Family planning programme progresses at slow pace

Around nine years ago, on 14 May 2015, the director general of the family planning directorate, Md Nur Hossain Talukdar, issued a four-page letter to all officials and employees of the directorate. The letter told them how to overcome all hesitancy, avoid all irregularities and corruption, and carry out their duties with integrity.

In the letter he wrote, "The government, donor agencies, UNFPA, the World Bank, no one is satisfied with the family planning directorate's performance at present... If we do not work and if we cannot prove that we are performing, what is the use of our office?"

Md Nur Hossain Talukdar has passed away, but the family planning director has undergone no change. In fact, many allege that the situation has deteriorated further.

Sources within the directorate say that there are over 9000 posts vacant at the field level. The incumbent director general is not taking any steps to fill these vacancies. There is a shortfall in birth control contraceptives in almost all warehouses around the country. No initiative was taken at the right time to replenish the stock. In about half the area of the country there is no equipment for normal delivery or child birth. There is not even any visible initiative to purchase the required equipment. The people are not fully receiving services.

Several attempts were made to contact the present director general Shahan Ara Banu, to learn about what measures are being taken by the family planning directorate in this situation and what is the directorate's stance. It was not possible to meet her nor did she reply to calls made to her mobile phone. In the latest effort, a visit was paid to the directorate in 12 February, but it was not possible to get any statement from her. Several senior officials of the directorate said that they were prohibited from speaking to the media.

The family planning programme has significant contribution to the success of Bangladesh's health sector. The increase in the use of birth control contraceptive had contributed to the decrease in fertility rates. The fall in fertility rates has led to a decrease in pregnancies and also maternal mortality. All this has had a positive impact on women's health. A section of economists firmly believe that the improvement in women's health has had a significant role in Bangladesh's economic advancement.

Koyra is an upazila near the Sundarbans in the southern district Khulna. There are 33 family planning units in 7 unions of Koyra upazila. An adequate number of family welfare assistants (FWA) have not been appointed to the upazila. At present the work is being carried out by only 23 family welfare assistants. And four of the six posts of deputy assistant community medical officer remain vacant.

An on-the-spot visit to the upazila on Tuesday revealed an impressive building of the South Bedkashi Union Health and Family Welfare Complex. But there is a lock hanging on the main entrance and all the rooms are closed. There is no staff there either. The tubewell in front of the health complex is unused for long and out of order. The windowpanes on the ground floor are broken and the equipment in the dusty rooms is in a state of disrepair.

Local resident Asadul Islam said that after the hospital was established, it was opened only occasionally. However, it has now been closed for a stretch of six months.

Resident of South Bedkashi village Amena Begum said, it has been nine years since she got married and she has two children. But she never received any advice or services. No family planning staff visited them. They have to visit the local physician for consultation.

The Prothom Alo correspondent visited a few villages at Koyra upazila's South Bedkashi, North Bedkashi and Maheskhali union at spoke to at least 50 couples. Of them, 21 couples never received any services from the health and family welfare complex. And 13 of them went to the homes of the family welfare assistants seeking their services. Family welfare assistants visited the homes of 16 couples.

Speaking about the matter, the head of the upazila family planning directorate Abdullah Al Mamun said that Koyra was a densely populated upazila. Though there are 33 units of the family planning directorate in this upazila, there is a shortage in workforce to run these. While there are all sorts of birth control medicines in supply, these services were not reaching the people due to lack of unit workers.

Concerned persons say a field worker is supposed to visit the home of one couple at least once a month. However, in Maheshkhali upazila of Cox's Bazar district, it's a different scenario. In ward 2 of Matarbari union of the upazila, there is only one family welfare assistant for 2,385 couples. And so each family does not see the family welfare assistant even once in three months.

Matarbari union family planning inspector Mohammad Asiur Rahman, speaking to Prothom Alo, said there are supposed to be nine workers for the 9,000 fertile couple in this union. However there are only three family welfare assistants and one volunteer.

Maheshkhali upazila family planning officer (acting) Shaikat Barua said that the family planning programme was being somewhat disrupted due to the crisis in manpower at the field level.

The field workers, in particular the family welfare assistants and family planning inspectors, are behind the success of the family planning programme in Bangladesh. The primarily go to the homes of newly married women and give them health awareness messages and contraceptives. The latest records of the health and family welfare ministry indicate that there are 4,334 posts vacant all over the country. The family planning  inspector supervises the family welfare inspector's work. There are 350 posts of this position vacant around the country. That means there is no supervision of the field workers in these areas.

Sources in the family planning directorate's administration department say that there are 32 categories of officers and employees from the centre down to the field. These consist of 48,087 posts. At present there are 11,145 posts vacant, waiting to be filled. That means 23 per cent of the posts of the family planning directorate are vacant.

According to the government supply chain portal, the stock of various birth control contraceptives is dwindling. The stock has dwindled to nil in some districts. A visit to the website on Tuesday showed that there were no condoms in 21 districts, no Implanon in 21 districts, no oral birth control poll 'Apon' in 6 districts. There were no menstruation cycle treatment drugs and commodities in 22 districts. There was no normal delivery equipment in 2 districts.

The stock of contraceptives is in a pitiful state. Prothom Alo and a few other media outlets reported on the issue at the start of this month. Directorate sources say, after the reports were published, the family planning directorate hurriedly transferred items from one district to another in an effort to improve the situation. As a result, while the districts do not have nil stock, there really is no improvement in the situation.

The birth control programme is being disrupted due to the lack of manpower and supervision at a field level. The birth control programme in Bangladesh was a success basically through the decrease in fertility rates. During the time of the country's independence, a woman of reproductive age (15 to 49) would have six children on average. At the end of the seventies and start of the eighties, after the birth control programme was strengthened, the fertility rate began to fall. But since 2011 the fertility rate has remained stuck at around 2.3.

Public health expert Abu Jamil Faisal has been working in family welfare services and maternal health for four decades. Speaking to Prothom Alo, he said, "From the way things stand, it look likes the directorate has fallen flat on its face. There is a serious lack of leadership here. The problems have accumulated and now pose as a crisis. A thorough inquiry needs to be carried out into the matter."