Implementation Research

Generation and utilization of evidence of ‘what’ works and ‘how’ can be crucial for health sector decision-making as to guide policies and programs and thus, accelerating performance in health indicators to achieve the Sustainable Development Goal (SDG) targets. The USAID’s RDM endeavours to carry out implementation research studies to address the evidence gaps regarding ‘what’ and ‘how’ to advance the application of both new and previously-evaluated approaches into sustainable and high impact interventions. RDM is doing so with particular focus on maternal, newborn and child health, family planning and reproductive health, tuberculosis, and nutrition as well as cross cutting issues like universal health coverage and health systems strengthening.

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Even with significant achievements, maternal mortality remains a critical concern for Bangladesh. Evidence shows that almost 14 mothers die every day due to complications of pregnancy and child birth in the country. On the other hand, Bangladesh is still among the top 10 countries with the highest burden of under-5 and newborn deaths in the world. So, to achieve sustainable development goal targets 3.1 and 3.2, Bangladesh needs to bring down the maternal mortality rate and neonatal mortality rate respectively. The RDM Activity is carrying out implementation research in the area of maternal and neonatal health to identify and resolve operational challenges to generate evidence of what works and how works.

Related studies:

Identification of Newborn Signal Functions and development of Health Facility Assessment Tools for Bangladesh
Assessment of licensing status and readiness of MNCH services at private facilities
A cohort study to examine the dynamics of decision making process for maternal health care services in Bangladesh
Advancing Routine Health Management Information Systems (HMIS) to deliver for Every Newborn (EN-BIRTH study phase 2): Assessing the feasibility of incorporating, and exploring data quality and utility for selected maternal and newborn indicators in Kushtia, Bangladesh

While Bangladesh has seen impressive progress in family planning, challenges still remain that have relatively slowed own the progress in the last 10 years. For instance, regional variations persist in the use of contraception; short term non-clinical methods dominate contraceptive use, and use of LARC/PM remains stagnant at very low levels. In addition, adolescent fertility in the country is one of the highest in the world with low levels of contraceptive use while country-level information on the overall adolescent health is limited.

Related studies:

Explanation of discrepancy in LARC/PM use between data recorded through service statistics and household reporting
Segmented communication approach for increasing LARC/PM use in Bangladesh
Assessment of the Advancing Adolescent Health (A2H) Project in Bangladesh
2019 Bangladesh Adolescent Health and Wellbeing Survey

Tuberculosis (TB) is one of the top ten principal causes of death globally. In Bangladesh, which is one of the 30 high TB burden countries and also a high multi-drug resistant TB (MDR-TB) burden country, the incidence of TB (all forms) is estimated at 225 per 100,000 population per year and mortality is estimated at 45 per 100,000 population per year. The rate of MDR-TB is 1.6% among new cases and 29% among retreatment cases (3). More than 200,000 TB cases are detected annually; however, around 150,000 cases are still missing which contribute around 40% of the total estimated TB cases in Bangladesh. RDM is carrying out several implementation research studies that could help identify the some of the gaps in TB management and thereby, support in effective program planning and designing.

Related studies:

Evaluation of OMNIgene-SPUTUM as a sputum stabilizer for transportation to referral laboratories
Costs of Services of the Bangladesh National TB Control Program Using One Health Tool
Evaluation of Xpert MTB/RIF Ultra for the diagnosis of childhood pulmonary tuberculosis using stool specimen
Assessment of delay in diagnosis and treatment initiation among TB patients and acceptability of Tuberculosis notification app (Janao) among private providers

To improve the prevailing nutritional status in the country, further exploration, feasibility testing and research are required in the area of infant and young child feeding (IYCF), management of acute malnutrition in children, counselling and other interventions that are targeted to better nutritional status of adolescent girls, women of reproductive age, and pregnant and lactating women.

Related studies:

Assessing effectiveness of growth monitoring and promotion (GMP) in improving nutritional status of children <2 in rural Bangladesh

As reaching universal health coverage (UHC) is both a global and a national agenda, RDM has taken UHC as a cross cutting theme while developing and conducting implementation research in the four priority areas. Health systems strengthening and gender are other cross cutting areas where RDM puts high emphasis.

Related studies:

Testing alternative channels of information on death for routine estimation of maternal mortality
Evaluation of the benefits of community and facility level RMNCH national e-Registries under eMIS initiatives in Bangladesh
Evaluation the pilot Shasthyo Suroksha Karmasuchi (SSK): A health protection scheme of the government of Bangladesh
Designing and developing electronic Management Information System (e-MIS) to capture maternal hypertension and diabetes services