Over the past three years, material mortality has dwindled to zero in Kapasia, Gazipur. The government has taken initiative to introduce the Kapasia model in 100 other upazilas of the country. The model is even gaining recognition globally. The Kapasia model has been selected by the United Nations Population Fund (UNFPA) to be highlighted in 27 different countries for best practices in population and reproductive health.
A database software called ‘Gorbobotir Aina’, has been created to implement the Kapasia model in reducing maternal mortality. This database includes 27 different components of information including the risks faced by an expectant mother, her age and so on. This is accompanied by a health manual, ‘Gorbobotir Goina’. These two tools are being used to conduct the entire programme.
The upazila health complex has been carrying out the initiative since 4 December 2017, to free Kapasia of maternal mortality. Before the programme started, 8 expectant mothers died in 2017 in Kapasia. There had been 6,700 expectant mothers in the upazila at the time. In the year that the implementation of the programme began, 2018, maternal deaths fell to 4. There had been 6,300 expectant mothers at the time in the upazila. And from 2020 till the present, there hasn’t been a single maternal death. There had been 6,500 expectant mothers there last year.
Kapasia’s local member of parliament Simeen Hossain is the patron of this programme aimed at freeing Kapasia of maternal mortality. She told Prothom Alo, “Before I was elected member of parliament, I would go to every village and speak to the mothers. They were not aware of many things and did not get proper healthcare either. The situation has changed radically after this software was made and other measures taken.”
The entire programme is coordinated by the Kapasia upazila family planning officer Md Abdur Rahim. During a conversation in his office on 14 March, he indicated the database dashboard on his computer. This was ‘Gorbobotir Aina’, roughly translated as the ‘expectant mothers’ mirror’. According to the data on the dashboard, there were 1,169 expectant mothers in Kapasia at the time, of whom 636 were risky cases. From January 2018 to 14 March 2021, a total of 1,227 expectant mothers had been provided service.
Such deaths can be prevented by ensuring a minimum four checkups before childbirth, delivery of the child by a skilled attendant or midwife, and proper ante-natal care. Basically these factors have been included in the model to free Kapasia of maternal mortality
Abdur Rahim said, the software identified risk prone cases automatically based on certain data. The different risks were determined if the expectant mother was identified as below 20 years old, over 35, under 4ft 10 inches in height, if it was her first pregnancy, if she had a negative blood group, etc.
If an expectant mother dies within the time of conception to 42 days after delivering the child, this is considered as maternal mortality, unless the death is caused by any other unrelated accident. According to the last report of the National Institute of Population Research and Training (NIPORT) in 2017, Bangladesh’s maternal mortality rate is 196 per every 100,000 live births. However, the family planning directorate puts this figure at 176.
According to the UN’s Sustainable Development Goals (SDG), the maternal mortality rate must be brought below 70 by the year 2030. The two major causes of maternal deaths are excessive bleeding during childbirth and eclampsia, though such deaths can be prevented by ensuring a minimum four checkups before childbirth, delivery of the child by a skilled attendant or midwife, and proper ante-natal care. Basically these factors have been included in the model to free Kapasia of maternal mortality.
37 info inputs for ‘Gorbobotir Aina’
The programme is running in 11 unions of the upazila. The expectant mothers have to answer 37 questions to fill up a form. The health workers at a union level then enter this information into the database with the help of the ‘Gorbobotir Aina’ software. Each pregnant woman is given an ID number. After her last menstruation date is recorded, the software comes up with dates for four visits, in the fourth, sixth, eighth and ninth month respectively, of her pregnancy.
Three days before the scheduled visit, a reminder is sent by SMS to the expectant mother’s mobile phone. The message includes the mobile number of the concerned union health worker. The health worker can be consulted on any matter. On the morning of the visit, a voice call is sent by mobile phone, reminding the expectant mother of the visit. The voice is of MP Simeen Hossain.
Nasrin Akhter is a resident of the village Kuridayi in Singhasri union of Kapasia. She gave birth to her second child on the last week of March. During her pregnancy, she paid four visits to the local health complex for checkups. She even had some extra tests done at the upazila health complex for free.
Nasrin Akhter’s husband Sadiqur Rahman told Prothom Alo, “They gave us a book when we went to the health centre after she was pregnant. It listed the dates of the scheduled visits for checkups. The union health worker is in regular contact. They provided ultrasonography and other tests for free.”
‘Gorbobotir Goina’ health manual
Every expectant mother of the upazila is given a manual called ‘Gorbobotir Goina’, with easily understandable information and illustrations on prenatal and antenatal care. The manual contains health related information recorded during the four visits, prescriptions and such.
Fatema Khatun of the village Haridari in Singhasri union is pregnant. She is 41 years old and is identified as a risk case. Her husband Shamsuddin told Prothom Alo, “I have taken her to the health centre thrice. They carried out several tests, but did not charge us. We are poor people and happy to get this service.”
A full physical checkup and tests of an expectant mother at the upazila health complex costs Tk 540, but this is done for free. Upazila family planning officer Abdur Rahim said, 198 midwives, 18 from each union, have been trained. A union-based list of voluntary blood donors had also been entered into the software. A Syeda Zohra Tajuddin Mother and Child Health Corner has been set up at the upazila health complex to give special attention to expectant mothers.
Increase in awareness
A non-government organisation, Innovation for Poverty Action, carried out a survey in 2017 and 2019 on expectant mothers in Kapasia upazila. This revealed that the ‘maternal mortality-free Kapasia’ programme has increased awareness among expectant mothers. In 2017 no one would bother to preserve their prescriptions. 97 per cent of the expectant mothers preserved their prescriptionm in 2019 . only 26 per cent were aware about prenatal care in 2017. In two years this went up to 95 per cent.
A fund called ‘Humanitarian Aid’ has been set up to arrange the required funds for this programme. Every day one taka from each of the 1,700 government officers and employees of Kapasia upazila goes into this fund. The funds are used to the SMS sent to the expectant mothers, voice calls, tests and checkups and, in some cases, C-section surgery too. There is Tk 1.1 million (Tk 11 lakh) in the fund at present.
The health and family planning ministry has taken an initiative to expand the Kapasia model to a national level. Director of the family planning directorate (MCH services), Mohammad Sharif, told Prothom Alo, the initiative taken at Kapasia to reduce child mortality is laudable. The Kapasia model will gradually be replicated in 100 upazilas. So far 12 upazilas have been selected
Kapasia model on a global platform
Partners in Population and Development (PPD), an initiative involving 27 countries with large populations, is implementing a project funded by UNFPA to reduce maternal mortality. PPD sought Bangladesh best practices in 2020 for population, family planning and reproductive health. The government nominated the maternal mortality-free Kapasia model for best practices.
PPD consultant Shahriar Nafis told Prothom Alo, the Kapasia model has been documented as a best practice. This will be published on PPD’s website and as a separate publication. PPD will strongly recommend that other members replicate this model.
* This report appeared in the print and online edition of Prothom Alo and has been rewritten for the English edition by Ayesha Kabir