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Bangladesh Local Initiatives Program

Bangladesh Local Initiatives Program

Since 1987, TAI along with MSH has been assisting Ministry of Health & Family Welfare to improve the performance of the Bangladesh Family Planning Program at the community level. USAID supported this highly successful project over the ten-year period.

Over 20 years ago, with one of the highest maternal mortality rates and population densities in the world, the Government of Bangladesh declared fertility reduction the nation’s “number one priority.” The government recognized the need to increase community involvement in family planning initiatives and to develop well-managed, sustainable programs with high-quality services at the local level. Through the FPMD project, TAI and MSH worked with the Ministry of Health (MOH) from 1987-1998 to improve the national family planning program at the grassroots level.

Through the Local Initiatives Program (LIP), worked to strengthen the management skills of thana (sub-district) family planning staff, public administrators, and local leaders. The mainstay of the program was the introduction of female volunteers from the local communities to provide family planning outreach. Through the LIP, has increased community awareness about family planning. More importantly, it has involved the community in developing action plans and mobilizing human and financial resources, contributing to the significant advances Bangladesh has made in its national family planning program despite continued poor economic development.

The LIP has shown that it is possible to effectively and economically deliver modern contraceptives to hard-to-reach populations. It provides a strong example of how public and private organizations can work together to meet local needs by conducting training programs, developing and using tools, and following up with local leaders. The success of the LIP has led to its use as a model for similar programs in other countries, such as India. With strong political support and community participation, Bangladesh will continue to make great strides in meeting the needs of its families.

Other Key Achievements

  • More than 2.1 million couples have been served under the LIP, representing approximately 10% of all eligible couples and 25% of administrative units in the country
  • The contraceptive prevalence rate in LIP areas is 65%, compared to the national average of 41.5%
  • Approximately 40,000 female community volunteers provide family planning and maternal health outreach services in LIP areas
  • Between 1989 and 1998, the number of public sector family planning workers trained annually by the LIP increased from 41 to over 1,000
  • Community volunteers have been empowered and their social status elevated in the eyes of their husbands, families, and communities
  • By training a total of 5,000 female government family planning professionals to supervise the volunteers, the LIP has decreased the visitation cycle from two months to one month

Lessons Learned

Lesson 1: Developing management skills at the community level helps to improve service delivery

Lesson 2:  The program achieves more by involving communities in program planning, implementation, and resource mobilization

Lesson 3: Large numbers of volunteers can be used efficiently to minimize program costs, increase accessibility of services, and institutionalize community participation

Lesson 4: The efforts made to institutionalize management skills, techniques, and tools at the community level should not exceed the community’s ability to absorb these new skills.

Bangladesh LIP Successes

The LIP has succeeding in increasing access to health services through three major initiatives:

  • Involving local women as key service providers
  • Locating health posts in the neighborhood
  • Referring clients to a network of local doctors

Bangladesh LIP Project Testimonial

“Project accomplishments to date are highly commendable and a model for the integration of “top down” management interventions at the government level, with “bottom up” community supported development and MCH/FP activities…”

Bill Trajfords et. al. Evaluation of the FPMD