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Open Access Research article

Scaling up community mobilisation through women's groups for maternal and neonatal health: experiences from rural Bangladesh

Tasmin Nahar1, Kishwar Azad1, Bedowra Haq Aumon1, Layla Younes2, Sanjit Shaha1, Abdul Kuddus1, Audrey Prost2, Tanja AJ Houweling23, Anthony Costello2 and Edward Fottrell2*

Author Affiliations

1 Perinatal Care Project, Diabetic Association of Bangladesh (BADAS), BIRDEM 122 Kazi Nazrul Islam Avenue Shahbagh, Dhaka-1000, Bangladesh

2 UCL Centre for International Health and Development, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK

3 Department of Public Health, ErasmusMC University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands

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BMC Pregnancy and Childbirth 2012, 12:5  doi:10.1186/1471-2393-12-5

Published: 24 January 2012

Abstract

Background

Program coverage is likely to be an important determinant of the effectiveness of community interventions to reduce neonatal mortality. Rigorous examination and documentation of methods to scale-up interventions and measure coverage are scarce, however. To address this knowledge gap, this paper describes the process and measurement of scaling-up coverage of a community mobilisation intervention for maternal, child and neonatal health in rural Bangladesh and critiques this real-life experience in relation to available literature on scaling-up.

Methods

Scale-up activities took place in nine unions in rural Bangladesh. Recruitment and training of those who deliver the intervention, communication and engagement with the community and other stakeholders and active dissemination of intervention activities are described. Process evaluation and population survey data are presented and used to measure coverage and the success of scale-up.

Results

The intervention was scaled-up from 162 women's groups to 810, representing a five-fold increase in population coverage. The proportion of women of reproductive age and pregnant women who were engaged in the intervention increased from 9% and 3%, respectively, to 23% and 29%.

Conclusions

Examination and documentation of how scaling-up was successfully initiated, led, managed and monitored in rural Bangladesh provide a deeper knowledge base and valuable lessons.

Strong operational capabilities and institutional knowledge of the implementing organisation were critical to the success of scale-up. It was possible to increase community engagement with the intervention without financial incentives and without an increase in managerial staff. Monitoring and feedback systems that allow for periodic programme corrections and continued innovation are central to successful scale-up and require programmatic and operational flexibility.