, Bangladesh

    Kaosar Afsana

  3. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Room E8537, 615 North Wolfe St., Baltimore, MD, 21205, USA

    Henry B. Perry

Authors
  1. Lucy Marcil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaosar Afsana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henry B. Perry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henry B. Perry.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marcil, L., Afsana, K. & Perry, H.B. First Steps in Initiating an Effective Maternal, Neonatal, and Child Health Program in Urban Slums: the BRAC Manoshi Project’s Experience with Community Engagement, Social Mapping, and Census Taking in Bangladesh. J Urban Health 93, 6–18 (2016). https://doi.org/10.1007/s11524-016-0026-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-016-0026-0

Keywords

Search

Navigation