This past week, we completed another round of our antenatal care (ANC) training for our Village Health Workers (VHWs). Our study which looks at two main sites in the rural population of Cox’s Bazar (one near the Hope Hospital site, and one near the Hope clinic in Moheshkali) will assess the impact of the VHW-mediated and SMS- supplemented, home-based ANC program on the proportion of live births attended by skilled health workers among newly pregnant mothers.
Before the expectant mothers can actually be enrolled in our study, it is important for the VHWs to feel confident in performing antenatal care on expectant mothers. Therefore, the VHWs engaged in training over the past few weeks, led by our ANC specialist, where they learned the curricula and procedures required for each of the four ANC visits as recommended by the WHO. The VHWs also learned how to properly perform several antenatal care tests such as blood collection for hemoglobin and glucose testing, all very necessary to confirm the health of a soon to be mother and her baby. The training ran very smoothly, and Faye and I were thoroughly impressed with the ease and confidence with which the VHWs performed the various tests.
Working at the hospital now for over 6 weeks, Faye and I are learning and witnessing the challenges facing women in Bangladesh. The need for sound antenatal care which is crucial in determining the health of the child and the mother, in our eyes has increased manyfold. Currently, only 21% of women in Bangladesh seek antenatal care, and 49% do not attend a single session (UNICEF, 2010). The continued incidence of obstetric fistula in low-resource settings is one of the most visible indicators of the enormous gaps in maternal health care between the developed and developing world (WHO, 2006). Access to quality maternal healthcare such as antenatal care can lessen the severity of these challenging circumstances for many young women. Medical problems such as obstructed labour and obstetric fistula, problems that are largely in the past for developed countries, are very much present in countries such as Bangladesh, and can be anticipated during antenatal care appointments.
Later this week, we will begin training our VHWs on how to use FrontlineForms, the mobile application through which they will submit data during each of the four ANC appointments. As scheduled ANC appointments approach, PatientView (our light weight patient record system) will automatically generate SMS-based educational messages and reminders to the health workers that they will share with the mothers during the course of their pregnancies. Stay tuned!