Workshop report on “Health Systems Research and Evidence-based Health Policy Making’ in Jhenaidah from 7th to 9th August, 2016


European Union supported SHARE (Strengthening Health, Applying Research Evidence) project of icddr,b in collaboration with the Planning, Monitoring & Research unit, Directorate General of Health Services(DGHS) organized a workshop on “Health Systems Research and Evidence-based Health Policy Making’ from 7th to 9th August, 2016 at Aid Complex Conference Room in Jhenaida. Around 20 District Health Managers along with Upazila Health and Family Planning Officers of Jhenaidah participated in this workshop.

Inauguration session

Dr. Rashidun Nessa, Line Director, Planning & Research, DGHS attended this three day long workshop as Coordinator and Special Guest. Mr. Md. Ashadul Islam, Director General of Health Economics Unit, Ministry of Health and Family Welfare inaugurated this workshop as the Chair. Dr. Md. Abul Hashim, ex-Line Director, ESD, DGHS, Dr.Mushtuq Husain, ex-Principal Scientific Officer, IEDCR, Dr. Md. Abdus Salam, Civil Surgeon, Jhenaidah and Dr. Golam Sarwar Faruk, Assistant Director, DGHS attended the workshop as Special Guests.

Dr. ATM Iqbal Anwar, Scientist and Project Director of icddr,b welcomed the participants to the workshop.

In order to strengthen health systems, health policy making should be evidence-informed. We appreciate icddr,b for their relentless efforts with DGHS in capacity building towards evidence-informed health policy making’, Dr. Rashidun Nessa, Line Director, Planning & Research, DGHS said in the first day of three day long workshop as Coordinator and Special Guest at AID Complex training room of Jhenaidah.

Mr. Md. Ashadul Islam, Director General of Health Economics Unit, Ministry of Health and Family Welfare said in his speech, ‘ This workshop will enable health managers to better utilize of knowledge and information in health service management and decision making’. Dr. Md. Abul Hashim, ex-Line Director, ESD, DGHS said that smooth implementation of SDGs demands health managers to be well equipped with evidence-informed health policy making and health systems research.

Dr. Sohana Shafique, Senior Research Investigator and resource person from icddr,b facilitated  brief inauguration before the workshop started on August 7, 2016.

Workshop session details

The workshop started with the session on ‘Evidence Based Health Policy Making’ facilitated by Dr. ATM Iqbal Anwar, Scientist and Project Director of icddr,b. While acknowledging benchmark contribution of district and upazila level health managers in achieving success in national immunization programme and reducing maternal and child mortality in Bangladesh, Dr ATM Iqbal Anwar asked them what their priority actions would be if they are posted in central office of DGHS in Dhaka. Health programme managers of the workshop talked about existing gap between field level health programmes and centralized health policy making. They pointed out that country-level effort to link research to action to be undertaken on urgent basis. They also mentioned that knowledge materials like research findings should be easily accessible to health programme managers for bridging the know-do gap.

Later Dr. Sohana Shafique and Mr. Dipika Shankar Bhattacharyya, resource persons from icddr,b took their session on ‘Research Methods in Health’. Dr. Shahed Hossain, Scientist of icddr,b conducted his session on Critical appraisal of a biomedical literature backed by group exercise.

Current sector programme recognizes the challenges of urbanization and the need to organize health service delivery differently to meet the needs of the urban poor (still 40% without primary health care services). Dr Sohana Shafique, Senior Research Investigator of icddr,b focuses on urban health challenges and strengthening urban health governance in the second day of the workshop.

By 2020, over 50% of Dhaka’s population will live in slums. The urban healthcare landscape in Bangladesh shows rapid urban growth occurring in slum settlements where health risks are greatest. Participants of the workshop recommended for better utilization of health budget allocated under city governance and emphasized on targeting slum population. Dr Sohana Shafique, Senior Research Investigator of icddr,b conducted this session on urban health in the workshop.

Around 59% of deaths in Bangladesh are due to non-communicable diseases (NCDs) and other chronic health conditions. NCDs are the single biggest cause of death in the world. Mass media campaign on NCDs prevention, orientation of all health service providers from community level to tertiary level etc. activities were prioritized in the presentation session of Prof. Dr. Shibbir Ahmed, Professor and Head, Community Medicine Sylhet MAG Osmani Medical College. He conducted this session on NCDs in the workshop.

Learning effective search strategies to identify and access relevant knowledge resources on public health is important component of “Health Systems Research and Evidence-based Health Policy Making” workshop. Mr Al Mamun,Resource Person from icddr,b demonstrated how to find scientific literature from PubMed which comprises more than 26 million citations for biomedical literature from life science journals, public health journals and online books.

Mushtuq Husain, ex-Principal Scientific Officer, IEDCR conducted the session on ‘Implementation Research’ which determines the best ways to implement evidence-based health interventions. With real life examples, participants learnt how implementation research draws much of its strength from practitioners & communities they serve, and generates context specific insights.

Effective health data management can create desired accountability and transparency in the performance of health sector. District health managers can create their own dashboard in the DHIS2 with charts, pivot tables and GIS maps to monitor progress of health programmes and strengthen local health planning. Dr.Jannatul Ferdous, Senior Technical Expert of icddr,b conducted capacity building session for district and upazila health managers to promote routine use of Management Information Systems data using the DHIS2 platform.

Leadership and management are essential skills for health care professionals- irrespective of frontline leadership in health facility or strategic leadership in national health management system. Transformational healthcare leaders can effectively deliver health outcomes and can transform health interventions into impact based on best available research evidence. This was reflected in the session on ‘Leadership and Management’ conducted by Dr ATM Iqbal Anwar, Scientist and Project Director of icddr,b.

Champion like Dr. Md.Emdadul Haque shows the way how community participation can make a difference in health service delivery. ‘Chowgacha Health Model’ introduced by this Senior Consultant of Jhenaidah Sadar Hospital got national and global recognition at national and global level. Once Dr Margaret Chan Director-General of WHO said, ” Bangladesh does not require any external world model; Chowgacha Health Model is enough to ensure benchmark health services.” Dr. Haque shared his experience in introducing ‘Chowgacha Health Model’ to the workshop participants on the last day of the workshop.

Pre-evaluation and post-evaluation test were conducted before and after the workshop. Preparatory Investigators meeting was also organized on August 2, 2016 in Dhaka.

Closing session

 ‘Thank you, icddr,b team for organizing this capacity building workshop for us. We have learned a lot on evidence-informed health policy making and health information system’, Dr. Rasheda Sultana, Upazila Health & Family Planning Officer commented after the workshop. Dr. ABM Golam Sarwar Faruk, Assistant Director, DGHS urged the health managers to continue their learning spirit to strengthen health system of Bangladesh in concluding session. Mr. Saidul Karim Mintu, Jhenaidah Municipality Mayor who works closely with community support group for health services also spoke in concluding session. He said, ‘Best practices of our health service delivery should be scaled up with necessary audio-visual campaign’. Mr. Aminur Rahman Khoka, Ex-Mayor of Jhenaidah Municipality also spoke in the session. Dr ATM Iqbal Anwar, Scientist and Project Director of icddr,b facilitated the closing session. Dr. Md. Masum Ali, Divisional Director, Khulna grace the session as Chief Guest and Dr. Md. Abdus Salam, Jhenaidah Civil Surgeon chaired the closing session.

Communicating Branding

 Main workshop banner was appropriately branded with icddr,b and EU logos. SHARE project brochure was distributed among the participants. Also, SHARE project documentary on ‘Evidence-informed Health Policy Making’ was run in the workshop relevantly. In inauguration and closing sessions, resource persons from icddr,b gave briefing on SHARE project. Different sessions of the workshop were highlighted in SHARE project facebook page.

Interaction with community support group

 Two fruitful public engagement sessions on ‘community participation in health service model’ were held on August 7 at AID Complex Conference room and August 9, 2016 at Hospital Conference room.

Dr. Md.Emdadul Haque, Senior Consultant of Jhenaidah Sadar Hospital gave introductory presentation on ‘Integrated approach of Administration, Community Leaders & Health Management’ in the context of ‘Chowgacha Health Model’. After his session, representatives from community support group and icddr,b team exchanged their views and experiences. Following findings came out from the interaction:

Md.Emdadul Haque mobilized community support to develop Upazila level standard services in Chowgacha upazila health complex (UHC) . from 1996 to 2012

This resulted in mobilizing 46 additional workers from community, increasing  EOC Beds from 11 to 41, and rendering Chowgacha UHC as  the best EOC center  with 98.4% delivery rate

Chowgacha Health complex is awarded for best performance in EOC form 2005 to 2014.

  • Later Dr. Md.Emdadul Haque introduced community Participation in hospital service improvement in Jhenaidah Sadar Hospital and proved maximum utilization of government  resources can be ensured with honesty and sincerity.
  • Initial challenges of Jhenaidah Sadar Hospital was shortage of manpower, specially 4th class staff, inadequate services especially EOC, dire problem in cleanliness, inadequate coordination with local administration and community leaders, poor documentation and reporting system, demoralized  and insecure environment.
  • In course of time, Dr. Md.Emdadul Haque activated community participation for the achievement of Jhenaidah Sadar Hospital with the involvement of local MP, Mayor, local industrialists, doctors, community members. They provide honarium for 57 non-govt. hospital workers for improving performance of Obstetric Program. This support also instituted ANC, PNC and breastfeeding, MR & PAC service corner at Jhenaidah Sadar Hospital, improved cleanliness and beautification of hospital campus, improved Pediatric Service, improved security and improved financial management.

Few examples of community support are mentioned below

MP of Jhenaidah-2 providing 14 manpower support.

Doctors of the hospital and Jhenaidah town supports 18 man power.Mayor plays an important role in cleanliness, repaired the boundary wall, made 4 dustbins and supports 3 man power.

Significant role in ensuring security and wastage management

A retired Secretary donated a generator for 24 hours OT service with a cost of nearly 33 thousand taka

Chairman of Zahedee foundation supports 10 manpower and an intercom at a cost of nearly two lac taka.

Jhenaidah Sadar Hospital was the highest revenue generation hospital in Khulna Division  in 2014.

Lessons learned

 Public health and hospital services and resources are inadequate to serve the need specially for the poor. This gap can be minimized through local participation.

Effective health service and hospital management require local support and participation.

Health personnel, specially the local health manager should take the role of catalyst. Local support can be attracted through improved services, and visible efforts and morality of the health managers like Dr. Emdadul Haque.

Mr. Saidul Karim Mintu, Jhenaidah Municipality Mayor, Mr. Aminur Rahman Khoka, Ex-Mayor of Jhenaidah Municipality, Additional Superintendent of Police, Jhenaidah, AC Land, Jhenaidah, teachers, lawyer, businessmen, cultural activists, representatives of local political party and different professional representatives working closely with community support group for health participated in vibrant sharing meeting in Jhenaidah.