Director General
National institute of Population
Research and Training (NIPORT)
Ministry of Health and Family Welfare
Foreword
The National Institute of Population Research and Training (NIPORT) under the Health
Population and Nutrition Sector Development Program (HPNSDP) of the Ministry of
Health and Family Welfare [MOHFW) has been assigned to conduct the study entitled
“Follow-up of FWV Basic Training” Associates for Research Training and Computer
Processing (ARTCOP) carried out the study with an aim to assess the effectiveness of
FWV basic training, in providing services at facility and outside facility level in terms of
their knowledge, skills and performance in order to identify the gap in the training
curriculum, process and identify needs for refresher training.
The study revealed that most of the respondents did not have any comment on the
curriculum. About 23% felt that the curriculum was sufficiently large. The duration of the
training should be increased. More than half of the respondents were in favor of
increasing training allowances. Need for practical training as well as field level training
was felt by some of the respondents.
The extent of additional short-term training required was reported to be of very low
magnitude. The mid-term training requirements were also of the same magnitude, the
requirement being varied between 5.1% and 14.5%. The topics on which they require
these training most notably were reported to be on midwifery, ANC, IUD insertion. The
long-term training requirements were even lower than the previous two categories of
training, viz. short-term and mid-term but they have some common elements.
I am grateful to the researchers of ARTCOP, who have so generously helped to bring
out this research report within the stipulated time.
I express my gratitude to the professionals of NIPORT for their sincerest efforts in
publishing this report.
Shelina Afroza, Ph.D
Director Research
National institute of Population
Research and Training (NIPORT)
Ministry of Health and Family Welfare
Preface
We are happy to introduce the Survey Report on “Follow-up of FWV Basic Training”.
This study was conducted by Associates for Research Training and Computer
Processing (ARTCOP) under the overall supervision and financial support of the
National Institute of Population Research and Training (NIPORT).
The present study addresses the issue with an aim to assess the effectiveness of FWV
basic training in providing services at facility and outside facility level in terms of their
knowledge, skill and performance in order to identify the gap in the training curriculum,
process and identify needs for refresher training.
I am delighted to note that professionals of NIPORT, Ministry of Health and Family
Welfare (MOHFW) and Directorate of Family Planning (DGFP) took the timely initiative
to conduct a study in this regard. I hope that the findings of this report would generate
interest among the policy makers, program mangers and researchers and lead to further
research and relevant policy decisions in future.
Finally, I would like to express my gratitude to the members of Research Unit of
ARTCOP, the author and the members of the Technical Review Committee (TRC)
for their important contributions in different stages of the study.
Md.Rafiqul Islam Sarker
ACKNOWLEDGEMENT
Associates for Research Training and Computer Processing (ARTCOP) Ltd. conducted
the study on Follow-up of FWV Basic Training” under the overall supervision and
financial support of the National Institute of Population Research and Training
(NIPORT). We are greatly indebted to professionals of NIPORT, Ministry of Health and
Family Welfare (MOHFW) and Directorate of Family Planning (DGFP) who were
associated with the study.
We express our heartiest thanks and gratitude to Director General, NIPORT who
showed continued interest and provided full cooperation at different stages of the study.
We acknowledge and appreciate the professional support and guidance of Md. Rafiqul
Islam Sarker, Director (Research) and Mr. Mohammed Ahsanul Alam, Evaluation
Specialist, NIPORT and Deputy Program Manager (Research and Development) for
their contribution and effort at all stages of the study.
We must appreciate the contribution of all service providers, field workers and
respondents of the selected Upazilas covered by the study, who extended all possible
co-operation and assistance during data collection.
Finally, our deepest appreciation goes to the research personnel, officials and field staffs
of ARTCOP Ltd. whose tireless work has made the study a success. We are really
thankful to all of them.
Executive Director
ARTCOP
LIST OF ABBREVIATIONS
AD (FP)
:
Assistant Director (Family Planning)
ANC
:
Ante Natal Care
BCC
:
Behavior Change Communication
BDHS
:
Bangladesh Demographic and Health Survey
DD (FP)
:
Deputy Director (Family Planning)
EPI
:
Expanded Programme for Immunization
FPI
:
Family Planning Inspector
FWA
:
Family Welfare Assistant
FWV
:
Family Welfare Visitor
FP
:
Family Planning
SACMO
:
Sub Assistant Community Medical Officer
MA
:
Medical Assistant
MCH
:
Maternal and Child Health
MCWC
:
Mother and Child Welfare Center
MO
:
Medical Officer
MO (MCH-FP)
:
Medical Officer (Maternal Child Health-Family Planning)
NGO
:
Non-governmental Organization
NIPORT
:
National Institute of Population Research and Training
PHC
:
Primary Health Care
PNC
:
Post Natal Care
SBA
:
Skilled Birth Attendant
Sr.FWV
:
Senior Family Welfare Visitor
TBA
:
Traditional Birth Attendant
TFR
:
Total Fertility Rate
TRC
:
Technical Review Committee
TT
:
Tetanus Toxoid
UFPO
:
Upazila Family Planning Officer
UH&FWC
:
Union Health and Family Welfare Center
UHC
:
Upazila Health Complex
CONTENTS
Page
Forward
Preface
Acknowledgement
List of Abbreviations
Executive Summary
i-v
CHAPTER 1: Introduction
1.1
Background
1.2
Literature review
1.3
Rationale
1.4
Objectives of the study
1-4
1
2
3
3
CHAPTER 2: Methodology
2.1
Study design
2.2
Target population
2.3
Sample size
2.4
Sampling procedure
2.5
Study instruments
2.6
Training
2.7
Data collection
2.8
Data analysis
2.9
Quality control
2.10 Implementation strategy
2.11 Manpower for the survey
2.12 Recruitment
5-9
5
5
5
7
7
7
8
8
8
9
9
9
CHAPTER 3: Knowledge
3.1
Current Knowledge of the FWVs in Providing RH-FP Services
3.2
Performance of the FWVs in the Working Situations
10-20
10
16
CHAPTER
4.1
4.2
4.3
4.4
4.5
21-25
21
21
22
23
23
24
4: Performance
Introduction
Sources of Supply of Bedicine and Logistic Support
Record Keeping
Training Requirement
Follow-up Visit
CHAPTER 5: Training
5.1
Training Related Knowledge about the Module
26-29
26
CHAPTER 6: Strength and Weakness
6.1
Strength and Weakness
30-35
30
CHAPTER 7: Observation
36-38
CHAPTER 8: Discussion and Recommendations
8.1
Discussion and Conclusions
8.2
Recommendations
39-42
39
41
Bibliography
ANNEXURE-A: Tables: Exit Client
ANNEXURE-B: Tables: Trainer
ANNEXURE-C: Questionnaires
Contributors/Research Team
Executive Summary
Introduction
Bangladesh Family Planning Program has made remarkable progress over the last forty
years (after independent) due to continuous political commitment, innovative program
approach, government, non-government and development partners collaboration, strong
IEC program, method-mix cafeteria approach and commitment of the field-level
functionaries.
As part strategy, the Government of Bangladesh (GoB) has subscribed to the overall
objectives of ‘Health for All’. It has agreed, in principle, to pursue a policy for providing
essential minimum health care to all citizens, particularly to those who are under
privileged and under served. This study, therefore, focuses on the existing institutional
training arrangements for the FWVs as principal community level public health workers
in the country. The main purpose of the study is to examine the effectiveness of FWVs
basic training in the light of their (FWVs) knowledge, skill, practice, performance in order
to identify the gap in the training curriculum and process and also identify the needs for
refresher training as a holistic approach.
The study followed a cross sectional design to obtain information from primary, and
secondary sources. Both quantitative and qualitative instruments were used to collect
information from the selected respondents. All the trainers (principals of FWVTIs,
UFPOs, MO (MCH_FP), MO (Clinic)), 400 newly trained FWVs and eligible service
recipients (exit client) of the FWVs working at union levels FWCs were the respondents
of the study. Standard statistical formulae was used in deciding the minimum sample
size for each stratum. About 400 FWVs who received basic training from 12 FWVTI’s
were selected and for this separate list was prepared for each of the FWVTI. Stratified
random sampling technique was applied to select the FWVs. However, 360 FWVs were
successfully interviewed.
Ascertain the Current Knowledge of the FWVs in providing RH–FP services can be
visualized in the following sections.
An attempt to ascertain the knowledge on the reproductive and family planning related
services, the Family Welfare Visitors (FWVs) were asked if they were aware of the tasks
in the relation to the following services:




Antenatal services
Care during delivery
Post-natal care, and
Pubertal care (Adolescent care)
Knowledge on antenatal care services, by and large was nearly satisfactory. More than
94% of the FWVs were found to possess knowledge on the fact that recording case
history is mandatory that has to be accomplished when a pregnant women desire
antenatal services. Performing clinical test, examining pulse, measuring temperature,
checking blood pressure, imparting nutrition education, providing TT should be
accomplished––were endorsed by 80% to 85% of the FWVs.
The knowledge of the FWVs about the tasks to be performed during delivery was
assessed and their answers were checked against a few selected issues pertinent to the
safe delivery. The respondents agreed in about 88% cases that their primary task is to
advise on safe delivery. This was endorsed by about 76% of the FWVs.
A substantial proportion of the respondents knew the type of job they are supposed to
perform. On an average, about three-fourths of the respondents provide such services
as motivating the eligible couples for accepting family planning methods (80.3%),
encouraging adopting permanent method (82.8%), counseling (74.4%), helping
physicians in their endeavor to provide permanent method (77.1%), advising clients for
follow-up visits (75.8%).
Knowledge on couple screening is a necessary step before administering injection is
known to about 84% of the respondents. This is followed by ‘encouraging the clients’,
being mentioned by 83.4% of the respondents.
The FWVs are required to attend two days a week in satellite clinics to provide services
related to MCH and family planning to the clients. All the selected FWVs were asked if
they are aware of the services provided from these clinics. MCH related services
include, among others, ante-natal care (ANC), postnatal care (PNC), nursing under-5
children, and treatment of general patients and the awareness was highly satisfactory as
in most cases, 87% to 89% FVWs could recall these services. Knowledge on the family
planning services provided from the satellite clinics was also significantly high. That oral
pills are distributed from the satellite clinics is known to 90.4% of the respondents,
followed by injection being known by 88.5% of the respondents. Knowledge on condom
and IUD was also reasonably high being mentioned by 87.3% and 79.6% respectively.
How much importance the FWVs attach to providing reproductive health and family
planning services? The feedback of this question was sought in terms of the services
related to the ANC, MCH, FP and nutrition education. Overall nearly one third of the
respondents were found to give most attention to the services pertaining to ANC, MCH
and FP. A little more than 62% pay normal attention in providing ANC services, 56% in
MCH, 59.2% in FP and 56% in nutrition.
The second objective of the study is Performance of the FWVs in the working
situations.
The number of clients who were reported to seek services from the clinics was seen to
vary substantially by type of services. The average numbers clients asking for general
treatment was 868 followed by ANC 133.
An enquiry was made to know the extent of awareness among the FWVs about the type
of materials employed to motivate mothers in receiving services from the clinics. As
reported by the respondents, the most important material was the flip chart being
reported by 84.4% of the respondents. This was followed by posters (83.0%), sample of
FP methods (70.7%), IUD model and ANC manual (70.1%).
On a query to whether the service providers hold joint meetings with the field level
workers and the clients, 93% of the FWVs provided affirmative answers. Further
investigations revealed that the meetings are arranged on strengthening MCH services
(28.8%), ante-natal care (30.1%), and services to deal with adolescent problems
(10.3%), family planning program (23.5%) and to deal with issues on general treatment
What were the subjects of discussion in the aforesaid meetings? In response to this
query, over 80% of the respondents mentioned issues related to antenatal care were
discussed. More than three out of every four respondents said that the discussion was
on health of the adolescents and new born babies. These were followed by the
discussion on family planning (68.5%) and maternal and child health (50%). Nutrition
and services in satellite clinics recev4ed the least priority being mentioned by 22.6% and
11% of the respondents.
On a query to the type of registers maintained in the center to provide services to the
clients and the patients, as many as a dozen of registers was mentioned by the
respondents. It is noted with satisfaction that in almost over 90% of the cases, these
registers were reported to be maintained in the center. These include among others,
register to maintain pregnancy records (97.5%), ANC registers (94.3%), and PNC
registers (93.6%), child care (94.6%), general treatment (93.6%). It was learned that the
monthly reports are sent to UHC in 90% of the cases on the 30th of every month.
Training requirement
The extent of additional short-term training required was reported to be of very low
magnitude. For example, only 12.9% of the respondents felt that they require training on
inserting copper -T. Training on MR is required by only 18.8% and training on IUD
insertion is required by 19.7%.
Follow-up of the clients was reported be universal, about 97% of the cases the follow-up
visits are made. In doing so, satellite clinics are used as means in more than 67% of the
cases. FWAs are used as a means in 44.7% of the cases followed by neighbors
((44.1%) as means. FWVs showed their inadequate performances in respect of record
keeping (34.4%) and accommodation problem (44.4%).
The knowledge of the respondents on the training module was assessed through
unprompted as well as prompted questioning. Prompting procedure could only
moderately increase the knowledge of the respondents. Unprompted knowledge was the
highest in the case of skill checklist (98.8%) which increased 100 after prompting was
done. Next was the anatomy, physiology, pharmacology and microbiology (93.0%) which
increased also to100 after prompting was done followed by safe motherhood, delivery
care, newborn care and PNC (89.8%), which increased to.100 after prompting.
In response to a query on the type of training received on antenatal care, the
respondents provided several answers which were judged for their correctness in the
light of the module answers. Here too, both unprompted followed by prompted answers
were recorded in the case the respondents fails to answer spontaneously. As we can
see although prompting procedure led to substantial increase in the knowledge, yet
there remains a significant gap of about 2 to about 5 to bring the knowledge in many
instances to universality. In 90% of the cases, the unprompted knowledge remains in the
neighborhood of 80%. Knowledge on PNC, even after prompting, it seldom reaches 90%
leaving a wide gap from 100, as it should have been. Unprompted knowledge in almost
all cases is about 90% and the prompting procedure raises the knowledge to
universality.
To meet objective three, problems in performing FWVs job in actual field situation
has been discussed in the following ways.
A query to know the field level problems, it was revealed that in most cases they (FWVs)
are able to do the same performance neighborhood 90%, except problem to get Medical
Surgarical Requisite (MSR) (43.3%), Record keeping and record generation (34.4%).
Accommodation problem ( 44.4%) and problem in applying training knowledge in
practical field (28.7%).
The respondents were asked about the problems they encountered in providing services
to the clients or to run the program as per their scope of work. A little more than 19% of
the respondents reported problems related to ANC. Of these, 56.5% were not happy
with the ANC related services and hence they were in the opinion that ANC service
should be improved. About 20% complaint of not getting adequate services. Only a little
more than 7% did not encounter any problem.
Problems on delivery issues were encountered by about 20% of the respondents.
Among them 59% mentioned about insufficient instruments. Another 28% were unhappy
on clinic facilities. Problems of PNC, lack of new born care facilities, problems on
adolescents, problems of record keeping, clinic management, providing medicine and a
few more problems were mentioned by the respondents.
It can be noted that Strengths and weaknesses of the program is one of the vital
objective (objective four) and moreover, obtain suggestions from FWVs for further
improvement of basic training.
Opinions on the facilities while providing training were assessed through five categorical
responses in qualitative terms. The opinion was sought on sitting arrangement in terms
of the responses ‘very good’, ‘good’, ‘almost good’, ‘not good’, ‘not at all good’ in the
class room, materials supplied in the class room in terms of the responses ‘enough’,
‘almost enough, ‘almost’, ‘not enough’, ’not at all enough’ and so on. The query also
made on method of training, quality of training, duration of training, usefulness of the
training, hostel arrangement and many others.
It can be focused that nearly 40%–50% of the respondents were on the opinion that
most of the arrangements were highly satisfactory. On average, 5–10% expressed their
dissatisfaction on the arrangement. The weakest side of the training was that the training
was unrelated to their job, which was mentioned by about 6% of the respondents, while
41.4% of them found the training consistent with their current job. An equal proportion
disclosed that the training manual was not useful at all. On the contrary, 42% found the
manual very helpful for them. About 5% of the respondents were dissatisfied with their
training allowances while 52.2% expressed their utmost satisfaction on the training
allowances.
The practical training on child health care was extremely unsatisfactory
being reported by 43% of the respondents.
An investigation was made to ascertain the different aspects of the training course,
These include, among others, curriculum, trainer, duration of training, training
allowances, practical training, training at field level, accommodation, food, behavior of
the trainer and supporting and staff. About 62% of the respondents did not have any
comment on the curriculum. About 23% felt that the curriculum was sufficiently large.
Need for more trainers was mentioned by 15% of the respondents. That the duration of
the training should be increased was mentioned by 26% of the respondents. More than
half of the respondents were in favor of enhancing the training allowances. Need for
practical raining was felt by 27% of the respondents. About an equal proportion of the
respondents wanted field level training. Nearly 20% respondents felt scarcity of
accommodation. Suggestions came from 37% of the respondents to take care of food
quality. About the behavior of the trainers and support staff, 58% of the respondents
passed no comment.
Recommendations

The study indicated that nearly one-third of the FWVs felt the need for practical
and field level training. This suggests that the duration of hands on training was
inadequate. It is recommended that duration of hands on training should be
increased.

Training on eleven modules was provided in 18 months duration. The lectures on
these modules were supposed to be given by highly skilled resource persons.
However, some institutions failed to engage highly skilled resource persons. It is
recommended that more skilled persons should be engaged to provide
professional training.

Most of the trainers reported that the training was lecture-based but this sort of
training should be participatory as well as field based. Group basis training with
20 participants were also questioned in the interest of the program. It is
recommended that training module should include both theoretical and practical
issues. The current size of the group should be reduced.

In some training centers, the authority of the center failed to provide sufficient
training materials in due time. It is recommended that sufficient training materials
should be provided to the participants in due time for the betterment of the
training.

Most of the FWVs felt that they need some refresher and mid-term training on
various issues that will enhance their professional skills. It is recommended that
refresher training on MR, IUD Copper T and midwifery can be arranged to
enhance the skill of the newly trained FWVs. It is also recommended that as per
the desire of the FWVs the above mentioned refresher training should be
provided on short term basis.
CHAPTER
1
Introduction
1.1 Background
Bangladesh Family Planning Program has made remarkable progress over the last forty
years (after independent) due to continuous political commitment, innovative program
approach, government non-government and development partners collaboration, strong
IEC program, method-mix cafeteria approach and commitment of the field-level
functionaries. Bangladesh played an extremely important role in the formulation of
International Conference on Population and Development ’94 (ICPD’94) Program of
Action. Over the last ten years following the ICPD, Bangladesh has achieved
commendable success in improving the reproductive health status of the people.
However, despite progress Bangladesh is facing challenges like, high maternal and child
mortality and morbidity, inadequate adolescent health care, threat of HIV/AIDS,
migration towards cities, aging, drug abuse, inadequate nutrition intake, poverty, less
accessibility of health facilities, low quality health care and unplanned urbanization etc..
On the other hand, the government of Bangladesh has already taken necessary steps to
overcome the problems and trying hard to translate its commitment into a reality.
The public health sector policies in Bangladesh have undergone substantial change and
rethinking in the recent times. In 1978, the WHO-UNICEF International Conference on
Primary Health Care (PHC) at Alma-Ata adopted a comprehensive global strategy to
achieve ‘Health for All by the Year 2000’. Maternal and Child Health care (MCH) was
seen as one of the essential components of PHC. As part of this strategy, the
Government of Bangladesh (GoB) has subscribed to the overall objectives of ‘Health for
All’. It has agreed, in principle, to pursue a policy for providing essential minimum health
care to all citizens, particularly to those who are under privileged and under served
(mostly women, living in the rural areas of Bangladesh). During the last Fourth Five Year
Plan (FFYP) period (1990-91 through 1994-95), the health and family planning
programme has achieved some progress in reaching the most vulnerable groups of the
country's population, i.e. mother and children. After the expiry of the FFYP’s population
and health programme, the Ministry of Health and Family Welfare (MOH&FW)
formulated the ‘Health and Population Sector Programme (HPSP)’ in June 1998. The
HPSP became operational in July 1998 for a period of five years with the goal of
achieving “improved health and family welfare status of the people of Bangladesh in
general, and the most vulnerable women and children in particular”. Its primary focus is
to ensure “client-centred provisions and client utilisation of an Essential Services
Package (ESP) and associated health services”. Inorder to ensure the quality of, and
universal access to health care at the community level, the services, under the ESP
system, will be provided from a permanent centre called the ‘Community Clinic’ (this is a
significant shift from the existing domiciliary-based service delivery system). In view of
the above changes and development in the country’s health policies, the role and
significance of the appropriately trained health personnel, especially those engaged in
field or community level service delivery, have moved centre stage. For successful
operation and management of the Community Clinics, for example, the role of Family
Welfare Visitors (FWVs) – the premier health service providers at the local community
level – is vital. They are assigned to attend each Community Clinic on a regular basis
and to (rotationally) supervise the activities of other health staff (such as the Health
Assistants). This study, therefore, focuses on the existing institutional training
arrangements for the FWVs as principal community level public health workers in the
country. The main purpose of the study is to examine the effectiveness of FWVs basic
training in the light of their (FWVs) knowledge, skill, practice, performance in order to
indentify the gap in the training curriculum and process and also identify the needs for
refresher training as a horestic approach.
1.2 Review of Literature
Such type of curriculum based evaluation is few and far between the applied and
academic research in Bangladesh. The following section will verify the existing status of
these follow up study position of the nation.
At first, it could be said that virtually no major study exists on the training of the FWVs in
this country. The quantity and quality of research on the general state of education
sector are poor in context of Bangladesh. Academic research is also very limited.
Ashraf et al. (1997) found wide regional variation in the performance of the Bangladesh
Family Planning Programme. The knowledge and skills of the service providers is one of
the important factors for improved performance. When a refresher course was
undertaken at Mirsarai Thana an appreciable gain in the knowledge of trainees has
occurred. The project experience showed that with very little input a training program
can be organised at the local tevel. There is a need to organise a group of trainers which
could contribute to the establishment and institutionalisation of a system of on-the-job
training for the workers in the national programme, and would also ease the problem of
conducting any short training at the local level.
Sultana, sabir and Bhadra have briefly account the training needs assessment for the
health personnel at the local level.
Hussain et. al. have reported that the performance of the FWVs in the area of ante-natal
and post-natal care. The study has focused significant improvement found in grassroot
level of health center.
Nessa and BRAC also showed that the FWVs had very low level of performance in
record keeping as well as utilising institutional facilities and management of equipment
and supplies. The role of the FWVs, especially in the welfare of mother and children in
rural Bangladesh is very significant. Notwithstanding their role, however, the training
services for the FWVs have remained inadequate and poor in general.
Baqee and Koblinsky reported that FWVs were neither trained appropriately in their
basic training nor they received routine in-service training to maintain a standard for all
their services. Besides, a recent research based on the reports provided by the
concerned health personnel has found that FWVs’ training to be inadequate and this led
to the limited performance. In context of the government’s newly introduced ‘Health and
Population Sector Programme (HPSP)’ strategy, Khuda et. al. (1997) have suggested
that the service providers (FWVs) need to be retrained to perform all their current job
requirements.
Mridha and khan sheds light on the nature, design and provision of institutional services
for providing training to the premier community health service providers in the public
sector (i.e. the Family Welfare Visitors or FWVs) in Bangladesh. The findings suggest
that there is a broad agreement among the trainers and managers of concerned training
institutes about the general inadequacy of the existing training programmes for the
FWVs.
Shamsuddin et al. (1994) showed that during supervisory visits, they checked the
attendance registers as to whether the workers performed their duties, examined and
signed the FWV registers, observed the methods of disinfecting equipment, checked
whether FWVs provided MCH-FP services to clients at FWCs and satellite clinics, observed
the management of satellite clinic, visited EPI camps and verified data, etc. (Shamsuddin et
al. 1994).
A majority of them were exposed to basic training as well as in-service training and opined
that training helped them in performing their jobs (Mabud et al. 1988). A majority of them
(FWVs) reported that their training and skills in these areas were marginal.
1.3 Rationale
The above literature review has clearly identified that the gap in the basic training on
curriculum and refresher training of the FWVs. It has found that basic training is quite
helpful in performing their tasks but it has found that some FWVs have not clear
knowledge in their assigned job. Moreover, FWVs performance was not found
satisfactory in their working place.
Literature review also revealed that the FWVs in-service training/ refresher training
application is quite poor. They said that basic training did not developed properly for
FWCs level and they need refresher training in different sector as stated in curriculum.
Now the need the training in the job oriented sector mostly. So the present study
attempts to find out the training gap of the FWVs in FWCs for their development of
knowledge, skill, performances and practices in working sectors. So the finding of the
study will find out the needs in planning, direction and implementation of training on the
basis of curriculum. On the basis of upcoming findings NIPORT can prepare workable
curriculum for the FWVs.
1.4 Objectives of the study
The general objective of the study is to assess the effectiveness of FWV basic training in
providing services at facility and outside facility level in terms of their knowledge, skills
and performance in order to identify the gap in the training curriculum and process and
also identify needs for refresher training.
The specific objectives of the study are:
1. Ascertain the current knowledge of FWV in providing RH-FP services;
2. Examine the performances of FWVs in the working situation (observe how they
utilized their knowledge and skills received through training, number of clients
served in the last one month);
3. Identify the problems in performing their job in actual field situation;
4. Determine strength and weak areas of basic training and obtain suggestions from
FWVs for further improvement of basic training program;
5. Identify needs for refresher training and revising the basic training.
CHAPTER
2
Methodology
2.1 Study Design and Source of Data
The study followed a cross sectional design to obtain information from primary, and
secondary sources. The primary sources included the sample population from FWVs and
service recipient (exit client). The secondary sources included reports, journals and service
statistics.
2.2 Target Population
All the program managers (principals of FWVTIs, UFPOs, MO (MCH_FP), MO (Clinic)),
service providers and eligible service recipient (exit client) of the FWVs working at union
levels FWCs constituted the universe of target population.
2.3 Sample size
The following statistical formula was used in deciding the minimum sample size for each
stratum.
nh 
N h z 2 p(1  p)
N h d 2  z 2 p(1  p)
where, nh is the required sample size of hth stratum
N h is the h th stratum size
z is value of standardized normal variate
p is the estimated proportion of retention of knowledge on the training
components
Considering, z  1.96 , p  0.5 , d  0.11 , the minimum estimated sample size of each
stratum is given in the following table.
Table 2.1: Minimum sample size required by stratum
Sl. No.
FWVTI
Stratum size
( Nh )
Sample
assigned
( nh )
Sample to
interviewed
1
Comilla
73
38
31
2
Kushtia
73
38
28
3
Ragamati
75
39
27
4
Dinajpur
75
39
29
5
Bogra
75
39
35
6
Tangail
74
38
36
7
Rajshahi
87
42
38
8
Khulna
71
37
29
9
Barisal
73
38
32
10
Sylhet
25
18
14
11
Faridpur
73
38
31
12
Dhaka
66
36
29
840
440
360
Total
As shown in Table 2.1, about 440 FWVs who received basic training from 12
FWVTI’s were selected and for this purpose, a separate list was prepared for each of
the FWVTIs. However, 360 FWVs were successfully interviewed. The overall precision
level, viz. the value of d, dictated by the total sample size comes out to be 3.9%. The
computation of this marginal level of error is based on the following formula:
d
z 2 p1  p N  n 
Nn
The sample size by individual stratum dictates much lower level of precision in terms of
the d value compared to the overall precision. However, such a low level of precision is
highly unlikely to yield valid estimates of the population parameters of interest. It is also
true that we are seldom interested to provide estimates by individual stratum unless
otherwise asked for. Despite all these limitations, the estimates presented in the report
appear to be reasonably acceptable when compared with other independent estimates
of similar nature found elsewhere in Bangladesh. Taking into consideration of the
smallness of the sample size and given the time and resource constraints, the consultant
took every care of the study beginning from its initial stage to the end of the study on
issues pertaining to the recruitment of the field personnel, their training, data collection,
field supervision, monitoring and data analysis so as to make the study reasonably
representative. Even if we are interested in the individual level estimates, we can
consider our estimates based on our small samples to be comparable with the overall
(combined) estimates under certain assumptions of population composition of the
country with respect the socio-economic and demographic behavior. These
characteristics, by and large appear to be uniform and hence smallness of the sample is
likely to play trivial role in the validity of the estimates at the individual stratum level.
2.4 Sampling Procedure
Stratified random sampling technique was applied to select the FWVs. At the beginning, a
list of the trainee FWV was prepared for each FWVTI. From the list required number of
FWVs was selected by simple random sampling technique.
Table 2.2: Distribution of sample by types
Sl. No.
Categories of Sample
1.
2.
FWVTI
Program Manager-
3.
Principals of FWVTIs
UFPO
MO (MCH-FP)
MO (Clinic)
FWV
4.
Eligible
women
(Service
recipient of FWVs)Exit client
5.
FWV for observation
Number of
sample unit
12
12
440
Remarks
All the FWVTIs
One from each FWVTI
All of the selected upazilla
All of the selected upazilla
All of the selected upazilla
One from each selected FWC
Two of each selected FWVs
24
-
2.5 Study Instruments
The following instruments were used to collect data from the respondents:
 Interview questionnaire for - FWVs
 Interview questionnaire for service recipients
 Observation checklist
 KII guideline
All the instruments were developed with the help of training materials of different survey
and other relevant materials, available reports, service records, service providing manuals,
journals etc. related to field level service provision and consultation with resource persons
in NIPORT and DGFP.
To assess the adequacy, the draft instruments were pre-tested in the non-sampling
areas and necessary modifications (that were identified during pre-testing) were done
before using the instruments in the field.
2.6 Training of Field Data Collectors
All the Supervisors, Quality Control Officers and Investigators of the study have
undergone training by the research team of ARTCOP in order to collect reliable data.
The major contents of this training focused on different issues of the questionnaires
which covered the job description of FWVs, components of the basic training of FWV,
role and responsibilities of FWVs , study objectives, methodology and implementation
process. Some practical sessions were included in the training contents to provide
hands on training in data collection.
2.7 Data Collection
The data of the study were collected using in-depth interview, Semi-structured
questionnaire and observation checklist.
2.8 Data Analysis
The editing and coding of the collected data were done in ARTCOP by the research team
and then data were entered into the database of the computer. Necessary measures were
taken at the data entry level to protect wrong entry or double entry. The SPSS software
was used for data analysis.
Finally, tabulation was done according to the objectives of the study for preparation of
report where both the uni-variate and bi-variate tables were accomplished.
2.9 Quality Control
Quality control is the vital part of quality research. Quality control was ensured in the
following stages:
i)
ii)
iii)
iv)
v)
vi)
vii)
Identification of the variables and it’s moderation
Develop standardized pre-tested questionnaire instrument
Recruitment of interviewer and training and trained them accordingly
Field data collection and scrutinize the data properly
Field data verification and data entry
Range check and consistency check of collected data/information
Analyze the data as per objective and methodology.
For the detail presentation, it could be said that quality control is essential to ensure
soundness and correctness of collected information or data. In the present study, quality
control was considered continuously during the field operation. Field supervisors of the
study ensured the proper use of instruments, recording and editing of the field data. The
team leader, the associate team leader and the research associates/officers frequently
visited the field to support the supervisor’s and investigator’s in overcoming technical
problems related to the study methods and instruments or any problems related with
management.
More specific quality control measures were taken to remind field investigators to remain
neutral and passive; to question, prompt and facilitate in-depth conversational
atmosphere during interview. Rapport was developed between interviewers and
interviewees for quality data. They also rechecked missing information items.
Finally, quality control measures were taken during the data processing stages as
consistency check. Data management activities included editing, verification, coding
verification, computer data entry verification and cleaning of the data for smoothness of
higher quality analysis.
2.10 Implementation Strategy
The study was implemented in three stages. In the first stage recruitment and training of
field personnel were done while the second stage is concerned with data collection and
processing and the third stage was consisted of data analysis and report writing. In
between the personnel recruitment and the report writing at least three review committee
meeting were held for finalization of instruments, analysis plan and approval of draft
report.
2.11 Manpower for the Survey
The respondents of the study were widely scattered. So for completion of the fieldwork
within the stipulated time, adequate number of field personnel need to be deployed.
We deploy 10 teams for data collection. Each team is constituted with two female
interviewers and one male supervisor.
All field staffs were recruited as well as trained for data collection. They were supervised
by appropriate project staff at field and central levels. There were Co-ordinator, Quality
control officer and ARTCOP professional group for monitoring and quality control.
2.12 Recruitment
All the field personnel were recruited and appointed temporarily. The recruitment
followed the following procedure:
 All the field posts were advertised and be circulated to different institutes & NGOs;
 Selection was made on the basis of oral tests ;
 The requirement for different categories of field staff was as follows:
Name of Post
Minimum Qualification
1. Field Co-ordinator
Masters
geography
2. Field Supervisors
Master in Social Science
2 years experience in survey work
3. Field Investigator
Graduate
Experienced

degree
Experience
in
3 years experience in research work
Provisions for selecting one team of reserve field investigator was made to meet the requirements
incase of dropouts.
CHAPTER
3
Knowledge
3.1 Current Knowledge of the FWVs in providing RH–FP services
In an attempt to ascertain the knowledge on the reproductive and family planning related
services, the Family Welfare Visitors (FWV) were asked if they were aware of the tasks
in relation to the following services:




Antenatal services
Care during delivery
Post natal care, and
Pubertal care (Adolescent care)
Knowledge on antenatal care services, by and large was nearly satisfactory. More than
94% of the FWVs were found to possess knowledge on the fact that recording case
history is mandatory that has to be accomplished when a pregnant women desire
antenatal services. Performing clinical test, examining pulse, measuring temperature,
checking blood pressure, imparting nutrition education, providing TT etc should be
accomplished––were endorsed by 80% to 85% of the FWVs. The extent of knowledge
that the respondents were reported to possess is shown in Table 3.1.
Table 3.1: Distribution of the FWVs by their knowledge on the tasks
related to ANC
Item
Case History
Clinical test
Pulse
Temperature
Respiratory
Test for Anemia
Measuring BP
Abdomen Examination
Test for edema
Examination of urine sugar albumin
Fetal Heart Sound
Follow-up
Nutrition education
TT
Other
N
Average response
%
94.3
85.4
84.1
80.3
79
81.5
75.8
73.9
72.0
73.2
82.8
85.4
82.2
0.6
360
11.2
Multiple responses
The knowledge of the FWVs about the tasks to be performed during delivery was
assessed and their answers were checked against a few selected items of activities
pertinent to safe delivery. The respondents agreed in about 88% cases that their primary
task is to advise on safe delivery. They are also well aware that they are in obligation to
ensure safe delivery. This was endorsed by about 76% of the FWVs. In case of any
emergency arising out of complications related to pregnancy or delivery, they are
supposed to refer the cases elsewhere for improved treatment and management. This
was honestly felt by 48% of the FWVs. The responses related to these queries are
displayed in Table 3.2.
The possession of extent of knowledge of the FWVs on the post natal care was also
assessed in terms of a few related items or activities, a list of which appears in Table
3.3. As we can observe, cleanliness, and advice to breast-feeding at birth received the
top priority among the PNC services being indicated by 86.5% of the FWVs in both
cases. The respondents were also aware of the fact that the new born infant should be
wrapped with dry cloth, which was mentioned by more than 80% of the FWVs. The
others were such issues as ‘examining the new born’ (77.7%), ‘visiting the baby’
(75.8%), ‘referring’ (82.2%), ‘advice on food supplementation’ (75.2%), ‘providing
nutritious food’ (77.7%) and ‘advice to preserve child’s health card’ (76.4%).
Table 3.2: Distribution of the FWVs by their knowledge on the tasks related
to delivery
Item
Advise on safe delivery
Conduct delivery
Refer complicated case
Other
N
Average response
%
87.9
75.8
77.7
4.5
360
2.4
Multiple responses
Table 3.3: Distribution of responses by their knowledge regarding task
about PNC
Item
Cleanliness
Rapping with dry cloth
Advice to breast feeding at birth
Examine new born baby
Advice to Vaccination
Visit
Refer
Advise on food supplementation
Advise on Cleaning
Nutritive food
Advise to preserve health card of child
Other
N
Average response
%
86.6
80.3
86.6
77.7
68.8
75.8
82.2
75.2
83.4
77.7
76.4
0.6
360
2.4
Multiple responses
It is also recognized that the FWVs have some additional responsibilities to perform to
promote the health care facilities for the adolescents and consequently about their
reproductive health issues. How much they are aware of their responsibilities on this?
More than 83% of the FWVs are aware that they are supposed to educate the
adolescents on reproductive health. That nutrition and health education are also two
important issues for them is known to about 80% and 87% of the FWVs respectively.
They are further to motivate the adolescents to defer their marriage until they reach at
least to legal age at marriage and delay pregnancy when married.
Table 3.4 Distribution of responses by their knowledge regarding task
about adolescent
Item
Reproductive health education
Nutrition education
Adolescent health education
Delay marriage pungency
Other
Average response
%
83.4
79.6
87.3
65.0
3.1
Multiple responses
The knowledge of the FWVs on the type of services they are supposed to provide to
promote family planning program was assessed through simply asking them the type of
job they perform. A substantial proportion of the respondents knew the type of job they
are supposed to perform. On an average, about three-fourths of the respondents provide
such services as motivating the eligible couples for accepting family planning methods
(80.3%), encouraging adopting permanent method (82.8%), counseling (74.4%), helping
physicians in their endeavor to provide permanent method (77.1%), advising clients for
follow-up visits (75.8%) and the like. The responses are shown in Table 3.5.
Table3.5 Distributions of responses by their knowledge regarding task
about Family Planning, Satellite Clinic service and other services
Items
Encourage couple
Counseling
Screening
Management of side effect Refer
Help to provide Implanon
Incourage for permanent method
Help physician to provide permanent method
Advise client for follow-up
Method distribution
Other
N
Average response
IUD
Encourage
Counseling
Screening
Insertion
Management for side effect
Refer for complication
N
Average response
Injection
Encourage
Counseling
Screening
Insertion
Management for side effect
Refer for complication
N
Average
Pill
Encourage
Counseling
Screening
Management for side effect
Refer for complication
N
Average response
Condom
Encourage
Counseling
Other
N
Average response
Multiple responses
%
80.3
74.4
76.4
72.0
73.2
70.7
82.8
77.1
75.8
68.8
8.3
360
7.4
83.4
79.0
84.1
82.2
78.3
69.4
360
4.7
84.1
78.3
86.0
82.2
84.7
73.2
360
4.8
81.5
79.0
84.7
79.6
65.6
360
3.9
92.4
87.3
1.9
360
1.7
The acceptance of IUD, injection, pill and condom as some methods of contraception
depends on several factors. These include, among others, motivation, counseling,
couple screening, administering, management of side effect, and referring cases in case
of complications. These activities were observed to be known to the FWVs at least in
80% of the cases.
For example, that couple screening is a necessary step before administering injection is
known to about 84% of the respondents. This is followed by ‘encouraging the clients’,
being mentioned by 83.4% of the respondents. These factors have received almost
equal importance and attention, as can be seen from a close examination of the
responses furnished in the table under reference. Use of condom also needs motivation,
encouragement, and counseling. The FWVs are well aware of their responsibilities in
regard to these issues. This feeling is substantiated by the findings of the study. For
example, over 92% of the FWVs felt that encouragement to adopt condom is a necessity
precondition for its promotion. For general treatment too, the FWVs’ role is of crucial
importance. This feeling is held by more than 98% of the respondents. In case of
complications encountered by the general patients, the referral gets priority to the FWVs
in 77% of the cases, (Table 3.6).
Table 3.6 Distributions of responses by their knowledge regarding task
about, General Treatment services
Items
Provide service
Refer for complication
%
98.1
77.1
Multiple responses
The FWVs are required to attend two days a week satellite clinics to provide services
related to MCH and family planning to the clients. All the selected FWVs were asked if
they are aware of the services provided from these clinics. MCH related services
include, among others, anti-natal care (ANC), postnatal care (PNC), nursing under-5
children, and treatment of general patients. As the results in Table 3.7 reveal, the
awareness was highly satisfactory as in most cases, 87% to 89% FVWs could recall
these services. Knowledge on the family planning services provided from the satellite
clinics was also significantly high. That oral pills are distributed from the satellite clinics is
known to 90.4% of the respondents, followed by injection being known by 88.5% of the
respondents. Knowledge on condom and IUD was also reasonably high being
mentioned by 87.3% and 79.6% of the respondents respectively. Satellite clinics do
provide also nutrition education, reproductive health education ARH, and treatment of
RTI/STI. The average positive response was close to 75% in regard to these services
(see Table 3.7). A scoring system was developed to measure the extent of knowledge
on the services. Based on these scores it was noted that the FWVs were 17% more
likely to have knowledge on the family planning services than their knowledge on the
MCH services provided from the satellite clinics.
Table 3.7 Distributions of responses by their knowledge regarding task
about, Satellite Clinic service
Items
MCH
ANC
PNC
Care of children (0-5)
General patient
Other
N
Average response
Family planning
Pill
Condom
Injection
IUD
Encourage for permanent methods and Implanon
Other
N
Average response
Other
Nutrition education
Reductive Health education
ARH
Treatment of RTI/STI
Refer complicated patient
Site selection
Prepare work plan
N
Average response
%
89.2
90.4
86.6
87.3
1.3
0.6
360
3.5
90.4
87.3
88.5
79.6
19.1
0.6
360
4.1
79.0
71.3
79.6
67.5
84.7
71.3
46.5
360
2.9
Multiple responses
In matters related to logistics and supply, certain activities are involved and these are
expected to be known to the FWVs. In line with this expectation, it was reveled from the
queries that in need, they send list of requirements to the UFPO. This is endorsed by
about 81% of the respondents. More than 71 % of the respondents admitted that
collecting medicine from the stores and recording the same in the stock registers also
falls in their duty list. About 62% of the respondents could identify that they are also
required to isolate the expired medicine from the others.
Table 3.8: Distributions of responses by their knowledge regarding task
about Logistics and Supply
Send requirement to UFPO
Collect medicine from store of upazilla and
upto date stock
Separate expired medicine
N
Average response
80.9
71.3
61.8
360
0.84
Multiple responses
Record keeping and preparation of performance report is an integral component of the
FWVs. The FWVs do the job of record keeping in 80% of the cases. They also maintain
updating the reports in more than 70% of the cases. Updating the list of pregnant
mothers and preparation of monthly reports on MCHFP are also done by the FWVs in
about 70% cases. The results of this investigation are presented in Table 3.9.
Table 3.9 Distributions of responses by their knowledge regarding task
about, Record Keeping and reporting
Fill up all records
UP to date4 all registers
Up to date the list of pregnant mothers
Prepare monthly report on MCH-FP
80.3
70.1
77.7
73.9
N
Average response
360
1.2
Multiple responses
How much importance do the FWVs attach to providing reproductive health and family
planning services? The feedback of this question was sought in terms of the services
related to the ANC, MCH, FP and nutrition education. As the data in Table 3.10 dictate,
overall, nearly one third of the respondents were found to give most attention to the
services pertaining to ANC, MCH and FP. A little more than 62% pay normal attention in
providing ANC services, 56% in MCH, 59.2% in FP and 56% in nutrition education. The
related responses are shown in Table 3.10.
Table 3.10 Distribution of respondents according to importance given in
providing RH- FP services
Service
ANC
MCH
FP
Nutrition
N
Normal
62.4
58.0
59.2
56.1
––
Level of attention
More than normal
5.1
10.5
10.2
19.7
–
Most attention
32.5
31.2
30.6
24.2
–
100
100
100
100
360
3.2 Performance of the FWVs in the working situations
The clients who were reported to seek services from the clinics were seen to vary in
number substantially by type of services. The average number of clients asking for
general treatment was 868 followed by ANC 133. Adolescents were the next category of
clients being 100 in number on the average. The results of this investigation are
displayed in Table 3.11
Table 3.11: Distribution clients received services last two months from the center
Service
1. ANC
2. Delivery
3. PNC
4. <1 year children
5. 1-5 years
6. Pill
7. Condom
8. Injection
9. IUD
10. Care of infants
11. Management
RTI/STI
12. Adolescent health
13.General treatment
14. ECP
Other
N
Provide service in the last two months
Not at all
Minimum
Maximum
3.8
2
8037
48.4
1
200
23.6
1
500
6.4
2
500
2.5
3
650
4.5
3
860
10.8
1
420
7.6
1
441
45.2
1
77
60.5
1
200
of
45.2
1
1400
53.5
5.7
98.1
100.0
1
37
1
-
1669
2500
60
-
Mean
132.7
18.1
39.9
58.4
130.8
63.9
27.8
57.3
10.6
23.3
43.0
Std
653.2
30.1
72.1
62.5
118.9
90.2
61.6
64.1
15.4
31.4
151.0
99.9
867.8
33.7
-
173.0
586.1
30.0
360
An enquiry was made to know the extent of awareness prevailing among the FWVs
about the type of materials employed to motivate mothers in receiving services from the
clinics. As reported by the respondents, the most important material was the flip chart
being reported by 84.4% of the respondents. This was followed by posters (83.0%),
sample of FP methods (70.7%), IUD model (70.1%), IUD manual (63.9%) and ANC
manual (70.1%). Table 3.11 shows these responses.
Table 3.12: Distributions of respondents by type of materials used to
encourage mothers
1. Material
1. Flip char
2. IUD model
3. IUD manual
4. ANC manual
5. Poster
6. Sample of FP method
7. Sample of ORS
8. Flash chart
9. Growth chart
10. 10
11. Nothing
N
%
84.4
70.1
63.9
70.1
83.0
70.7
53.1
47.6
39.5
36.7
6.4
360
Multiple responses
More than 80% of the FWVs assessed that the local people are fully knowledgeable
about the type of services provided from the centers. The remaining 20% believe that
the local people have moderate knowledge about the services provided from the
centers. The responses are shown in Table 3.13.
Table 3.13: Distributions of respondents regarding knowledge of
community people about the services of the center
Knowledge
Completely
Moderately
Total
N
%
80.3
19.7
100.0
360
On a query to whether the service providers hold joint meetings with the field level
workers and the clients, 93% of the FWVs provided affirmative answers to this query.
Further investigations revealed that the meetings are arranged on strengthening MCH
services (28.8%), ant-natal care (30.1%), and services to deal with adolescent problems
(10.3%), family planning program (23.5%) and to deal with issues on general treatment.
The numbers of meeting organized by type of services are shown in the accompanying
table (Table 3.14).
Table 3.14: Percentage distribution of number of meetings by type of
services
Number
meetings
1
2
3
4
5
6
7
8+
Average
of
MCH
ANC
38.1
35.7
0
2.4
2.4
0
2.4
19.0
1.5
27.3
43.2
2.3
6.8
0
4.5
2.3
13.6
3.0
Adolescent
problems
33.3
46.6
0
6.7
0
6.7
0
6.7
2.0
Family planning
Others
47.1
26.6
0
2.9
0
0
0
23.5
3.5
37.5
25.0
12.5
0
0
0
0
25.0
3.2
The average number of meetings organized on family planning was the highest (3.5)
followed by general issues (3.25) and ANC (3.0). Organizing one to two meetings were
the most frequently cited for all categories of the services accounting for about threefourths of all meetings on MCH, ANC, FP and on general treatment.
Our observations reveal that the meetings in many occasions could not be organized for
one reason or others. The respondents were asked to indicate the reasons for being
failed to organize the meetings. Over 27% of the respondents could not say any definite
reason for such failure. About an equal proportion mentioned inadequate drink/lack of
opportunity as a reason for not holding the meeting. Bad communication and lack of
opportunity were also cited to be two more reasons for the failure, which was mentioned
by 18.2% of the respondents.
Table 3.15 Distributions of respondents by reasons for which they failed to
conduct meetings
Reason
1.Without reasons
2. Inadequate drink
3. Bad communication
4. Lake of opportunity
Multiple responses
%
27.3
27.3
18.2
18.2
During the last two months prior to the survey, how many meetings could be organized?
In response to this query, nearly 51% of the respondents said that less than 5 meetings
were organized. That 16 to 20 meetings were organized was mentioned by over half of
the respondents. Table 3.16 displays the distribution of meeting organized in last two
month’s period. The average number of meetings was computed to be 2.93.
Table 3.16 Distribution of respondents according to number of meetings
conducted during last two months
1<5
6-10
11-15
16-20
20+
%
44.7
29.0
14.7
50.9
5.6
Mean: 2.93
What were the subjects of discussion in the aforesaid meetings? In response to this
query, over 80% of the respondents mentioned issues related to antenatal care that
were discussed. More than three out of every four respondents said that the discussion
was on health of the adolescents and new born babies. These were followed by the
discussion on family planning (68.5%) and maternal and child health (50%). Issues
related to nutrition and services in satellite clinics received the least priority being
mentioned by only 22.6% and 11% respondents. The responses are shown in Table
3.17 below:
Table 3.17 Topics discussed in the meeting during last two months prior to
the survey
Topic
On improving quality of services
On antenatal care
On adolescent health
New borne babies
On family planning
On maternal and child health
On nutrition
On satellite clinic
Percent
28.8
80.2
76.6
75.3
68.5
50.0
22.6
20.0
CHAPTER
4
Performance of the FWVs in the Program
4.1 Introduction
FWVs are regarded as the premier health service providers at the local community level.
It is learned from a number of studies that FWVs had very low level of performance in
record keeping as well as utilizing institutional facilities and management of equipment
and supplies. The role of the FWVs, especially in the welfare of mother and children in
rural Bangladesh is very significant and vital. Notwithstanding their role, however, the
training services for the FWVs have remained inadequate and poor in general.
Available literature review suggests that there is a wide regional variation in the
performance of the Bangladesh Family Planning Program. The knowledge and skills of
the service providers is one of the important factors for improved performance. When a
refresher course was undertaken at Mirersarai Thana an appreciable gain in the
knowledge of trainees has occurred. The project experience showed that with very little
input, a training program can be organized at the local level. There is a need to organize
a group of trainers which could contribute to the establishment and institutionalization of
a system of on-the-job training for the workers in the national program, and would also
ease the problem of conducting any short training at the local level.
One of the objectives of the present investigation was to examine the performance of the
FWVs in activities related to the family planning program. The present chapter is
designed to shed light on the performance of the FWVs
4.2 Sources of Supply of Medicine and Logistic Supports
Upazila Health Complex (UHC) is the major source of supply of medicine and logistic
supports for the center as mentioned by more than 94% of the FWVS. MCH center,
UHFWC and family Planning Officer together provide these facilities only in about 24%
of the cases. These responses are shown in Table 4.1.
Table 4.1: Sources of Supply of Medicine and Logistics
Place
1. UHC
2. MCH centre
3. UHFWC
4. family planning officer
N
%
94.3
12.7
7.6
4.1
360
Multiple responses
4.2 Record keeping
On a query to the type of registers maintained in the center to provide services to the
clients and the patients, as many as a dozen of registers was mentioned by the
respondents. It is noted with satisfaction that in almost over 90% of the cases, these
registers were reported to be maintained in the center with adequate care. These include
among others, register to maintain pregnancy records (97.5%), ANC registers (94.3%),
and PNC registers (93.6%), child care (94.6%), general treatment (93.6%) and the like.
The responses are shown in Table 4.2.
Table 4.2: Type of registers maintained
Type
1. Pregnancy
2. ANC
3. PNC
4. General treatment
5. Child care
6. Visitors register
7. Stock register
8. Condom distributions
9. Pill distributions
10. Inject able register
11. IUD payment
12. M.R register
13. Others
%
97.5
94.3
93.6
94.6
94.9
93.0
91.7
93.6
91.7
88.5
84.1
75.8
49.0
Multiple responses
It was learned that the monthly reports are sent to UHC in 90% of the cases on the 30th
of every month.
Table 4.3: Distribution of respondents by place where send monthly report
Type
1. HUC
2. Not yet send
Total
N
%
90.4
9.6
100.0
360
Table 4.4: Distribution of respondents by place where send monthly report
Type
1.Every month 30th
2. Within 1st day to 5th day
Toal
N
%
87.5
12.5
100.0
360
4.3 Training requirement
The extent of additional short-term training required was reported to be of very low
magnitude. For example, only 12.9% of the respondents felt that they require training on
inserting copper T. Training on MR is required by only 18.8% and training on IUD
insertion is required by 19.7%. The other trainings were of insignificant importance. The
responses are shown in Table 4.5
Table 4.5: Short-term training required
Topic
Copar T
MR
Anatomy
Pharmacology
IUD
Clinic management
Delivery
Nutrition education
Other
Percent
12.9
18.8
9.4
2.6
19.7
5.1
7.7
5.1
2.6
Multiple responses
The mid-term training requirements were also of the same magnitude, the requirement
being varied between 5.1% and 14.5%. The topics on which they require these training
most notably were reported to be on midwifery (14.5%), ANC (17.9%), and IUD insertion
(17.1%).
Table 4.6: Mid-term training required
Topic
Midwifery
ANC
NSV
IUD
Family planning
MCH
ECP
Percent
14.5
14.5
17.9
17.1
11.1
10.3
5.1
Multiple responses
The long-terms training requirements were even lower than the previous two categories
of training, viz. short-term and mid-terms but they have some common elements. Table
4.7 shows these requirements.
Table 4.7: Long-term training required
Topic
Midwifery
ECP
Delivery
Method of Family planning
EOC
NSV
IUD
MCH
Percent
12.0
8.5
7.7
4.3
4.3
9.4
6.8
2.6
Multiple responses
4.4 Follow-up visits
Follow-up of the clients was reported to be universal: in about 97% of the cases the
follow-up visits are made. In doing so, satellite clinics are used as a means in more than
67% of the cases. FWAs are used as a means in 44.7% of the cases followed by
neighbors (44.1%) as means. In case of complexity or appearance of side effect, the
clients/patients are referred to UHC. This was mentioned by 65.6% of the respondents.
In case of any emergency, the patients are also referred to MCWC, as reported by 54%
of the respondents.
Table: 4.8 Distribution of respondents by means applied to follow-up their
clients
Means
Neighbor
FWA
Satellite clinic
Multiple responses
percent
44.1
44.7
67.1
Table: 4.9 Distribution of respondents by their response about where they
refer for complexity/ side effect
Place
MCWC
UHC
Other
percent
53.5
65.6
1.9
Total
100.0
Multiple responses
On a query to whether the respondents can provide services properly and adequately, it
was revealed that in most cases they are able to do so with satisfaction. The table below
shows the extent of the FWVs ability in this regard.
Table: 4.10 Distribution of respondents by their response on whether they
can provide service properly
Served properly
Item
MCH
Satellite clinic
ANC&PNC
Nutrition education
Family planning service
General treatment
Problem to get MSR
Record keeping and report generation
Accommodation problem
Problem in applying training
Knowledge in practical field
Yes
96.2
95.5
94.3
98.7
95.5
94.9
43.3
34.4
44.4
28.7
No
3.8
4.5
5.7
1.3
4.5
5.1
56.7
65.6
55.4
71.3
Total
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
As the responses in the above table dictate, the FWVs showed their inadequate
performances in respect of record keeping (34.4%), accommodation problem (44.4%)
and the like.
CHAPTER
5
Training
5.1 Training related knowledge about the module
The knowledge of the respondents on the training module was assessed through
unprompted as well as prompted questioning. As can be seen from the tabular
responses, prompting procedure could only moderately increase the knowledge of the
respondents. Unprompted knowledge was the highest in the case of skill checklist
(98.8%) which increased100 per cent after prompting was done. Next was the anatomy,
physiology, pharmacology and microbiology (93.0%) which increased also to 100 per
cent after prompting was done followed by safe motherhood, delivery care, newborn
care and PNC (89.8%), which increased to100 per cent after prompting. Table 5.1
shows the results of the detailed investigation on this issue.
Table 5.1: Knowledge on the module training: Unprompted and prompted
Module
1.
Anatomy,
Physiology,
Pharmacology Micro-Biology
2.
Behavior
change,
Communication Gander,
3. Safe mother hood, Delivery
care, New brown care, PNC
4. Family panning
5. RTI/STI HIV/ AIDS Adolescent
RH care
6. Child health care
7. Infection control and Remerging
of new Diseases
8. Limited curative care
9. Clinic management
10. Skill checklist
11. Midwifery
Unprompted
93.0
Response
Prompted Did not respond
7.0
-
Total
100.0
87.9
11.5
0.6
100.0
89.8
10.2
-
100.0
87.3
82.8
12.7
16.6
0.6
100.0
100.0
84.7
77.7
14.6
21.0
0.6
1.3
100.0
100.0
79.6
77.1
98.8
72.0
15.9
19.1
26.1
26.3
4.5
3.8
5.1
3.4
100.0
100.0
100.0
100.0
N=360
Type of training received on MCH–FP was also asked for each respondent. The results
on the responses on this query are summarized in Table 5.2. As we can note, the
unprompted knowledge in the case of MCH–FP are far below the knowledge on the
training module. Prompting also could not raise the knowledge up to the expectation in
many instances and as a result, the lack of knowledge remains substantial. Note that,
unprompted knowledge on safe delivery, PNC and ANC remains in the neighborhood of
80%.
Table 5.2: Knowledge on MCH–FP: Unprompted and prompted
Module
1.Safe delivery ANC
2. Delivery care
3. New brown care
4. PNC
5. Motivation
6. Counseling
7. Condom
8. Pill
9. Injection advantage
disadvantage
10. Implanon
11. IUD
12. Permanent method
13. ECP
Unprompted
80.9
79.0
75.8
80.9
71.3
72.6
74.5
73.2
& 66.2
61.8
70.1
69.4
66.9
Response
Prompted
17.2
17.8
21.0
15.3
26.1
23.6
21.0
22.9
28.0
Did not respond
1.9
2.5
3.1
3.8
2.5
3.8
4.4
3.8
5.7
Total
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
28.0
21.7
24.2
21.0
10.2
8.3
6.3
12.1
100.0
100.0
100.0
100.0
N=360
The respondents’ knowledge on safe motherhood and care of pregnant mothers was
also assessed through unprompted and prompted procedure. As the responses in Table
5.3 demonstrate, the knowledge of the respondents on safe motherhood and care of
pregnant mothers remain in the neighborhood of 70%–78%. Prompting procedure fails
to raise the knowledge to a satisfactory level.
In response to a query on the type of training received on antenatal care, the
respondents provided several answers which were judged for their correctness in the
light of the module answers. Here too, unprompted assessment was followed by
prompted procedure in the case the respondents fails to answer spontaneously. The
results of this investigation are displayed in Table 5.4. As we can see, although
prompting procedure led to substantial increase in the knowledge, yet there remains a
significant gap of about 2 to 5 to bring the knowledge in many instances to universality.
In 90% of the cases, the unprompted knowledge remains in the neighborhood of 80%.
Even after prompting, it seldom reaches 90% leaving a wide gap from 100, as it should
have been.
Table 5.3 Knowledge on Safe motherhood and care of pregnant mothers:
unprompted and prompted
Module
Safe delivery
ANC
Anemea
Blodpressure
Abdomen exam
Edema
Urine sugar and almomen examination
Pregnancy women card
Pregnancy problem management
TT
Benefit of colestrol
Anemia
Reason of bleeding and management
Aclamshia
Aclamshia problem and prevention
Unprompted
77.1
82.8
77.7
75.2
76.4
79.6
78.4
72.0
73.3
75.8
77.1
78.3
71.3
74.5
68.8
Response
Prompted Did not respond
16.6
6.4
12.1
5.1
15.9
6.4
14.6
10.2
11.5
12.1
12.1
8.3
14.6
7.0
17.2
10.8
15.9
10.8
15.3
8.9
17.2
5.7
15.3
6.4
18.5
10.2
16.6
8.9
17.8
13.4
Restriction of medicine during pregnancy
70.7
16.6
12.7
Total
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
100.0
Table 5.4 Training received on ANC Unprompted and prompted
Module
Unprompted
79.0
79.6
76.4
76.4
Response
Prompted
11.5
10.6
16.6
13.4
Total
Did not respond
9.5
9.6
7.0
10.2
100.0
100.0
100.0
100.0
1.
2.
3.
4.
Steps of normal delivery
Delivery symptom
Normal delivery technique
Observation mother and chilled at the
time of 2nd stage of delivery
5.
6.
7.
Newborn examination
Newborn primary care
Premature rapture membrane
80.9
77.1
76.4
11.5
12.7
15.3
7.6
10.2
8.3
100.0
100.0
100.0
8.
Primary treatment at the time of
rapture of membrane
79.0
14.6
6.4
100.0
9. Reason of prolong delivery
10. Cases of rapture of uterus and
primary treatment
77.1
78.3
15.9
14.6
7.0
7.1
100.0
100.0
11. Cord prolapsed
12. Sing of critical condition fatal in the
uterus
77.8
80.9
14.6
12.7
7.6
6.4
100.0
100.0
13.
14.
15.
16.
79.6
76.4
81.5
79.6
17.2
15.9
11.5
12.1
3.2
7.6
7.0
8.3
100.0
100.0
100.0
100.0
Post partum hemorrhage
Reasons of fatal utters
Reasons of death of child in uterus
Perineum tear
N=360
The responses of the FWVs on the training on PNC were assessed and the results
obtained thereof are presented in Table 5.5. As it is evident, the unprompted knowledge
was by and large higher in this case in all issues related to the PNC. A close view of the
responses presented in table under reference shows that the unprompted knowledge in
almost all cases is about 90% and the prompting procedure raises the knowledge to
universality.
Table 5.5 Knowledge on PNC: Unprompted and prompted
Module
1.
Essential care of newborn
and sing of danger
2. Breast feeding new born
3. Preparation of ORS
4. Observation of continues
increase of child
5. Action of Vitamin
6. Sing of shock
7. Objective and importance
of ANC
8. Reasons of bleeding and
prevention after delivery
9. Puerperal sepsis
10. Counseling after delivery
N=360
Response
Unprompted Prompted
Total
90.5
7.6
Did not
respond
1.9
89.8
81.5
84.1
8.9
14.0
12.1
1.3
4.5
3.8
100.0
100.0
100.0
82.2
85.4
88.5
12.1
10.2
9.6
5.7
4.4
1.9
100.0
100.0
100.0
91.7
7.6
0.7
100.0
89.8
89.8
8.9
8.9
1.9
1.3
100.0
100.0
100.0
CHAPTER
6
Strength and Weakness of Training Program
6.1 Strengths and weaknesses
The FWVs in-service training/refresher training application is assessed to be very poor in
a few studies conducted in Bangladesh. These studies reveal that basic training was not
developed properly for FWCs level and they need refresher training in different sectors
as stated in curriculum. Now they need the training in the job oriented sector mostly. The
present study attempts to ascertain the training gap of the FWVs in FWCs for their
development of knowledge, skill, performances and practices in working sectors. The
present chapter is devoted to deal with this issue from the data collected directly from
the selected FWVs.
Opinions on the facilities while providing training were assessed through five categorical
responses in qualitative terms. The opinion was sought on sitting arrangement in terms
of the responses ‘very good’, ‘good’, ‘almost good’, ‘not good’, ‘not at all good’, in the
materials supplied in the class room in terms of the responses ‘enough’, ‘almost enough,
‘almost’, ‘not enough’, ’not at all enough’ and so on. The query also made on method of
training, quality of training, duration of training, usefulness of the training, hostel
arrangement and many others. A detailed list of these indicators are presented in Table
6.1.
Note that nearly 40%–50% of the respondents were on the opinion that most of the
arrangements were highly satisfactory. On an average, 5–10% of the respondents
expressed their dissatisfaction on the arrangement. The weakest side of the training was
that the training was unrelated to their job, which was mentioned by about 10% of the
respondents, while 41.4% of them found the training consistent with their current job. An
equal proportion disclosed that the training manual was not useful at all. On the contrary,
42% of them found the manual very helpful for them. About 5% of the respondents were
dissatisfied with their training allowances while 52.2% expressed their utmost
satisfaction on the training allowances.
The distribution of the respondents regarding their opinion on different aspects of
training module is shown in Table 6.2. A close view of the tabular data reveals that the
77.1% of respondents assessed the duration of training on anatomy, physiology,
pharmacology and microbiology to be enough for them. The trainers experience on this
subject was assessed to be satisfactory by 81.4% of the respondents. The training
method followed for this was reported to be suitable in 83.1% of the cases. The training
materials were sufficient in about 90% of the cases and the practical training on this
module was also sufficient. The practical training on child health care was extremely
unsatisfactory being reported by 43% of the respondents.
Table 6.1 Opinion about the training facilities
1
2
3
4
5
Total
1.
Class room
sitting arrangement
Very good
58.0
Good
36..3
All most
5.1
Not good
0.6
Not at all
-
2.
Class
materials
Enough
49.0
All most
10.8
Not enough
2.5
Not at all
0.6
All most
13.4
Not enough
2.5
Not at all
3.2
100.0
All most
13.4
Not
Appropriate
Not at all
2.5
100.0
Not at all
3.6
100.0
room
100.0
3.Whether the get
training materials
Get Enough
44.6
4. Training method
Very Appropriate
41.4
All
most
enough
36..9
All
most
enough
36..3
Appropriate
40.8
5. Quality of training
materials
Very good
41.4
Good
47.1
All most
6.4
6. How much helpful
this training
Very Helpful
Helpful
Not Helpful
Not at all
100.0
40.1
Very Enough
46..5
Enough
1.3
Not enough
5.7
Not atall
100.0
44.6
Very consistent
41.4
40.1
Consistent
6.4
Not
consistent
5.7
Not useful
3.2
Not at all
100.0
4.5
Not at all
100.0
5.7
Not helpful
1.9
Not at all
100.0
2.5
Not good
3.2
6.4
Not at all
5.1
1.9
Not good
1.3
Very useful
40.8
Useful
42.0
Very helpful
44.6
Helpful
43..9
Very good
40.1
42.7
Good
42.7
All
most
Helpful
6.4
All
most
Enough
5.7
All
most
consistent
7.6
All
most
useful
5.7
All
most
helpful
4.5
All most
8.9
Good
33.8
Good
25.5
All most
12.7
All most
6.4
Not good
2.5
Not enough
4.5
Not at all
9.6
Not at all
11.5
100.0
13.
Training
honorarium
Very good
41.4
Enough
52.2
14.
Training
Very good
51.0
Good
36..3
All most
4.5
Not good
3.8
Not at all
4.5
100.0
Very good
49.0
Good
33.1
All most
6.4
Not good
3.8
Not at all
7.6
100.0
Very good
61.8
Good
22.9
All most
6.4
Not good
5.7
Not at all
3.2
100.0
7.
Duration
training
of
8. How much useful
for the job oriented
task
9. How much useful
the training manual
10. How match
helpful the training
environment
11.
Hostel
arrangement
12. Quality of food
Practical
15. Field Training
16.Management
a total
in
100.0
100.0
Table 6.2: Opinion on training modules
1.
Anatomy,
Physiology,
Pharmacology
Micro-Biology
2. Behavior change
Communication
Gander
3. Safe mother hood,
Delivery care, New
brown care, PNC
4. Family panning
5. RTI/STI
HIV/ AIDS
Adolescent RH care
6. Child health care
7. Infection control and
Remerging of new
Diseases
8. Limited curative care
9. Clinic management
10. Skill checklist
11. Midwifery
Duration of
training
N=360
Resource
person
experience / Skill
N=360
Training
Method
N=360
Training
Materials
N=360
Practical
training
N=360
77.1
83.4
83.4
89.8
82.2
19.1
3.8
89.8
8.9
1.3
77.1
21.0
1.9
91.1
7.6
1.3
77.1
20.4
2.5
91.1
8.3
0.6
90.4
8.3
1.3
93.0
7.0
89.8
8.3
1.9
91.7
8.3
76.4
8.3
5.1
14.0
2.5
91.1
7.6
1.3
82.8
16.6
0.6
91.7
7.6
0.6
86.0
13.4
0.6
89.1
10.8
91.7
7.6
0.6
94.3
5.7
91.1
7.0
1.9
91.1
8.3
0.6
82.8
15.9
1.3
14.0
2.5
89.8
8.9
1.3
88.5
8.3
3.2
91.1
7.0
1.9
87.9
9.6
2.5
90.4
8.3
1.3
93.0
5.1
1.9
93.0
5.1
1.9
91.1
7.0
1.9
94.3
3.2
2.5
87.9
10.8
1.3
7.6
2.5
89.8
9.6
0.6
95.5
3.8
0.6
91.7
7.0
1.3
94.9
1.9
3.2
95.5
3.8
0.6
95.5
2.5
1.9
94.9
2.5
2.5
41.7
6.4
1.9
94.9
4.5
1.2
90.4
8.9
0.6
10.2
7.6
90.4
6.4
3.2
86.0
8.3
5.7
89.2
5.7
5.1
96.6
7.6
5.7
43.0
3.8
3.2
89.8
5.7
4.5
91.7
4.5
3.8
91.7
4.5
3.8
92.4
3.8
3.8
89.8
5.1
5.1
1. Enough
2. All most
Enough
3.
Not
enough
1.Experience
2.All most Experience
3. Not Experience
1. Capable
2. All most
Capable
3.
Not
Capable
1.Maximum
2. All most
Maximum
3.
Not
Maximum
1.Maximum
2. All most
Maximum
3.
Not
Maximum
The respondents were asked about the problems they encountered in providing services
to the clients or to run the program as per their scope of work. A little more than 19% of
the respondents reported problems related to ANC. Of these, 56.5% were not happy
with the ANC related services and hence they were in the opinion that ANC service
should be improved. About 20% complaint of not getting adequate services. Only a little
more than 7% did not encounter any problem.
Problems on delivery issues were encountered by about 20% of the respondents.
Among them 59% mentioned about insufficient instruments. Another 28% were unhappy
on the clinic facilities. Problems of PNC, lack of new born care facilities, problems on
adolescents, problems of record keeping, clinic management, providing medicine and a
few more problems were mentioned by the respondents. Table 6.3 lists these problems.
An investigation was made to ascertain the different aspects of the training course,
These include, among others, curriculum, trainer, duration of training, training
allowances, practical training, training at field level, accommodation, food, behavior of
the trainer and supporting staff. About 62% of the respondents did not have any
comment on the curriculum. About 23% felt that the curriculum was sufficiently large.
Need for more trainers was mentioned by 15% of the respondents. That the duration of
training should be increased was mentioned by 26% of the respondents. More than half
of the respondents were in favor of enhancing the training allowances. Need for practical
raining was felt by 27% of the respondents. About an equal proportion of the
respondents wanted field level training. Nearly 20% respondents felt scarcity of
accommodation. Suggestions came from 37% of the respondents to take care of quality
of food. About the behavior of the trainers and support staff, 58% of the respondents
passed no comment. More details of the issue is presented in Table 6.4
Table 6.3: Problems faced by the respondents about different distribution of job related services
Problem
ANC
Improve ANC service
Did not get adequate service
No problem
Need more training on mother and child health
Bad communication
Total
Delivery
Insufficient instrument
No clinic facilities
Need training
Total
PNC
No sitting facilities for patient
Need training
No problem
Insufficient instrument
Total
New born care
Insufficient instrument
Total
Adolescent
Inadequate medicine for child
Need more knowledge about STI/ RTI
Need knowledge to identify disease
Total
Long tram
Need training
Total
Permanent
Need training
Less interested
Total
Recording and keeping
Fully not oriented
Total
Clinic management
Very good
Inadequate staff
Water problem
Insufficient furniture
No clinic
Total
Providing Medicine
Inadequate staff
Inadequate medicine
Total
Use of instrument
Insufficient instrument
Instrument not fit for use
Need training to instrument
Total
Working environment
Not good at all
Transport problem
Need staff
Total
Percent
69
56.5
20.2
20.2
1.3
1.8
100.0
71
57.7
29.5
13.6
100.0
37
61.0
13.0
13.0
13.0
100.0
25
100.0
100.0
39
41.5
41.0
17.5
100.0
9
100.0
100.0
14
50.0
50.0
100.0
31
100.0
100.0
71
45.0
25.3
2.8
15.5
7.0
100.0
59
64.0
36.0
100.0
55
74.5
9.2
16.3
100.0
55
67.0
21.8
12.0
100.0
Percent
19.1
19.7
10.3
7.0
10.9
2.5
3.8
8.7
19.7
7.6
15.3
15.2
Table-6.4 Distribution of response by opinion regarding deferent aspect of training course
Suggestion
Curriculum
1. Large curriculum
2. Adequate curriculum
3.Prictical training advance
Cant say/ No comment
Total
Trainer
1. Need more trainer
2.Related training needed
3.Experience trainer needed
Cant say/ No comment
Total
Duration of training
1. Increase duration
2. Need training
Cant say/ No comment
Total
Training allowance
1. Increase amount of honorarium
2.Honorarium should be expenditure based
Cant say/ No comment
Total
Practical training
1. Small group will help batter training
2. Need more instrument
Cant say/ No comment
Total
Training at field level
1. Increase filled training
2. Adequate filled training need
Cant say
Total
Accommodation
1. Required standard should be maintain
2. Need more cleanness
Cant say/ No comment
Total
Food
1. Improve food quality
2. Not food at all
Cant say/ No comment
Total
Behavior of trainer and support staff
1.Good
2.Normal
3.Not good
Cant say/ No comment
Total
Other
1.Leave facility for marries woman
2. Need training
Cant say/ No comment
Total
Percent
22.9
9.6
5.9
61.6
100.0
15.3
14.0
1.9
68.8
100.0
26.1
10.8
63.3
100.0
51.0
12.7
36.3
100.0
26.8
10.8
62.5
100.0
23.6
9.6
74.1
100.0
19.5
6.4
58.0
100.0
36.9
5.1
100.0
21.0
3.2
1.3
58.0
100.0
74.7
3.8
1.3
95
100.0
CHAPTER
7
Observation
Introduction
The observational method is the primary technique for collecting data on nonverbal
behavior. Although observation most commonly involves sight or visual data collection, it
could also include data collection via the other senses, such as hearing, touch or smell.
Use of the observation method does not preclude simultaneous use of other data
gathering techniques. The present observational study is a non-participatory study.
The study was designed to observe the activity of FWV. A total of 24 FWV were brought
under the purview of the study. Needless to say, the observation check list was a
structured one and the types of observation followed was an overt one, with the observer
visible to the subjects and that subject were aware that they were being observed. The
observation period for the FWV was one day duration.
Total 24FWV (Newly recruited) were observed in 12 Upazila in seven divisions. From
each Upazila Two FWVs, one from each union was observed. The activity of FWV was
observed by spot observation. The observation was done by a structured checklist.
Performance on the day observation
A. 1. Out of 24 FWVs about (67%)16 received the patients and (33 %) 8 did not
receive the patients.
2. (100%) 24 FWVs have taken the case history of the patients.
3. Again (100%) 24 FWVs have maintained the privacy of the patients.
4. Enough ventilation has been observed in (100%) 24 FWCs.
Table 1 Environmental Activities
Item
Reception
Case history
Privacy
Enough ventilation
N = 80
Yes
66.7
100.0
100.0
100.0
No
33.3
-
B. Physical Examination
1. (78%) 19 FWVs measured the blood pressure and (22%) 5 did not do
this work.
2. Only (22%) 5 FWVs examined the edema and (78%) 19 did not
examine this activities.
3. About (35%)8 FWVs examined the temperature and (65%)16 did not
perform this work.
4. Abdomen was examined by only (22%) 5 FWVs and rest (78%) 19
ignored this activity.
5. Pulse was examined by (78%) 19 of the FWVs and (22%) 5 did not
perform this work.
6. (89%) 21 FWVs examined eye and rest only (11%)3 did not checked
the eye.
7. Lung was examined by cent percent of the FWVs.
8. More than (55%)13 of the FWVs examined the chest, and rest (45%)11 did
not check the chest.
Table 2 Physical Examination
Item
Measurement of Blood pressure
Examine edema
Examine temperature
Abdomen examination
Pulse examination
Eye examination
Lounge examination
Chest examination
Yes
77.8
22.2
34.5
22.2
77.8
88.9
100.0
55.6
No
22.2
77.8
65.5
77.8
22.2
11.1
00.0
44.4
N = 80
C. MCH and Family Planning
Observation study on MCH and family planning management observed the following
items:
1. (30%)7 FWVs informed the patient about family planning and a vast majority (70%)
17did not inform about family planning.
2. (100%)24 FWVs informed about complication & side effect of family planning method
3. Again (100%)24 FWVs advised on care of the pregnant mothers.
4. (100%)24 FWVs advised on PNC to the clients.
5. (100%)24 FWVs advised regarding nutrition education of the patients.
6. (100%)24 were entertained by the medicine/ family planning methods.
7. A very small percentage (11.1%) 3 of FWVs advised for next follow-up visit to the
health center.
8. About (67%)16 FWVs advised for safe delivery and rest 33%(8) did not ask for
safe delivery of the patients.
9. More than (55%)13 FWVs advised regarding different education on communication
and rest 45%(11) did not advise on this matter.
10. Only (33%) 8 FWVs advised on breastfeeding and care of children in the FWCs and
rest (67%) 16 ignored this service.
11. (100%)24 FWVs did the good behavior with the clients/patients.
12. About (67%)16 FWVs informed that they solve the MCH & family planning problems
to the patients and rest (33%)8 did not advice to the patients.
13. Again about (67%)16 FWVs provided help in case of any problem of the patients
and rest (33%)8 did not do so
Table 3 MCH and Family Planning
Item
About family planning
About complication & side effect
Advice for care of pregnant women
Advice for PNC
Said about nutrition
Distribution F.P method
Advice for next Follow-up
Advice for safe delivery
Advice for ANC & information education
Breast feeding and care of children
Behavior with client
Provided any help for problem
Recorded about problem & solution
N = 80
Yes
30.5
100.0
100.0
100.0
100.0
100.0
11.1
66.7
55.6
33.3
100.0
66.7
66.7
No
69.5
88.9
33.3
44.4
66.7
33.3
33.3
D. FWVs were asked about essential equipment in the FWCs:
1.
2.
3.
4.
(100%)24 FWVs said that they have BP machine in the FWC.
(100%)24 FWVs informed that they have weighing machine for the patients.
(100%)24 FWVs noticed that they have stethoscope.
About (67%)16 FWVs informed that they have thermometer but rest (33%)8 did
not have any thermometer in the FWCs.
5. Again, (67%)16 FWVs said that they have height measurement tape but rest
(33%)8 did not have any height measuring tape.
Table 4 Necessary Equipment
Item
Yes
No
BP machine
100.0
-
Weight machine
Stethoscope
Thermometer
Height measurement tape
100.0
100.0
66.7
66.7
33.3
33.3
N = 80
CHAPTER
8
Discussion & Recommendations
8.1 Discussion and Conclusions
Most of the FWV’s knowledge on antenatal care services was nearly satisfactory. More
than 94% of the FWVs were found to possess knowledge on the fact that recording case
history is mandatory that has to be accomplished when a pregnant women desiring
antenatal services. Most of them perform clinical test, examine pulse, measure
temperature, check blood pressure, impart nutrition education and provide TT. Our
findings thus substantiate the results obtained in contemporary studies conducted in
Bangladesh giving us a feeling that the present study has been successful in shedding
light on the extent of current knowledge of the FWVs in the course of discharging their
responsibilities. .
About 88% of the FWVs believed that their primary task during delivery is to advise on
safe delivery. About 75% of the FWVs are well aware that they are in obligation to
ensure safe delivery. Nearly half of the FWVs refer the cases elsewhere for improved
treatment in case of any emergency arising out of complications related to pregnancy or
deliver. The results of the present study point out the fact that our field workers will have
to go far more to be conscious enough about their scope of work and believe that the
success of the family planning program largely depends on their functional knowledge
on the area on which they are working.
The possession of extent of knowledge of the FWVs on the post natal care was also
assessed in terms of a few items or issues. As we can observe, cleanliness, and advice
to breast-feeding at birth received the top priority among the PNC services being
indicated by 86.5% of the FWVs in both cases. The respondents were also aware of the
fact that the new born infants should be wrapped with dry cloth, which was mentioned by
more than 80% of the FWVs. The others were examining the new born (77.7%), visiting
the baby (75.8%), referring (82.2%), advice on food supplementation (75.2%), providing
nutritious food (77.7%) and advice to preserve child’s health card (76.4%). While the
knowledge of the FWVs on the issues related to postnatal care was nearly satisfactory,
they must have more motivation so as to make them more knowledgeable on these
matters in the interest of the program vis-à-vis the interest of the clients who seek
services from the family planning workers
More than 83% of the FWVs are aware that they are supposed to educate the
adolescents on reproductive health. That nutrition and health education are also two
important issues for them is known to about 80% and 87% of the FWVs respectively.
They are further supposed to motivate the adolescents to defer their marriage until they
reach at least to legal age at marriage and delay pregnancy when married. Once again
we note that the importance of the reproductive health issues of the adolescents and
nutritional education are well viewed by the FWVs as important components of the family
planning program.
The present study finds that the FWVs work with very positive attitude to motivating the
eligible couples for accepting family planning methods, encouraging adopting permanent
method, counseling the clients, helping physicians in their endeavor to provide
permanent method, advising clients for follow-up visits and the like. Almost universally,
the FWVs find it extremely necessary to encourage women to adopt condom as a viable
and safe method of contraception. For general treatment too, the FWVs role was
assessed to be of crucial importance. This feeling is also universally expressed by the
FWVs In case of complications encountered by the general patients, the referral gets top
priority to the FWVs
The study results reveal that the awareness of the FWVs on ANC was highly
satisfactory. Knowledge on the family planning services provided from the satellite clinics
was also significantly high. A scoring system was developed to measure the extent of
knowledge on the services. Based on these scores it was noted that the FWVs were
17% more likely to have knowledge on the family planning services than their knowledge
on the MCH services provided from the satellite clinics.
The FWVs do satisfactory job in record keeping and preparation of performance report
They also maintain the updating of the reports in more than 70% of the cases. Updating
the list of pregnant mothers and preparation of monthly reports on MCHFP are also done
by the FWVs maintaining a satisfactory level. .
The FWVs give most attention to the services pertaining to ANC, MCH and FP. A little
more than 62% pay normal attention in providing ANC services, 56% in MCH, 59.2% in
FP and 56% in nutrition.
The extent of awareness among the FWVs about the type of materials employed to
motivate mothers in receiving services from the clinics appears to be by and large
satisfactory, the level of satisfaction ranges between 70 per cent and 85 per cent.
The service providers hold joint meetings with the field level workers and the clients. The
FWVs are pretty well aware of this meeting. It is pleasant to note that the objectives of
the meeting are also known to the FWVs. It is however pity to note that such meetings in
many occasions could not be organized for one reason or others, the reasons for which
remain almost unknown.
As expected, the subject matters of discussion in the aforesaid meetings included such
issues as reproductive health of the adolescents and new born babies. These were
followed by the discussion on family planning (68.5%) and maternal and child health
(50%). Discussion on nutrition and services rendered in satellite clinics also took place
but with less priority. Previous research on this aspect also demonstrates the same
feature in that nutrition and health aspects are usually ignored.
The regularity of the FWVs is noted from the fact that their monthly reports of all
activities are sent to UHC on a regular basis.
The knowledge of the respondents on the training module was assessed through
unprompted as well as prompted questioning. The study indicates that unprompted
knowledge was almost universal in the case of skill checklist. Prompting procedure led to
substantial increase in such knowledge. Similar features are observed when they were
asked about the training module of ANC, safe delivery and PNC. The knowledge of the
respondents on safe motherhood and care of pregnant mothers remain satisfactory
The training facilities were by and large praised by the FWVs. The weakest side of the
training was that the training was unrelated to their job, which was mentioned by about
6% of the respondents, while 41.4% of them found the training consistent with their
current job. An equal proportion disclosed that the training manual was not useful at all.
On the contrary, 42% found the manual very helpful for them. About 5% of the
respondents were dissatisfied with their training allowances while 52.2% expressed their
utmost satisfaction on the training allowances. These issues must be addressed while
arranging training program for the FWVs.
Duration of training could satisfy a large majority of the FWVs. The experience and
expertise of the resource persons were assessed to be satisfactory in most instances.
The training methods followed were appropriate and materials used were adequate. But
practical training on child health care was extremely unsatisfactory.
Problems encountered by the FWVs in providing services related to ANC is of
significance to mention and as such the FWVs were in the opinion that ANC service
should be improved. Services pertaining to PNC, new born care facilities, adolescents,
record keeping, clinic management, medicine were unsatisfactory and inadequate.
Mixed feelings were expressed by the FWVs on the training especially with respect to
curriculum, trainer, duration of training, training allowances, practical training, training at
field level, accommodation, food, behavior of the trainer and supporting and staff. By and
large, nearly two thirds of the trainees expressed their dissatisfaction on these issues.
These findings are in conformity with a number of studies undertaken in Bangladesh on
the issue of training of the FWVs, although research on training aspect is very limited.
The extent of additional short-term training required was reported to be of very low
magnitude. The topics on which they require these training most notably were reported
to be on midwifery, ANC, and IUD insertion. The long-terms training requirements were
even lower than the previous two categories of training, viz. short-term and mid-terms
but they have some common elements.
8.2 Recommendations

The study indicated that nearly one-third of the FWVs felt the need for practical
and field level training. This suggests that the duration of hands on training was
inadequate. It is recommended that duration of hands on training should be
increased.

Training on eleven modules was provided in 18 months duration. The lectures on
these modules were supposed to be given by highly skilled resource persons.
However, some institutions failed to engage highly skilled resource persons. It is
recommended that more skilled persons should be engaged to provide
professional training.

Most of the trainers reported that the training was lecture-based but this sort of
training should be participatory as well as field based. Group basis training with
20 participants were also questioned in the interest of the program. It is
recommended that training module should include both theoretical and practical
issues. The current size of the group should be reduced.

In some training centers, the authority of the center failed to provide sufficient
training materials in due time. It is recommended that sufficient training materials
should be provided to the participants in due time for the betterment of the
training.

Most of the FWVs felt that they need some refresher and mid-term training on
various issues that will enhance their professional skills. It is recommended that
refresher training on MR, IUD Copper T and midwifery can be arranged to
enhance the skill of the newly trained FWVs. It is also recommended that as per
the desire of the FWVs the above mentioned refresher training should be
provided on short term basis.
Bibliography
Ashraf et.al. (1997) Refreshers' Training of MCH-FP Paramedics and Field Workers:
Experience from a Low-PerformingRural Area of Bangladesh, ICDDR,B Working Paper
No.103, Dhaka, Bangladesh.
BRAC (1991). A tale of two wings: health and family planning programmes in an Upazila
in Northern Bangladesh. Bangladesh Rural Advancement Committee, 1991: 31-35,
Dhaka, Bangladesh.
Baqee L, MA Koblinsky(1948). The family welfare visitors (FWVs): paramedics of the
MCH-FP programme, International Centre for Diarrhoeal Disease Research, Dhaka,
Bangladesh.
Hussain MB, R Mita, JG Hagga (1991) Quality of care and contraceptive adoption in
rural Bangladesh: MCH-FP extension project areas, International Centre for Diarrhoeal
Disease Research, Dhaka, Bangladesh.
Khuda B, J Stoeckel J, N Piet-Pelon (1997) Bangladesh family planning programme:
lesson learned and directions for future, International Centre for Diarrhoeal Disease
Research, Dhaka, Bangladesh.
Mridha MA and N A Khan (2004) An Appraisal of the Institutional Training Arrangement
for Community Health Workers in Bangladesh, http://www.who.int/hrh/en/
HRDJ_4_2_04.pdf.
Nessa F. (1985) Evaluation of FWV: quality of care through pre-training observation,
International Centre for Diarrhoeal Disease Research, Operations Paper 42, 1985
(unpublished), Dhaka, Bangladesh.
Sultana S, A. Sabir, SK Bhadra (1997) Training needs assessment of Thana, union and
unit level family planning and health personnel,. Dhaka: NIPORT-GTZ, 1997: 83-90.
ANNEXURE A
Table of Exit Client
Table 1: Distribution of respondents by their age
Age
Percent
<20
4.7
20-29
46.8
30-39
31.4
40-49
12.0
50-59
2.7
≥60
2.3
Total
100.0
Min: 12; Max: 75; Mean: 30.7; S.E: 0.6
Table 2: Distribution of respondents by their education
Education
Percent
0
21.1
1-5
37.8
6-8
23.4
9-10
15.4
11-12
2.0
>12
Total
.3
100.0
Min: 0; Max: 16; Mean: 5.1; S.E: 0.2
Table 3: Distribution of respondents by their occupation
Education
Percent
Did nothing
2.3
Service
1.3
Business
1.0
Agriculture
0.3
Day labour
0.3
Housewife
94.0
Other
0.8
Total
100.0
Table 4: Distribution of respondents by their marital status
Marital status
Percent
Married
97.3
Unmarried
1.3
Divorced
0.3
Widowed
1.0
Total
100.0
Table 5: Distribution of respondents by their parity (q_6)
Number
Son
Daughter
Total
0
24.4
36.1
12.0
1
40.5
38.1
21.1
2
26.1
17.1
28.8
3
6.0
6.0
19.4
≥4
3.0
2.7
18.7
Total
100.0
100.0
100.0
Mean
1.3
1.1
2.3
S.E
0.1
0.1
0.1
Max
10
11
12
Table 6: Distribution of respondents by their response regarding place from where they
usually take service
Place
UHFWC
Rural dispensary
Percent
91.6
6.7
UHC
33.1
Satellite clinic
14.4
Community clinic
3
NGO
6.4
Other
5.7
Total
-
Multiple responses
Table 7: Distribution of respondents by their
Distance (km)
Percent
0
24.7
1
46.5
2
17.1
3
4.3
4
1.0
5
2.0
≥6
4.4
Total
100.0
Min: 0; Max: 28; Mean: 1.5; S.E: 0.1
Table 8: Distribution of respondents by their response regarding ways they used to
reach the service center
Ways
Percent
On foot
73.5
Rickshaw/ Van
23.7
Cycle
0.3
Baby taxi
4.0
Bus
2.3
Other
5.4
Total
-
Multiple responses
Table 9: Distribution of respondents by their response regarding fp method they are using
Frequency
19
Percent
6.4
1
3
1.0
3
1
.3
4
4
1.3
7
1
.3
00
4
1.3
1
84
28.1
10
60
20.1
2
6
2.0
3
58
19.4
4
9
3.0
5
10
3.3
6
5
1.7
7
14
4.7
8
20
6.7
9
1
.3
299
100.0
Total
Table 10: Distribution of respondents by their response regarding problem for which
they come to take service
Problem
Percent
For fever and cold
28.4
For pain
18.0
For foot/ leg problem
5.4
For general diseases
48.5
For FP methods
36.1
For checkup
Antenatal care
For advise
9.4
14.4
2.3
Total
-
Multiple responses
Table 11: Distribution of respondents by their response for which they come to take
service
Reason
Percent
Sickness
56.5
Follow-up
21.4
To take new service
7.7
To give company to the relative
3.0
Family planning
31.4
Other
6.0
Total
-
Multiple responses
Table 12: Distribution of respondents by their knowledge regarding service provided from UHFWC
Yes
No
Total
Table 13 : Distribution of respondents by
type of services provided from the center
Problem
Drug are given for fiver and cold
Percent
88.0
12.0
100.0
Percent
20.5
Treatment for diarrhea
7.2
Given FP service
74.1
Service to the pregnant mother
63.9
General treatment
71.1
Mother & child health service
31.9
Education given about child nutrition
8.4
Total
-
Multiple responses
Table14: Distribution of respondents by their response regarding overall situation of the center
Percent
72.2
Good
Ok
16.7
Bad
10.0
Don't know
1.0
Total
100.0
Table 15: Distribution of respondents by their opinion about washroom/ toilet of the center
Good
Percent
51.2
Ok
23.4
Bad
17.1
Don't know
Total
8.3
100.0
Table 16: Distribution of respondents by their opinion about water facility of the center
Good
Percent
43.8
Ok
21.4
Bad
26.8
Don't know
Total
8.1
100.0
Table 17 : Distribution of respondents by services taken from the center at the survey
day
Services
For fever and cold
For loss motion
Percent
14.4
2.0
General service
50.5
Given advice
15.4
F.P service
36.5
Given vitamin
10.7
For cheek-Up
8.0
Mother and child health
3.3
Antenatal care
8.7
Total
-
Multiple responses
Table 18: Distribution of respondents by their response on whether service provider gave
prescription
Percent
69.6
30.4
Yes
No
Total
100.0
Table 19: Distribution of respondents by their response on whether service provider gave
medicine/ contraceptive
Percent
89.6
10.4
Yes
No
Total
100.0
Table 20 : Distribution of respondents by their response regarding advice given their
service provider
Services
Percent
Advise for rest
29.0
Advice to eat mutation food
32.3
Advice to take less salt
6.5
Not to perform home delivery
3.2
Advice to laboratory examine
6.5
Nutrition education
pregnancy
education
during
Given advice
6.5
32.3
Total
-
Multiple responses
Table 21: Distribution of respondents by their response on whether they were satisfied
Yes
No
Total
Percent
87.1
12.9
100.0
Table 22: Distribution of respondents by their response on whether they get the service provider
in time
Yes
Percent
94.0
No
6.0
Total
100.0
Table23: Distribution of respondents by their response on whether the service provider provided
sufficient time
Yes
Percent
87.3
No
12.7
Total
100.0
Table 24: Distribution of respondents by their response on whether the service provider examined
the patient
Yes
Percent
67.2
No
32.8
Total
100.0
Table 25: Distribution of respondents by their response on whether the service provider maintain
privacy
Yes
Percent
78.3
No
21.7
Total
100.0
Table26: Distribution of respondents by their response on behaviour of the service provider
Good
Moderate
Total
Percent
87.6
12.4
100.0
Table27: Distribution of respondents by their response on whether the service provider welcome
the patient
Yes
No
Total
Percent
72.6
27.4
100.0
Table 28: Distribution of respondents by their response on whether the service provider advice the
patient for follow-up
Yes
Percent
78.9
No
21.1
Total
100.0
Table 29: Distribution of respondents by their response on whether they provide money for the
service
Yes
Percent
8.0
No
Total
92.0
100.0
Table 30: Distribution of respondents by their response regarding amount spended for taking
service
Non response
Percent
58.3
5
16.7
10
8.3
50
8.3
300
4.2
1600
4.2
Total
100.0
Table 31: Distribution of respondents by their response on whether anybody advised they to come
to the center
Yes
Percent
54.5
No
Total
45.5
100.0
Table 32 : Distribution of respondents by their response about person advised them
Person
Percent
Neighbors
17.8
Relative
12.3
Family member
30.1
FWA
42.9
FWV
0.6
Own decision
1.8
Total
Multiple responses
-
Table 33: Distribution of respondents by their response on whether they come to the center in
future
Yes
Frequency
296
No
Total
Percent
99.0
1
1.0
299
100.0
Table 34: Distribution of respondents by their response on whether they will suggest any not to
take service from the center in future
No
Frequency
2
Percent
.7
Yes
297
99.3
Total
299
100.0
Table 35 : Distribution of respondents by their response on whether they provide any suggestion
for betterment of the service
Yes
No
Total
Percent
46.2
53.8
100.0
Table 36 : Distribution of respondents by their suggestion
Suggestion
Percent
1. Give more time for Patients
5.1
2. Prescribe specific medicine
3.6
3. Well behave with patient
8.7
4. Improvement of toilet and water facilities
47.1
5. Ensure necessary medicine / drug
53.6
6. Provide trained doctor
20.3
7. More manpower necessary
2.9
8. Necessary Instrument
2.2
9. Improvement of infrastructure
7.2
1.4
Total
Multiple responses
-
ANNEXURE B
SET CODE # 2
ID
Follow-up of FWV Basic Training
Questionnaire for FWV
IDENTIFICATION
DIVISION ....................................................................................................
DISTRICT ..................................................................................................
UPAZILA ..................................................................................................
UNION
...................................................................................................
UH&FWC .................................................................................................
EDITED BY :
INTERVIEWER’S
NAME
....................................................................................
SIGNATURE ...................................
SIGNATURE .................................................
Starting Time ------
DATE ...........................
DATE ..................................
Ending Time ------
National Institute of Population Research and Training (NIPORT)
Associates for Research Training and Computer Processing (ARTCOP)
Follow-up of FWV Basic Training
Questionnaire for FWV
cÖkœ
bs
DËi
101
Avcbvi bvg wK?
............................................................
102
Avcbvi PvKzixi mgq Kvj KZ gvm ?
gvm
103
wk¶vMZ †hvM¨Zv
1. Gm.Gm.wm I FWV †gŠwjK cÖwk¶bcÖvß
‡KvW
2. GBP. Gm. wm I FWV †gŠwjK cÖwk¶b
cÖvß
3. Ab¨vb¨............................................
104
‰eevwnK Ae¯’v
105
weevwnZv n‡j Avcbvi KZRb RxweZ mš— ‡Q‡j.............
vb Av‡Q ?
‡g‡q...............
weevwnZv -1
AweevwnZv - 2
2. Job Related Knowledge of RH –FP Services
201
cwievi Kj¨vb cwi`wk©Kv wnmv‡e Avcbvi wK wK KvR Ki‡Z nq Zv wK ej‡Z cv‡ib ?
†c‡i‡Qb - 1
cv‡ibwb - 2
1. cÖmec~e© wK wK †mev cÖ`vb 1. Case History ‡bqv
Ki‡Z nq Zv wK ej‡Z cv‡ib ?
2. Clinical cix¶v
1. cv©jm (bvwoi MwZ)
2. ‡U¤úv‡iPvi (ZvcgvÎv)
3. †imwc‡iUwi
3. Mf©eZx gv‡qi i³¯^íZv cix¶v
nu¨v -1 bv -2
nu¨v -1
nu¨v -1
nu¨v -1
nu¨v -1
bv -2
bv -2
bv -2
bv -2
4. i³ Pvc gvcv
5. †cU cix¶v
nu¨v -1 bv -2
nu¨v -1 bv -2
6. BwWgvi Rb¨ cix¶v
nu¨v -1 bv -2
7. cªmªv‡e myMvi I G¨vjeywgb cix¶v
nu¨v -1 bv -2
8. F.H.S (Fetal heart sound) cix¶v
nu¨v -1 bv -2
9. SuzwKc~b© Mf© mbv³ Kiv
nu¨v -1 bv -2
10. Mf©eZx I Zvi d‡jvAvc wfwRU
nu¨v -1 bv -2
11. Mf©eZx gv‡qi cywô ¯^v¯’¨ wk¶v cÖ`vb
nu¨v -1 bv -2
12. Mf©eZx gv‡qi TT ‡bIqvi Rb¨ civg©k
cÖ`vb
nu¨v -1 bv -2
13. Ab¨vb¨ (wbw`ó Kib)
..............................................................
2. cÖme †mev m¤ú©wKZ wK wK 1. wbivc` cÖme m¤ú©‡K civg©k cÖ`vb
KvR Ki‡Z nq Zv wK ej‡Z cv‡ib ?
nu¨v -1 bv -2
2. wbivc` cÖme Kiv‡bv
nu¨v -1 bv -2
3. RwUj cÖme ‡ivMx †idvi Kiv
nu¨v -1 bv -2
4. Ab¨vb¨ (wbw`ó Kib)
..............................................................
3. cÖme cieZ©x †mev cÖ`v‡b wK wK 1. beRvZ‡Ki hZœ :
KvR Ki‡Z nq Zv wK ej‡Z cv‡ib ?

cwi®‹vi Kiv
nu¨v -1 bv -2

ïK‡bv Kvc‡o †gvov‡bv
nu¨v -1 bv -2

R‡b¥i mv‡_ mv‡_ ey‡Ki `ya LvIqv‡bvi
civgk© †`Iqv
nu¨v -1 bv -2

beRvZ‡Ki cix¶v Kiv
nu¨v -1 bv -2

wUKv †`Iqvi civgk© †`Iqv
nu¨v -1 bv -2
2. cÖme cieZx© cwi`k©b Kiv
nu¨v -1 bv -2
3. cÖ‡qvR‡b cÖme cieZx© gv‡K / beRvZK‡K nu¨v -1 bv -2
D”PZi †mev ‡K‡›`ª †idvi Kiv
4. wkïi m¤ú~iK Lvevi m¤ú‡K© gv‡K civgk©
†`Iqv
nu¨v -1 bv -2
5. 1-5 erm‡ii wkï‡`i cª‡qvRbxq civg©k
†`Iqv
 cwi®‹vi cwi”QbœZv
 cywóKi Lvevi
nu¨v -1 bv -2
nu¨v -1 bv -2
6. wkïi ¯^v¯’¨ KvW© msi¶b Kivi Rb¨ Dc‡`k
nu¨v -1 bv -2
7. Ab¨vb¨ (wbw`ó Kib)
..............................................................
4. wK‡kvi wK‡kvwi‡`i †mev cÖ`v‡b 1. cªRbb ¯^v¯’¨ wk¶v cÖ`vb
wK wK KvR K‡i _v‡Kb Zv wK ej‡Z
cv‡ib?
2. cywó wk¶v
3. eq:mw× Kvwjb ¯^v¯’¨ wk¶v cÖ`vb
nu¨v -1 bv -2
nu¨v -1 bv -2
nu¨v -1 bv -2
4. †`ix‡Z weevn I mš—vb MÖn‡b DØy× Kiv
202
Ab¨vb¨ (wbw`ó Kib)
..............................................................
cwievi cwiKíbvi wK wK †mev w`‡q 1. m¶g `¤úwZ‡`i cwievi cwiKíbvi
_v‡Kb Zv wK ej‡Z cv‡ib ?
DØy×Kib
nu¨v -1 bv -2
wel‡q nu¨v -1 bv -2
2&. Counseling Kiv
nu¨v -1 bv -2
3. cwievi cwiKíbvi c×wZ †`Iqvi c~‡e© Dchy³ nu¨v -1 bv -2
cØwZi Rb¨ `¤úwZ evQvB (screening) Kiv
4. c×wZ e¨env‡i cv©k¦cªwZwµqvi Rb¨ †mev nu¨v -1 bv -2
cÖ`vb ev e¨e¯’vcbv
5. cwievi cwiKíbvi RwUjZvi †¶‡Î MO- (MCH- nu¨v -1 bv -2
FP) Gi wbKU †idvi Kiv
6. Bgc-vbb c×wZ cÖ‡qv‡M mn‡hvwMZv Kiv
nu¨v -1 bv -2
7. ¯’vqx c×wZ MÖn‡bi Rb¨ DØy× Kiv
nu¨v -1 bv -2
8. ¯’vqx c×wZ cÖ`vb (NSV, Tubectomy )
Gi mgq Wv³vi†K mn‡hvwMZv Kiv
nu¨v -1 bv -2
9. d‡jv-Av‡ci Rb¨ Client ‡K Avmvi Rb¨ ejv
nu¨v -1 bv -2
10. cwievi cwiKíbvi c×wZ †`Iqv
nu¨v -1 bv -2
Ab¨vb¨ (wbw`ó Kib)
..............................................................
K) I.U.D ‡mev w`‡Z wK wK Ki‡Z nq
ej‡Z cv‡ib wK ?

I.U.D
1. DØy× Kib
nu¨v -1 bv -2
2. Counseling
nu¨v -1 bv -2
3. `¤úwZ evQvB Kib
nu¨v -1 bv -2
4. cÖ‡qvM
nu¨v -1 bv -2
5. cvk¦©cÖwZwµqvi e¨e¯’vcbv
nu¨v -1 bv -2
6. RwUjZvi Rb¨ †idvi
nu¨v -1 bv -2
7. Ab¨vb¨ (wbw`ó Kib)
...............................
L) Injection ‡mev w`‡Z wK wK Ki‡Z
nq ej‡Z cv‡ib wK ?

Injection
1. DØy× Kib
nu¨v -1 bv -2
2. Counseling
nu¨v -1 bv -2
3. `¤úwZ evQvB (screening)
nu¨v -1 bv -2
4. cÖ‡qvM
nu¨v -1 bv -2
5. cvk¦©cÖwZwµqv e¨e¯’vcbv
nu¨v -1 bv -2
6. RwUjZvi Rb¨ †idvi
nu¨v -1 bv -2
7. Ab¨vb¨ (wbw`ó Kib)
..........................
M) Pill w`‡Z wK wK Ki‡Z nq ej‡Z
cv‡ib wK ?

Pill
1. DØy× Kib
nu¨v -1 bv -2
2. Counseling
nu¨v -1 bv -2
3. `¤úwZ evQvB (screening)
nu¨v -1 bv -2
4. cvk¦©cÖwZwµqv e¨e¯’vcbv
nu¨v -1 bv -2
5. RwUjZvi Rb¨ †idvi
nu¨v -1 bv -2
6. Ab¨vb¨ (wbw`ó Kib)
..........................
N) Condom w`‡Z wK wK Ki‡Z nq ej‡Z
cv‡ib wK ?

Condom
1. DØy× Kib
nu¨v -1 bv -2
2. Counseling
nu¨v -1 bv -2
3. Ab¨vb¨ (wbw`ó Kib)
..........................
203
204
General Treatment
Satellite clinic
1. mvavib i“Mx ‡`Lv
nu¨v -1 bv -2
2. RwUj †ivMx †idvi Kiv
nu¨v -1 bv -2
1. mßv‡n `yBw`b satellite clinic G emv
nu¨v -1 bv -2
Satellite clinic ‡mev cÖ`vb:
K) Satellite clinic G MCH welqK wK
wK †mev cÖ`vb Kiv n‡q _v‡K ej‡Z
cv‡ib wK ?
A.
MCH :
1. ANC (cÖmec~e© †mev)
nu¨v -1 bv -2
2. PNC (cÖmecieZx© †mev)
nu¨v -1 bv -2
3. 0-5 erm‡ii wkï cwiPh©v
nu¨v -1 bv -2
4. mvavib †ivMxi †mev
nu¨v -1 bv -2
5. Ab¨vb¨ (wbw`ó Kib)
.........................................................
L) Satellite clinic G FP Method wK
wK †mev cÖ`vb Kiv n‡q _v‡K ej‡Z
cv‡ib wK ?
cwievi cwiKíbv cØwZ :
1. Pill (Lvevi ewo)
nu¨v -1 bv -2
2. Condom (KbWg)
nu¨v -1 bv -2
3. Injection (Bb‡RKkb)
nu¨v -1 bv -2
4. I.U.D (AvB. BD. wW)
5. ¯’vqx cØwZ I Bgc­vbb MÖn‡bi Rb¨ DØy× Kiv
nu¨v -1 bv -2
nu¨v -1 bv -2
6. Ab¨vb¨ (wbw`ó Kib)
.............................................................
M) Ab¨vb¨ wK wK †mev cÖ`vb Kiv
n‡q _v‡K ej‡Z cv‡ib wK ?
B. Ab¨vb¨
1. cywó ¯^v¯’¨ wk¶v
nu¨v -1 bv -2
2. cÖRbb ¯^v¯’¨ wk¶v
nu¨v -1 bv -2
3. ARH (wK‡kvi wK‡kvwi‡`i cÖRbb
¯^v¯’¨ †mev)
nu¨v -1 bv -2
4. RTI/ STI- e¨e¯’vcbv
nu¨v -1 bv -2
5. Ab¨vb¨ (wbw`ó Kib)
........................................................
N) RwUj i“Mx / K¬vB‡q›U ‡K wK C. RwUj i“Mx / K¬vB‡q›U
†mev cÖ`vb Kiv n‡q _v‡K ej‡Z cv‡ib
1. MO (MCH-FP) Gi wbKU †idvi Kiv
wK ?
O) Satellite clinic G Ab¨vb¨ wK wK
D. Ab¨vb¨
KvR K‡i _v‡K ej‡Z cv‡ib wK ?
1. Satellite clinic RvqMv wb©avib
2. Satellite clinic Gi Kg©m~wP ˆZix Kiv
205
jwRw÷K Ges mvc-vvB wel‡q wK wK
K‡i _v‡Kb ej‡Z cv‡ib wK ?
nu¨v -1 bv -2
nu¨v -1 bv -2
nu¨v -1 bv -2
nu¨v -1 bv -2
Logistics and Supplies
1. cÖ‡qvRb Abymv‡i Pvwn`v ˆZix K‡i UFPO Gi
wbKU cvVv‡bv
2. Dc‡Rjv †÷vi †_‡K Jla I gvjvgvj Avbv Ges ÷K nu¨v -1 bv -2
‡iwRóv‡i wjwce× Kiv
3. †gqv` DIxY© Jla Avjv`v Kiv
206
(Z_¨ wjwce× Kib I cÖwZ‡e`b cÖbqb ) 1. mKj ai‡bi †iKW© c~ib
Record keeping and Reporting wK
wK K‡i _v‡Kb ej‡Z cv‡ib wK ?
2. mKj ai‡bi.‡iwRóvi nvjbvMv` Kiv
nu¨v -1 bv -2
nu¨v -1 bv -2
nu¨v -1 bv -2
3. Mf©eZx gv‡q‡`i ZvwjKv nvjbvMv` Kiv
nu¨v -1 bv -2
4. gv,wkï ¯^v¯’¨ I c: c: †mev (MCH-FP) nu¨v -1 bv -2
m¤ú©wKZ Kg©Kv‡Ûi gvwmK cÖwZ‡e`b ˆZwi
Kiv
207
208
GB †mev †K›`ª (UH&FWC) ‡_‡K cÖ`Ë
RH-FP †mev m¤ú‡K© gv‡q‡`i wK
c~e© ‡_‡K Rvbv‡bv nq?
GB †mev †K›`ª m¤ú‡K© gv‡qiv 1. m‡PZb - 1
KZUzKz m‡PZb, ej‡Z cv‡ib wK ?
2. m‡PZb bq - 2
3. Rv‡b bv - 3
nu¨v -1 bv -2
209
‡mev cÖ`v‡bi Rb¨ Avcbvi UH&FWC ‡Z hš¿cvwZ
wK ai‡bi hš¿cvwZ/ miÄvgvw` Av‡Q
1. we wc †gwkb
ej‡Z cv‡ib wK ?
2. ‡÷‡_v‡¯‹vc
3. _v‡©gvwgUvi
4. IRb gvcvi hš¿
5. D”PZv gvcvi wdZv
miÄvgvw`
1. AU‡K¬f †gwkb / ‡÷vf
2. cÖ‡qvM †Uwej
210
UH&FWC AvMZ †ivMx‡`i KZLvwb (1. ¸i“‡Z¡i mv‡_ 2. †gvUvgywU ¸i“‡Z¡i mv‡_ 3.
¸i“‡Z¡i mv‡_ wb‡gœi †mev mgyn †`Iqv †ek ¸i“‡Z¡i mv‡_)
nq?




Mf©Kvjxb †mev
gv I wkï ¯^v¯’¨ †mev
cwievi cwiKíbv †mev
cywói †mev
1
1
1
1
2
2
2
2
3
3
3
3
3. Performance
301
MZ 2 gv‡m KZRb wK wK ai‡Yi ‡mevi aib
†ivMx/ K¬vB›U †mev ‡bIqvi Rb¨
cÖme c~e©
Avcbvi †K‡›`ª G‡m‡Qb ?
cÖmeKvjxb
Rb
..........Rb
..........Rb
cÖme cieZ©x
..........Rb
GK eQ‡ii Kg eq‡mi wkï
..........Rb
1-5 ermi
..........Rb
cwievi cwiKíbv
1. Lvevi ewo
..........Rb
2. KbWg
..........Rb
3. Bb‡RKkb
..........Rb
4. AvB, BD. wW
..........Rb
behvZ‡Ki cwiPh©¨v
..........Rb
RTI/STI e¨e¯’vcbv
..........Rb
wK‡kvi ¯^v¯’¨
..........Rb
mvaviY †ivMx
..........Rb
..........Rb
B wm wc
..........Rb
Ab¨vb¨ (wbw`ó Kib)
.......................................
302
gv‡q‡`i †mev MÖn‡Y DØy× Kivi DcKi‡Yi bvgt
Rb¨ wK wK wk¶v DcKiY e¨envi K‡i
1. wd¬c PvU©
_v‡Kb ?
2. IUD g‡Wj
3. IUD g¨vby‡qj
4. Mf©eZxi cwiPh©v welqK g¨vby‡qj
5. ‡cvóvi
6. ct ct c×wZi bgybv
7. ORS-Gi bgybv
8. d¬vk KvW©
9. ‡MÖv_ PvU© (wkï ¯^v¯’¨ KvW©)
10. gvVKg©x mnvwqKv
11. wKQzB e¨envi Kwi bv
Ab¨vb¨(wbw`ó Kib)
.......................................................
303
¯’vbxq RbMb Avcbvi GB †K‡›`ªi 1. cy‡ivcywi Rv‡bb
†mev m¤ú‡K© KZUzKz Rv‡bb ?
2. ‡gvUv‡gvwU Rv‡bb
3. ‡gv‡UI Rv‡bbv
304
gv I wkï ¯^v¯’¨ cwiPh©v Ges cwievi
cwiKíbvi †mev MÖn‡Y DØy× Kivi
Rb¨ †mev cÖ`vbKvix wK gvV Kg©x
I K¬v‡q›U‡`i wb‡q Av‡jvPbv mfv
K‡ib?
305
n¨vu n‡j gv‡m wK wK I KZ¸wj mfv mfvi bvg
K‡ib ?
1
nu¨v- 1
bv - 2
2
3
4
5
msL¨v
306
bv K‡i _vK‡j †Kb K‡ib bv?
....................................................................................
....................................................................................
....................................................................................
307
MZ 2 gv‡m me©†gvU KqwU mfv
K†i‡Qb ?
...................... wU
308
D³ mfv‡Z wK wK wel‡q Av‡jvPbv 1 ..........................................................................
n‡q‡Q ?
2 .........................................................................
3 ..........................................................................
4 ...........................................................................
5 ...........................................................................
6 ...........................................................................
7 ...........................................................................
DcKiY I mieivn t
401
GB †K›`ª cwiPvjbvi Rb¨ cÖ‡qvRbxq Jla cÎ
1 ......................................................
I †mev cª`v‡bi Ab¨vb¨ `ªe¨v`x Avcwb †Kv_v †_‡K
2 ......................................................
‡c‡q _v‡Kb ?
3 ......................................................
4 ......................................................
Z_¨ msi¶Y I cÖwZ‡e`b ˆZix t
402
‡ivMx I K¬vB›U‡`i †mev cÖ`v‡bi wbwg‡Ë 1. Mf©Kvjxb †iwRóvi
Avcbvi †K‡›`ª wK wK †iwRóvi Av‡Q?
2. cÖmeKvjxb †iwRóvi
3. cÖm‡evËi †iwRóvi
4. mvaviY †ivMx cwiPh©¨v †iwRóvi
5. wkï †ivMx cwiPh©¨v †iwRóvi
6. cwi`k©b †iwRóvi
7. Stock Register (I .C .R)
8. Condom weZib †iwRóvi
9. Lvevi ewo †iwRóvi
10. Bb‡RK‡Uej †iwRóvi
11. I.U.D payment Register
12. M.R. Register
13. Ab¨vb¨ (wbw`ó Kib)
.......................................................
403
Avcwb KLb Ges †Kv_vq gvwmK cÖwZ‡e`b 1 ........................................................
†cÖib K‡i _v‡Kb ?
2 ........................................................
404
Avcwb wK †cªwiZ cÖwZ‡e`‡bi †Kvb Feed back
cvb ?
nu¨v -1
bv - 2
5 d‡jv-Avc:
501
‡mev MÖnYKvix‡`i‡K Avcwb wK d‡jv-Avc K‡ib/ nu¨v -1
†LvuR Lei †bb?
bv - 2
(K)
wKfv‡e d‡jv-Avc K‡ib/ Kiv nq ?
1 ......................................................
2 .....................................................
3 .....................................................
(L) ‡mev MÖnYKvix‡`i RwUjZv/ cv©k¦cªwZwµqv 1. MCWC ‡Z †idvi Kwi
†`Lv w`‡j wK K‡ib?
2. UHC ‡Z †idvi Kwi
3. Ab¨vb¨ ...........................................
502
Constrains (mxgve×Zv )
nu¨v-1
bv-2
Avcwb wK gv I wkï ¯^v¯’¨ †mev mwVK fv‡e
cÖ`vb Ki‡Z cvi‡Qb ?
1 2
bv n‡j ‡Kb cvi‡Qb bv ?/ Amyweav n‡j wK
Amyweav nq ?
503
Avcwb wK m¨vjvBU wK¬wbK msMV‡bi KvR
mwVK fv‡e Ki‡Z cvi‡Qb ?
1 2
504
Avcwb Mf©eZx I cÖm~Zx gv‡qi †mev cÖ`v‡bi
KvR mwVK fv‡e Ki‡Z cvi‡Qb wK?
1 2
505
Avcwb cywó wk¶v cÖ`v‡bi KvR mwVK fv‡e Ki‡Z
cvi‡Qb wK ?
1 2
506
cwievi cwiKíbv †mev cÖ`vb KvR mwVK fv‡e
Ki‡Z cvi‡Qb wK ?
1 2
507
mvaviY wPwKrmv cÖ`vb KvR mwVK fv‡e Ki‡Z
cvi‡Qb wK ?
1 2
508
M S R †c‡Z †Kvb Amyweav n‡h‡Q wK bv ?
1 2
509
Z_¨ wjwceØKib I cÖwZ‡e`b ˆZix Kiv‡Z †Kvb
Amyweav n‡h‡Q wK bv ?
1 2
510
‡K›`ª msjMœ evmvq _vK‡Z †Kvb Amyweav
n‡h‡Q wK bv ?
1 2
511
Avcwb †h ‡gŠwjK cÖwk¶b wb‡q‡Qb Zv ev¯—e
†¶‡Î cÖ‡qv‡M †Kvb Amyweav nq wK bv?
1 2
Training Knowledge
6
601
FWV ‡gŠwjK cÖwk¶†b KqwU gwWD‡ji Dci cÖwk¶b wb‡q‡Qb ?
................wU
602
Avcwb wK wK wel‡q / gwWD‡ji Dci cÖwk¶b MÖnb K‡i‡Qb ?
cÖwk¶b wel‡qi bvg ejyb
1. GbvUwg, wdwRIjRx
gvB‡µvev‡qvjRx
603
¯^ZùzZ©fv‡e
ej‡Z †c‡i‡Q
dvgv©‡KvjRx
Ges
mvnvh¨ Kivi ci ej‡Z cv‡iwb
ej‡Z †c‡i‡Q
1
2
3
2. AvPib cwieZ©‡b †hvMv‡hvM I †RÛvi
1
2
3
3. wbivc` gvZ…Z¡, Mf©Kvjxb hZœ, cÖmeKvjxb
hZœ, beRvZ‡Ki hZœ, I cÖm‡evIi hZœ
1
2
3
4. cwievi cwiKíbv
1
2
3
5. cÖRbbZ‡š¿i msµgb, †hŠbevwnZ msµgb,
GBPAvBwf / GBWm, eq:mwÜKvjxb ¯^v¯’¨, eܨvZ¡
I ¯¿x †ivM
1
2
3
6. wkï ¯^v¯’¨ †mev
1
2
3
7. msµgK †ivM wbqš¿Y I be Avwef~©Z †ivM
1
2
3
8. mxwgZ wbivgqg~jK †mev
1
2
3
9. wK¬wbK e¨e¯’vcbv
1
2
3
10. `¶Zv AR©‡bi †PKwj÷
1
2
3
11. wgWIqvBdvix
1
2
3
Avcwb †gŠwjK cÖwk¶‡b gv-wkï ¯^v¯’¨ I cwievi cwiKíbv wK wK wel‡q cªwk¶b wb‡q‡Qb ?
gv I wkï ¯^v¯’¨
1. wbivc` gvZ…Z¡ I Mf©Kvjxb hZœ
1
2
3
2. cÖmeKvjxb hZœ
1
2
3
3. beRvZ‡Ki hZœ
1
2
3
4. cÖm‡evËi hZœ
1
2
3
cwievi cwiKíbv
5. DØy×Kib
1
2
3
6. KvDwÝwjs
1
2
3
7. KbWg
1
2
3
8. Lvevi ewo
1
2
3
9. Bb‡RKk‡bi myweav-Amyweav mgyn
1
2
3
10. Bgc-vbb
1
2
3
11. AvB. BD. wW
1
2
3
12. ¯’vqx c×wZ
1
2
3
1
2
3
13.Ri“ix
Mf©wb‡ivaK
Contraceptive Pill, ECP)
ewo
(Emergency
604
605
wbivc` gvZ„Z¡ I Mf©eZxi hZœ m¤ú‡K© wK wK wel‡q cÖwk¶b †c‡q‡Qb ej‡eb wK ?
1. wbivc` gvZ„Z¡
1
2
3
2. Mf©eZxi hZœ
1
2
3
3. Mf©eZx gv‡qi i³¯^íZv
1
2
3
4. i³ Pvc gvcv
1
2
3
5. †cU cix¶v
1
2
3
6. BwWgvi Rb¨ cix¶v
1
2
3
7. cªmªv‡e myMvi I G¨vjeywgb cix¶v
1
2
3
8. Mf©eZx gv‡qi KvW©
1
2
3
9. Mf©Kvjxb mvavib Amyweav e¨e¯’vcbv
1
2
3
10. wUwU wUKv (TT) cÖ`vb
1
2
3
11. kvj `ya LvIqv‡bvi DcKvwiZv
1
2
3
12. i³¯^íZv
1
2
3
13. Mf©ve¯’vq i³cv‡Zi Kvib I e¨e¯’vcbv
1
2
3
14. GKjvgwmqvi j¶b/ wPý
1
2
3
15. GKjvgwmqvi RwUjZv I cÖwZ‡iva
1
2
3
16. Mf©ve¯’vq †Kvb †Kvb Jl‡ai e¨envi wbwl×
1
2
3
cÖme Kvwjb hZœ m‡¤ú‡K© †Kvb †Kvb wel‡q cÖwk¶b †c‡q‡Qb ej‡eb wK
1. ¯^vfvweK cÖm†ei avcmg~n
1
2
3
2. cÖme ïi“ nIqvi j¶b I wPýmg~n
1
2
3
3. ¯^vfvweK cÖm†ei †KŠkj
1
2
3
4. cÖm†ei wØZxq av‡c gv I wkïi ch©‡e¶b,e¨e¯’vcbv
1
2
3
5. beRvZK wkïi kvixwiK cix¶v
1
2
3
6. beRvZK wkïi cÖv_wgK hZœ
1
2
3
7. mg‡qi Av‡M cvwbi _wj †d‡U hvIqvi Kvib
1
2
3
8. cvwbi _wj †d‡U †M‡j cÖv_wgK wPwKrmv
1
2
3
9. `xN©vwqZ cÖm†ei Kvib, j¶b I wPý
1
2
3
10. Rivqy †d‡U hvIqvi Kvib, cÖv_wgK wPwKrmv I
†idvi
1
2
3
11. bvwoi¾y ¯’vbPzwZi (cord prolapsed ) Kvib
1
2
3
12. msKUvcbœ Mf©¯’ wkïi j¶b I wPý
1
2
3
partum
1
2
3
14. msKUvcbœ Mfve©¯’vi Kvibmg~n I cÖv_wgK
wPwKrmv
1
2
3
13.
cÖme
cieZx©
i³¶i‡bi
(Post
hemorrhage) Kvib
606
15. Mf©¯’ wkïi g„Zy¨i Kvib
1
2
3
16. †cwiwbqvg Tear KZ cÖKvi
1
2
3
beRvZ‡Ki hZœ I cÖm‡evIi †mevi wK wK wel‡q cÖwk¶b †c‡q‡Qb
beRvZ‡Ki hZœ
1. beRvZ†Ki AZ¨vek¨Kxq cwiPh©v Ges wec` wPý
1
2
3
2. beRvZK†K gv‡qi `ya LvIqv‡bv
1
2
3
3. ORS ‰Zix
1
2
3
4. wkïi µge„w× ch©‡e¶b
1
2
3
5. Lv`¨cªvY (vitamin) Gi KvR
1
2
3
6. Shock – Gi j¶b/ wPý
1
2
3
cÖm‡evIi hZœ
7. cÖm‡evIi h‡Zœi D‡Ïk¨ I ¸i“Z¡
1
2
3
8. cÖme cieZx© i³¶i‡bi Kvib I cÖwZ‡iva
1
2
3
10. cÖme cieZ©x msµgb (Puerperal sepsis )
1
2
3
11.cÖme cieZ©x KvD‡Ýwjs
1
2
3
701 GLb Avwg wewfbœ gwWD‡ji cÖwk¶b cwiPvjbv m¤ú‡K© Avcbvi
gZvgZ Rvb‡Z PvB| AbyMÖn K‡i mwVK gZvgZ w`‡q cÖwk¶‡bi gvb
Dbœq‡b mnvqZv Ki‡eb |
gwWDj
1.
GbvUwg,
wdwRIjRx
dvgv©‡KvjRx Ges
gvB‡µvev‡qvjRx
2. AvPib cwieZ‡b©
†hvMv‡hvM I †RÛvi
3. wbivc` gvZ…Z¡,
Mf©Kvjxb hZœ ,
cÖmeKvjxb
hZœ,
beRvZ‡Ki hZœ, I
cÖm‡evIi hZœ
4. cwievi cwiKíbv
5.
cÖRbbZ‡š¿i
msµgb , †hŠbevwnZ
cÖwk¶b
†gqv`
ch©vß wK
?
wi‡mvm©
cÖwk¶b
cv©mb
c×wZ Dchy³
AwfÁ/ `¶ wQj wK ?
wQj wK?
cÖwk¶b
DcKib
ch©vß wK
?
e¨envwiK
cÖwk¶b
ch©vß wQj
wK ?
cÖwk¶‡Ki
gvb
Dbœq‡bi
Rb¨
mycvwik
msµgb , GBPAvBwf
/
GBWm,
eq:mwÜKvjxb
¯^v¯’¨, eܨvZ¡ I ¯¿x
†ivM
6. wkï ¯^v¯’¨ †mev
7. msµgK †ivM
wbqš¿Y
I
be
Avwef~©Z †ivM
8.
mxwgZ
wbivgqg~jK †mev
9.
wK¬wbK
e¨e¯’¨vcbv
10.`¶Zv
†PKwj÷
AR©‡bi
11.wgWIqvBdvix
ch©vß -1
‡gvUv‡gv
wU- 2
Ach©vß -3
AwfÁ-1
‡gvUv‡gv
wU-2
AbwfÁ-3
Dchy³ -1
‡gvUv‡gvw
U-2
Abychy³ -3
ch©vß -1
‡gvUv‡gv
wU- 2
Ach©vß 3
ch©vß -1
‡gvUv‡gv
wU-2
Ach©vß -3
cÖwk¶b g~j¨vqb :
801. Avwg cÖwk¶b †Kvm© m¤úwK©Z wewfbœ welq m¤ú‡K© Avcbvi gZvgZ Rvb‡Z PvB, AbyMÖn
K‡i Avcwb mywPwš—Z gZvgZ ‡`‡eb ?
1
1. cÖwk¶‡b (‡kªbx LyeB fvj wQj
K‡¶) emvi e¨e¯’v †Kgb
wQj ?
2.
‡kªbx
K‡¶ h‡_ó wQj
cÖ‡qvRbxq cÖwk¶b
mvgMÖx h‡_ó wQj
wK bv ?
3. cÖwk¶‡b Avcwb h‡_ó †c‡qwQ
cÖ‡qvRbxq cªwk¶b
DcKib, n¨vÛ AvDU
†c‡qwQ‡jb wK bv ?
4. cÖwk¶‡b e¨eüZ LyeB h_v_©
cªwk¶b c×wZ h_vh_ wQj
wQj wK bv ?
5. cÖwk¶‡b e¨eüZ LyeB fvj wQj
cªwk¶b DcKib †Kgb
wQj ?
6. cªwk¶b cªvß Ávb/ LyeB
`¶Zv Avcbvi Kg©‡¶‡Î mnvqZv
KZUzKz
mnvqZv K‡i‡Q
K‡i‡Q e‡j g‡b K‡ib ?
7.
G
cªwk¶‡bi LyeB ch©vß
†gqv`Kvj ch©vß wQj wQj
e‡j g‡b K‡ib wK
8. cªwk¶bwU Avcbvi LyeB
Kg©‡¶‡Î
ˆ`bw›`b mvgÄm¨c~b©
Kv‡Ri mv‡_ KZUzKz n‡q‡Q
mvgÄm¨ c~b© n‡q‡Q
9. cÖwk¶‡b e¨eüZ LyeB e¨envi
cªwk¶b mnvwqKvwU Dc‡hvMx
Avcbvi †¶‡Î KZUzKz
e¨envi Dc‡hvMx e‡j
g‡b K‡ib ?
10. cªwk¶b ‡Kv‡m©i LyeB mnvqK
mvwe©K
cwi‡ek wQj
wk¶‡bi Rb¨ KZUzKz
mnvqK wQj e‡j g‡b
K‡ib ?
2
fvj wQj
3
†gvUvgywU
4
fvj wQj bv
5
‡gv‡UB
wQj bv
‡gvUvgywU
h‡_ó wQj
†gvUvgywU
h‡_ó wQj bv
‡gv‡UB
wQj bv
‡gvUvgywU
h‡_ó †c‡qwQ
†gvUvgywU
h‡_ó cvBwb
‡gv‡UB cvBwb
h_v_© wQj
†gvUvgywU
h_v_©
bv
fvj wQj
†gvUvgywU
fvj wQj bv
‡gv‡UB
wQj
mnvqZv
K‡i‡Q
†gvUvgywU
mnvqZv
K‡i‡Q
mnvqZv
Ki†Q bv
‡gv‡UB
mnvqZv Ki‡Q
bvB
ch©vß wQj
†gvUvgywU
ch©vß wQj
ch©vß
bv
11. Avevmb e¨e¯’v
LyeB fvj wQj
fvj
h‡_ó
wQj ‡gv‡UB h_v_©
wQj bv
fvj
wQj ‡gv‡UB ch©vß
wQj bv
mvgÄm¨c~b© †gvUvgywU
mvgÄm¨c~b© ‡gv‡UB
n‡q‡Q
mvgÄm¨c~b© nqwb
mvgÄm¨c~b©
n‡q‡Q
nqwb
e¨envi
Dc‡hvMx
†gvUvgywU
e¨envi
Dc‡hvMx
e¨envi
Dc‡hvMx bv
mnvqK wQj
†gvUvgywU
mnvqK wQj
mnvqK
bv
fvj wQj
†gvUvgywU
fvj wQj bv
‡gv‡UB e¨envi
Dc‡hvMx bv
wQj ‡gv‡UB
mnvqK wQj bv
‡gv‡UB
wQj bv
fvj
12. Lvev‡ii gvb
LyeB fvj wQj
fvj wQj
†gvUvgywU
fvj wQj bv
‡gv‡UB
fvj
wQj bv
13. cÖwk¶b fvZv
h‡_ó wQj
fvj
†gvUvgywU
h‡_ó wQj
LyeB Kg
14. e¨envwiK cÖwk¶b
LyeB fvj wQj
fvj wQj
†gvUvgywU
fvj wQj bv
‡gv‡UB
fvj
wQj bv
LyeB fvj wQj
15. gvV cÖwk¶b
fvj wQj
†gvUvgywU
fvj wQj bv
‡gv‡UB
fvj
wQj bv
mvwe©K LyeB fvj wQj
16.
e¨ve¯’vcbv
fvj wQj
†gvUvgywU
fvj wQj bv
‡gv‡UB
wQj bv
901 Kg©cwiwa Abyhvqx Kvh©µg cwiPvjbv ev †mev cÖ`vb Ki†Z wK wK Amyweavi m¤§yw¶b n†”Qb ?
01
cÖmec~e© †mev cÖ`v‡bi †¶‡Î
02
cÖmeKvjxb †mev cÖ`v‡bi †¶‡Î
03
cÖmecieZx© †mev cÖ`v‡bi †¶‡Î
04
behvZK †mev (0-28 w`b) †¶‡Î
05
wkï ¯^v¯’¨ (1-5 ermi) †mevi †¶‡Î
06
wK‡kvi wK‡kvwi cÖRbb ¯^v¯’¨
07
cwievi cwiKíbv

A¯’vqx

`xN© †gqvw`

¯’vqx c×wZ
08
†iKW© I wi‡cvw©Us
09
Clinic e¨e¯’vcbv
10
Jla cÖ`vb
11
hš¿cvwZ e¨envi
12
Kg©cwi‡ek
fvj
902 m‡ev©cwi cÖwk¶‡bi gvb Dbœq‡bi Rb¨ wK wK c`‡¶c MÖnb Kiv cÖ‡qvRb ?
01
cÖwk¶b KvwiKzjvg
02
cÖwk¶K
03
cÖwk¶b †gqv`
04
cÖwk¶b fvZv
05
e¨envwiK cÖwk¶b
06
gvV cÖwk¶b
07
Avevmb
08
Lvevi
09
cÖwk¶K I mnvqK Kg©Pvix‡`i AvPib
10
Ab¨vb¨ (wbw`ó Kib)
...............................................................
903
Avcbvi Kg©cwiwa Abyhvqx cÖRbb ¯^v¯’¨, gv I wkï ¯^v¯’¨, nu¨v -1 bv -2
cwievi cwiKíbv †mev cÖ`vb Kvh©µg mwVK fv‡e cwiPvjbvi Rb¨
Avi †Kvb cÖwk¶‡bi cÖ‡qvRb Av‡Q wK ?
904
nu¨v n‡j wK wK wel‡q cÖwk¶‡Yi cÖ‡qvRb Av‡Q ?
cÖwk¶‡bi welq
¯^í‡gqv`x
1.................................
2................................
3................................
ga¨ †gqv`x
1.................................
2................................
3................................
`xN© †gqv`x
1.................................
2................................
3................................
†gqv`Kvj (w`b)
Contributors/ Research Team
NIPORT:

Mohammed Ahsanul Alam
Evaluation Specialist and
Deputy Program Manager (Research and Development)
NIPORT

Mrs. Shahin Sultana
Senior Research Associate, NIPORT
ARTCOP:

Dr. Rejuan Hossian Bhuiyan
Professor
Department of Geography
and Environmental Science
University of Dhaka
Team Leader

Dr. M. Nurul Islam
Professor
Department of Statistics, Bio-Statistics
and Informatics
University of Dhaka
Team member

Mohammad Arif Sattar
Associate Professor
World University of Bangladesh
Team member

Abdur Rashid
Team member
Ex-senior Research Associate, NIPORT
and Chairman, ARTCOP

Dr. Md. Ashraf Ali
DD Audit DGFP and
Ex-DD Family Planning
Consultant

Shamsuddoha
Executive Director, ARTCOP
Co-ordinator

Md. Golam Kibria
Research Associate, ARTCOP
Research officer

Mr. Mahabub
Computer Programmer