Monitoring the disease trends, health care behavior and quality of care of an Adolescent Health Initiative (ARHI) by NGO in rural Bangladesh

Brief description of your proposed Master thesis: Dr. S. M. Shamim ul Moula
Monitoring the disease trends, health care behavior and quality of care of an Adolescent Health Initiative (ARHI) by NGO in rural Bangladesh
A. Introduction:
“Solidarity”, a local NGO of Kurigram District, Bangladesh has been implementing a project titled “Adolescent Reproductive Health Initiative (ARHI)” sponsored by Save the Children Fund UK and EC/UNFPA since August 2000. “Solidarity” contracted Chiinamukul Bangladesh (-CB1, the partner of Terre Des Hommes, Lausanne, Switzerland, a leading NGO of northern Bangladesh with HQ in Kurigram, working mainly on Health and Nutrition intensively in the community and institutional levels since 1975) for clinical and technical components of the project mainly for service delivery as CB has been operating considerable number of institutional and satellite service delivery centers (clinics) equipped with manpower and logistics since deades.
As per the contract, CB has been engaged in the project for i) management of male and female adolescents suffering from reproductive diseases ii) relevant expert level counseling for reproductive health anomalies referred by ““Solidarity”” from the community where “Solidarity” has been working for mainly community mobilization and awareness development component for the mentioned project.

CB commissioned the service in its Kurigram Mother and Child Health Center (KMCHC) and maintained relevant records for each adolescent patient with monthly reporting to “Solidarity” in the context.
Ideas and traces about health care behavior of adolescents in reproductive disease, reproductive disease trends in adolescent in (northern) Bangladesh, monitoring the quality of the treatment offered in context of Bangladesh, evaluating the outcome and impact for the management with follow up elements (that contained in the CB operating component of the project of ARHI sponsored by Save The Children UK) can be a mater of interest for a researcher in Reproductive Health.
The outcomes with the lessons learnts of the mentioned research can contribute significantly in the future interventions (more specifically to the monitoring and evaluation components of those) to manage the adolescent reproductive ailments in Bangladesh

B. Research Question

i) Psycho-social: How, when and why the adolescents seek health care in Reproductive Diseases (RD) in the rural context of Bangladesh? What is their health care behavior? What is their idea about “forbidden” RD in their conservative society, where people usually hesitate or discouraged to speak about
“sexuality” or reproductive health care and that is much truer for the adolescents, as in general their “talk” in the issue regarded as a punishable offence! What are the major constraints to seek health care for adolescent RD in the community? Are they started to open themselves to have proper managements for their reproductive anomalies? Do they have enough knowledge in the issue? What is (are) their source of “sexual” or reproductive knowledge what they contain? What is their experience in the society after being exposed to the (CB) hospital for RD? What is their own perception of the endeavors made by the NGOs to open them, acknowledge them and aware them in the Adolescent Reproductive issue? Did that do any “good” to them? Are they satisfied with the management offered in CB clinics for RD and what are their expectations? What is their satisfaction level in CB management of their reproductive ailments? And many more..................

ii) Medico-social: What was/is the adolescent RD trends in (northern) Bangladesh? How it is dealt/managed in the community usually in the rural Bangladesh and what management CB offered for them for the particular disease? What is the quality of care of CB offered services in comparison to the standardized management for the particular RD? How was/is the quality of care in the community component by “Solidarity” for adolescent RD? What was the service providers’ satisfaction level by managing adolescents for their RD?
What is service providers’ perception about the adolescent service seekers for their offered services? Did the service seekers think that a considerable percentage of adolescent service seekers have some type of “psycho-somatic” problems rather than any typical disease? And many more…………

iii) Monitoring , evaluation and impact analysis:
Was there any baseline or follow-up prior to the intervention?
Was the quality of service to the adolescents for their RD by CB and “Solidarity” monitored? If yes, then how? Was it internal or external? What were the tools and mechanisms for that and how effective those were? Who were involved with that monitoring process? What was their quality for the task? Review and rate the methodology of the conducted monitoring if any. Analysis of the conducted monitoring procedures if any.
If no, then what was/is the impact of that on the intervention?
Compilation of the appropriate tools for monitoring for the CB/”Solidarity” project those could fit with the intervention.
Was there any evaluation for the project? What type, internal or external? Midterm or final?
If yes, what were the tools? ? Review and rate the methodology of the evaluation if any.
If no, how it could be designed? What methodology would be better and effective?
Impact analysis in the community and among the service seekers (adolescents) and service providers (CB and “Soliderity”).

C. General Objective
To have knowledge to design effective adolescent reproductive health interventions in Bangladesh (specially in rural context), to explore and generate most effective tools for essential monitoring and evaluation of such projects for expected successes.
To track the adolescent reproductive and general health care behavior in (this part of) Bangladesh to design appropriate intervention program in future to address adolescent reproductive health ailments. To assess the outcome of the awareness building program among the adolescents and its impact in the community for use in the future for designing successful project/intervention. To assess the effectiveness, success and constraints of an ARHI project in the community and evaluation and monitoring of particular cases in an ARHI project to see the quality of care offered in comparison to the standard practice in Bangladesh with tracking the follow up process. Also the adolescent Reproductive Disease trend will be monitored and assessed for future use in the program designing and service seekers and providers’ satisfaction in the context will be documented for same reason.

Specific Objective
i) To see the Adolescent Reproductive Disease trends in (the part) of Bangladesh
ii) To monitor and evaluate the quality of care made available for Adolescent Reproductive Disease or anomalies in the “Solidarity”/CB ARHI project
iii) To track the health care behavior of the adolescents for their Reproductive Health anomalies
iv) To document the service seekers and providers satisfactions for the offered services in the ARHI
v) Investigating monitoring and evaluation processes and associated tools.
v) To see the impact of the ARHI in the community and the outcome of the awareness building process by the project
D. Literature Review minimum 1/2 page at least 5 article related with your subject
(Apa, I could not manage it till date, can any body help?)

E. Research Methodology
i) Study Design
The study will consist of a number of sub studies and those will be conducted through a number of surveys as follows:
a) Monitoring cases of adolescent reproductive diseases in CB KMCHC:
Cases that are recorded in the CB Kurigram Mother and Child Care Center register will be tracked, analyzed for quality of care offered and for the understanding of disease trends.
b) Monitoring particular cases of adolescent reproductive diseases in CB KMCHC:
A number of cases from CB Kurigram Mother and Child Care Center register will be tracked and analyzed for quality of care offered including that of the diagnosis, prescription and other advises.
c) Tracking adolescent reproductive service seekers KAP and comparison with a “control group”:
At least 30 adolescent patients will be identified from CB Kurigram Mother and Child Care Center register and will be interviewed for their health seeking behavior. They will also be checked for their satisfaction in the care offered by CB and ““Solidarity”” and they will be investigated for their perception of social impact for their health care seeking for reproductive anomalies. They will be carefully screened for their own feelings in the issue of seeking health care for reproductive health by the adolescents (themselves) that are normally “forbidden” in the society. Careful examination of their conceptual changes will be investigated changes. Endeavor will be made for tracking their KAP level and to compare it with a “control group”.
d) Tracking the service providers’ satisfaction and “lessons learnt:
For this, a total number of 10 service providers will be interviewed. Among them, 5 from each of the 2 groups, namely clinical service providers and non-clinical service providers for their perception of the adolescent health anomalies and their attitudes, social impacts and their satisfaction in rendering the service to adolescents. Endeavor will also be made for track their “lesson learnt” for providing the reproductive health services to the adolescents.
e) Tracking the social impacts/reaction in the community for the adolescent reproductive health initiative:
For the component, a total of 10 social elite will be interviewed to track their response to ARHI.
f) Examining the records for exploring monitoring and evaluation elements if any:
Interviews with “Solidarity” and CB officials, reviewing data and documents available.
g) Observation: Observation/case study.

ii) Study Population
Number of adolescents served by the project
iii) Place of Study
Place of the study will be in the district of Kurigram, Bangladesh where NGO “Solidarity” and CB have been engaged in the EC/UNFPA sponsored Adolescent Reproductive Health Initiative (ARHI) through Save the Children Fund, UK.
iv) Sampling techniques for the surveys:
a) Monitoring cases of adolescent reproductive diseases in CB KMCHC:
All the cases recorded in CB Kurigram Mother and Child Care Center register will be taken as sample.
b) Monitoring particular cases of adolescent reproductive diseases in CB KMCHC:
Systematic Random Sampling technique will be adopted for drawing the samples from each disease category for analyzing for quality of care offered including that of the diagnosis, prescription and other advises.
c) Tracking adolescent reproductive service seekers KAP and comparison with a “control group”:
Systematic Random Sampling technique will be adopted for drawing at least 30 Samples from CB Kurigram Mother and Child Care Center register for interviewing for their health seeking behavior.
d) Tracking the service providers’ satisfaction and “lessons learnt/recommendations:
Purposive sampling technique will be adopted for to draw a total number of 10 samples among the service providers for interviewing. Among them, 5 from each of the 2 groups, namely clinical service providers
(CB) and non-clinical service providers (“Solidarity”).
e) Tracking the social impacts/reaction in the community for the adolescent reproductive health initiative:
For the component, purposive sampling technique will be adopted to draw a total sample of 10 among social elite for interviewing to track their response to ARHI.

v) Sample size:
In fact, this composite study contains a number of studies containing different number of samples as follows:

Study Sample category Proposed number for interviewing
Monitoring disease trends Adolescent reproductive patient All patients recorded in CB
Monitoring quality of care Adolescent reproductive patient 15 (5 patients in each respondent category for 3 diseases)
Service seekers KAP i) Adolescent reproductive patient in CB
ii) Adolescents of “control group” i) 30ii) 30
Service Providers’ perception/interview i) Clinicians of CB
ii) Non clinical service providers from “Solidarity” 10 (CB-5+”Solidarity”-5)
Perception of social elites on ARHI Local elites 10

vi) Analysis plan/presentation of findings

Survey data of the study will be analyzed keeping in view the need and direction of the study objectives. Analytical Strategies will be chosen in such a way so that all possible requirements needed to address each objective in an optimum position can be met.

Separate analyses will be carried out for all sub studies in the study. These analysis have been carried out with the help of uni-variate and bi-variate tables, and if necessary with graphic presentation.


F. Outcome of the research study:
Useful secondary data will be revealed for future use to design and implement similar project.
Useful monitoring and evaluation tools can be generated for use in future projects of similar nature.
Constraints/limitations for similar projects/interventions can be assessed.
Idea about cost, logistics and technical inputs for the similar projects can be perceived.
Expertise can be developed in similar project.
Future research questions can be drawn out.

G. Conclusion
As the study has been designed with effective knowledge of research, it has got the better scope for success. If it is successfully implemented, it will serve the purpose of the researcher yielding the different objective oriented outcomes for a noble academic purpose.
The study can reveal the utmost need for a appropriate monitoring and evaluation system for a (reproductive) health project for its final success and can unveil the problems those can be en countered in absence of such a appropriate M&E system.