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Operations research to improve 24/7 delivery and EmONC services in public facilities by health systems strengthening in Bangladesh


In Bangladesh, TRAction is funding a research study investigating strategies to improve 24/7 (24 hours; 7 days a week) Emergency Obstetric Care (EmOC) service availability. In Bangladesh there is one comprehensive EmOC facility for every 500,000 population. However, 24/7 services are not available in most of these facilities, mainly due to unavailability of providers. This problem stems from inefficient human resource configurations leading to inadequate 24/7 service availability. It is further compounded by poor retention of providers in peripheral health facilities, particularly in hard-to-reach areas. There is little evidence on incentivized interventions to address gaps in human resources for health (HRH) in Bangladesh, and the need to develop and test additional interventions is imminent. Potential strategies to mitigate this problem are identifying minimum HRH needs, sharing of providers within the public sectors, exploring public-private-partnership, and incentivizing the EmOC work force in public facilities to ensure 24/7 services.





  1. To configure and test effectiveness of an incentivized intervention package to minimize HR gaps to ensure round the clock (24/7) availability of providers for emergency obstetric and newborn care services in hard-to-reach public facilities
  2. To assess the effectiveness of the intervention package for: increased utilization of different components of emergency obstetric and newborn care services and improved quality of care
  3. To develop a fund generation mechanism through local level participation for sustainability of the incentivized intervention package
  4. To document if there is any gender differentials in availability of providers for round-the-clock services for emergency obstetric and newborn care.

The major components of the proposed intervention is to:

  1. Fulfill the need of specialist doctors (obstetricians and anesthesiologists) by sharing of providers among public facilities.
  2. Using the services of private doctors in public facilities with an on-call system, backed-up by incentives and hardship allowances. These will be supplemented by advocacy with the government to fulfill the need of additional resources and supportive supervisions.


This study has major implications in making EmONC services available in hard-to-reach areas, and for accelerating progress in achieving MDG 4&5 by 2015 and beyond. Ministry of Health stakeholders will be directly informed of potential strategies to mitigate the problem of HRH shortage from the results of this study, contributing to the overall strengthening of health systems in Bangladesh.


International Centre for Diarrheal Disease Research (icddr,b)


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