Transformative Education
for Health Professionals

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Redistribution of health sector resources - Matlab experience


One of the most ambitious attempts at extending coverage to underserved populations involves the redistribution of health system resources to the periphery.

The Matlab experiment in Bangladesh is perhaps the most widely known example of this approach. 


Full project description: 

Beginning in the 1970s, the government, with support from international donors, sustained nearly 20, 000 female community health workers whose jobs involved visiting households, meeting with residents, caring for the health needs of mothers and children and offering contraceptives (injectable, oral and barrier methods). 

In an effort to make skilled attendance at birth more accessible, some countries in Asia have begun major initiatives to promote the option of home delivery with a midwife. Yet there is little empirical evidence from the region to suggest that home- based care is as safe or effective as care in medical facilities. Qualitative research involving key informant and in-depth interviews and group discussions was carried out in 2003 and 2004 in Matlab, a rural area of Bangladesh, to examine the feasibility of home- vs. facility-based delivery from the perspective of 13 skilled birth attendants. 

Doorstep services were supported by clinic-based professionals who offered permanent contraceptive methods along with basic primary health care services. Evaluations of the programme have shown improvements in maternal mortality, contraceptive use and child survival indicators. Although the programme has not been directly linked to equitable availability of family planning services, nationally representative surveys show little variation in contraceptive use among socioeconomic groups.

The strong preference for home birth is commonly associated with restrictions on female mobility and cultural norms.

The difficulties faced while assisting the home deliveries were, transport, lack of proper environment, Lack of acceptability of procedures: delivery position and episiotomies, Lack of necessary supplies and equipment, Resistance to referrals, Lack of training for home delivery and Medical supervision, social pressure, Scheduling difficulties.

Major constraints encountered during home deliveries, including poor transportation, inappropriate environment for delivery, insufficient supplies and equipment, lack of security, and inadequate training and medical supervision, which may prevent the provision of skilled care. There remains an ongoing debate among national and international stakeholders about whether skilled birth attendants should be posted at the domiciliary or facility level 


See Systematic Review on Human Resources for Health Interventions to Improve Maternal Health Outcomes: Evidence from Developing Countries

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