Background :
Bangladesh has achieved success in family planning programs against the backdrop of low literacy rate, low status of women, low income and so on. Despite this, one must note that due to past high fertility and falling mortality rates, Bangladesh’s population has a tremendous growth potential built into its age structure. So, population continues to remain as one of the most important nation’s problems as well as one of the major cause of poverty. Considering the fact, government has updated the population policy.
Major successes in population sector programs were achieved in expanded access to family planning services with introduction of a broader range of modern and effective methods. Replacement level of fertility by 2016 at the earliest is the priority vision of the GOB. In line with this vision present TFR of 2.5 children per woman (UESD 2010) needs to be reduced to 2.0 children per woman to attain net Reproductive Rate (NRR) =1 by 2016. To achieve replacement level of fertility by 2016, corresponding CPR to be increased to 74% by mid-2016 from 61.7% (UESD 2010). Further efforts proposed to shift family planning use patterns towards more effective, longer lasting and lower-cost clinical and permanent methods covering low performing areas. But the major impact on fertility will be achieved by raising the age of marriage, which will push up age at first birth, and again trigger a tempo effect, to bring fertility down.
Introduction :
The Family Planning Field Services Delivery Program started functioning with the existing manpower and infrastructure of the Directorate General of Family Planning under revised total of Tk. 161410.00 lakh for 2011-2016. In this work plan FP-MCH activities, adolescent & reproductive health services, services for the elderly people, about ARI, STD/AIDS counseling & services are provided through domiciliary visits. Through FP-FSDP the activities taken to increase the acceptance rate of temporary methods, to reduce the dropout rate, cover the unmet needs, to create awareness on AIDS & other STDs which are taken according to the PRSP designed on the Millennium Development Goals (MDGs). For these activities the UH&FWC’s will be up-graded to ensure the quality services.
Objective of Family Planning Field Services Delivery :
General objectives :
To provide Family Planning & MCH-RH services for ensuring the healthy life & family welfare and to facilitate the decline in fertility, maternal, infant and child mortality and morbidity of the people of Bangladesh , specially the women , children and the poor.
Specific objectives :
- To reduce Total Fertility Rate (TFR).
- To increase Contraceptive Prevalence Rate (CPR).
- To reduce discontinuation / drop-out rate of temporary contraceptive methods
(Oral pill, Injectables & Condom).
- To reduce unmet need of contraceptives to eligible couple.
- To strengthen domiciliary services.
- To provide adolescent reproductive health care services.
- To reduce early marriage, adolescent pregnancy and unsafe abortion.
- To provide health and family planning services through satellite and community clinics.
- To improve the services status in the hard to reach and low performing areas.
- To facilitate better MCH-FP services in the urban areas.
Major Components of the OP :
- Intensification of FP-FSD program .
- GO-NGO Co-ordination .
- Ensuring availability of contraceptives and other supplies .
- Monitoring& Supervision of the Program .
- Capacity Building .
- Family Planning Services in Urban Slums .
- Family Planning Services in Hard-to-Reach Areas.
- Services for newly married couples .
Activities:
Activities under component- 1
- Domiciliary services by FWAs will be ensured by increased supervision and monitoring.
- Registrations of eligible couples and supply of FP methods to all couples will be ensured.
- The service providers will be trained up.
- Initiative will be taken to fill up the vacant posts.
- To cover the hard to reach areas GO-NGO collaboration activities will be explored.
- Family planning committees at different levels will be activated.
- Special BCC campaign i.e. workshop, forum, day observation, advocacy meeting etc. will be undertaken.
Activities under Component- 2
Multi-sectoral efforts and co-ordination with NGOs to be strengthened by-
- GO-NGO co-ordination and co-operation for field level family planning services.
- Including NGOs family planning services activities in Local Level Planning (LLP) of DGFP.
- Ensuring coordinated efforts for effective supervision and monitoring by family planning field level managers with NGOs for providing FP services .
- Ensuring reporting and record keeping for family planning services by NGOs field level workers.
- Monitoring and supervision of RH-MCH-Family Planning related NGO’s Program activities by family planning field level managers under DGFP.
Activities under component- 3
- Need assessment for required commodities, MSR.
- Procurement of Oral pills, Condoms and Injectables.
- Ensure timely supply of contraceptives to the field .
Activities under component- 4
- Ensuring proper implementation of field activities.
- Monitoring the field activities & progress through field visit, MIS report, LMIS report and other reports analysis as needed.
- Regular monthly/bimonthly meeting with field managers with feedback and directions to the field level offices.
- Regular field visit from central office.
- Ensure family planning committee meeting.
- Midterm and end evaluation.
- Operation research and special studies.
Activities under component- 5
- A capacity building strategy will be developed to enhance the capacity of FSDP personal as well as the Field Service Providers.
- Orientation training for Government non-government personal at district and upazila.
- Orientation in Family Planning program for political leaders, religious leaders, policy maker, field level workers of health, agriculture, livestock, cooperative etc. volunteers and NGOs.
- The Family Planning Committee Members will also be oriented about Family Planning Program.
Activities under component- 6
The following activities will be done for strengthening Family Planning Services in Urban Slums:
- Registration of eligible couples in urban slums.
- Domiciliary and door to door services for distribution of FP commodities .
- Counseling & motivational works for FP services .
- To establish referral linkage between urban slum and FP service centers within the City Corporation and Pourashava .
- Arranging FP Package programs for eligible couples in urban slums.
- Orientation and coordination meeting chaired by Family Planning Divisional Director will be conducted in respective City Corporation, Municipalities and Pourashava areas in consultation with City Corporation & MoLGRD. Appropriate guidelines with financial support will be provided from KFW and other donors.
Activities under component- 7
- Coordination with local NGOs, Family Planning services will be provided
- A package of services will be prepared and provided to the population of hard to reach areas through selected NGOs.
- Special camp for family planning methods, MCH-RH services will be organized to increase the performance
- Package Program including recruitment of service providers for FP services for hard-to- reach areas especially in Sylhet and Chittagong regions on the basis of financing for performance will be explored. Volunteers/depo holder/community workers will be selected for providing family planning services in hard to reach areas.
Activities under component- 8
- Up-date listing of newly married couples.
- Orientation and motivational workshops for newly married couples to adopt FP.
- Ensure family planning methods availability for newly married couples.
- Educational forum for adolescent.
.
Management and Implementation:
Director ( Finance), Directorate General of Family Planning is the Line Director of the Family Planning Field Services Delivery Program operational plan. Under the leadership of the Line Director two Program Managers and four Deputy Program Managers are assigned to implement the activities of the operational plan and thereby achieving the program goals and objectives.
Organogram of Field Services Delivery Program :
Annexure -1 |
Estimated Cost of OP (According to Financing Pattern):
Source |
Financing Pattern |
2011-12 |
2012-13 |
2013-14 |
2014-16 |
Total [Tk.] |
Source of the Fund |
GOB |
GOB Taka
(Foreign Exchange) |
5345.92 |
6320.92 |
8379.42 |
14352.74 |
34399.00 |
GOB(Dev) |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
|
CD-VAT |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
|
GOB Others (e.g.JDCF) |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
|
Total GOB= |
5345.92 |
6320.92 |
8379.42 |
14352.74 |
34399.00 |
|
PA |
RPA (Through GOB) |
16670.00 |
14791.08 |
14904.00 |
42470.92 |
88836.00 |
Pool fund |
RPA (Others) |
0.00 |
0.00 |
0.00 |
0.00 |
0.00 |
|
DPA |
4227.08 |
7100.00 |
7564.58 |
19283.34 |
38175.00 |
KFW, USAID & others |
Total PA= |
20897.08 |
21891.08 |
22468.58 |
61754.26 |
127011.00 |
|
Grand Total [Tk.] |
26243.00 |
28212.00 |
30848.00 |
76107.00 |
161410.00 |
|
Relevant Result Frame Work (RFW) and OP level Indicator
(i) Relevant RFW Indicators :
Indicators |
Unit of Measurement |
Base line
(with Year and Data Source) |
Mid- 2016 |
Total Fertility Rate (TFR) |
% of women |
2.7 (BDHS 2007) |
2.0 |
Contraceptives Prevalence Rate (CPR) |
% of user |
55.8% (BDHS 2007)
61.7% (UESD 2010) |
72% |
Unmet need for family planning |
% of user |
17.1% (BDHS, 2007) |
9.0% |
Use of modern contraceptives in low performing areas |
% of user |
Syl. 35.7%, Ctg. 46.8% (UESD,2010)
Syl. 24.7%, Ctg. 38.2% (BDHS 2007) |
Syl. & Ctg. 50% |
% of facilities without stock-outs of contraceptives at a given point of time |
% of service center |
58.1%, BHFS 2009 |
70% |
(ii) OP level indicators (Output/Process) :
Indicators |
Unit of Measurement |
Base line
(with Year and Data Source) |
Projected Target |
Mid-2014 |
Mid-2016 |
Percentage of Injectable acceptors
(method mix) |
% |
7.0% (BDHS 2007) |
11% |
12% |
Percentage of Oral Pill users
(method mix) |
% |
28.5% (BDHS 2007) |
33% |
34% |
Percentage of Condom users
(method mix) |
% |
4.5% (BDHS 2007) |
5% |
6% |
Percentage of Satellite Clinic conducted |
% |
360,000 / year |
1080000 |
1800000 |
Lowest performing (FP) districts monitored |
Number |
Monthly Report |
10/month |
10/month |
% of UFP Committee meeting held |
Number |
MIS Report |
75 |
125 |
Discontinuation rates reduced:
a. Oral pill
b. Injectables
c. Condom |
% |
54.2 (BDHS 2007)
53.0 (BDHS 2007)
75.7 (BDHS 2007) |
25
25
45 |
15
15
30 |
Unmet need for FP reduced |
% |
17.1%(BDHS,2007) |
12 % |
9.0% |
Performance up to June 2013:
Sl No |
OP Indicators |
Unit of Measurement / Means of verification |
Baseline
(2011-112 |
Target
Mid-2014 |
Achievement
Jun’12-Jun’13 |
1 |
Percentage of Injectables acceptors
( Method mix) |
DGFP MIS |
11.2
(BDHS-2011) |
11% |
*20% |
2 |
Percentage of Oral Pill acceptors(Method mix) |
DGFP MIS |
27.2
(BDHS-2011) |
33% |
*50% |
3 |
Percentage of Condom users (Method mix ) |
DGFP MIS |
5.5
(BDHS-2011) |
5% |
*8% |
DGFP MIS report shows data on the basis of contraceptive acceptors with BDHS data shows on the basis of contraceptive users.
Budget & expenditure of Family Planning Field Services Delivery Program are shown bellow:
[ Taka in lac ] |
Financial 1 Year |
Budget |
Expenditure |
GOB |
PA |
Total |
GOB |
PA |
Total |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
2011-12 |
3450.00 |
18157.28 |
21607.28 |
3246.76 |
18058.95 |
21305.71 |
2012-13 |
4050.00 |
17200.00 |
21250.00 |
3832.35 |
4478.25 |
8310.00 |
Procurement Status of FSDP in Final Year 2012-13
Sl. no |
Commodities |
Quantity |
Actual cost
(In Lack Taka) |
Source of Fund |
1. |
Injectables |
9.9 m |
3897.70 |
RPA(GOB) |
A D Syringe |
9.5 m |
522.50 |
RPA(GOB) |
Vehicle(Jeep) |
1 pcs |
58.05 |
RPA(GOB) |
2.
|
Injectables |
2 m |
791.20 |
GOB(DEV) |
A D Syringe |
2 m |
110.00 |
GOB(DEV) |
Cotton |
0.4 m |
122.00 |
GOB(DEV) |
Vehicle(Jeep) |
10 pcs |
580.50 |
GOB(DEV) |
Motor cycle |
165pcs |
198.00 |
GOB(DEV) |
|