Despite some visible progress in some areas of health sectors, Bangladesh is still struggling to sustain efforts towards decreasing Maternal Mortality Rate (MMR). Evidence shows that there is lower access to skilled birth attendant in Bangladesh. Access to skilled birth attendants (SBAs) during delivery has been identified as an effective mechanism to significantly reducing MMR. Previous studies have focused on socio-demographic characteristics of women including cultural and religious dynamics with communities with limited attention to the health system. Using the World Health Organisation’s health system strengthening framework, this paper analyses how health system ‘architecture’ playing role in create fragile platform for the women to access skilled birth attendants. It draws emphasis on governance and policy, financing, health information, workforce, service delivery, medicines and commodities including infrastructure. As governance is the dominant factor and plays critical role in determining success of all facets of the health system, this paper further proposes a systematic strategy that seeks to mitigate the identified challenges. Lessons from this study are relevant to guiding policy makers in Bangladesh as well as in other resource-constrained settings in making evidencebased decisions regarding strengthening the health system to access a skill birth attendant to make birth safer for both mothers and newborns.
Manika Saha, Emmanuel Nene Odjidja