Title: Community insights into demand-side barriers to health facility assisted delivery at the Rohingya refugee camps.  

Authors: Farnoosh Vahedi, Meredith Walsh, Jen Leigh, Mst Sifunnahar

Author Affiliations: Community Partners International (CPI)

Background: The 2019 Joint Response Plan (JRP) set a target of >55% of deliveries occurring at a health facility. Despite efforts to promote health facility assisted delivery, roughly 70% of births continue to occur at home. CPI currently runs three programs aimed at this issue. CPI community health volunteers (CHV’s) are trained to assist expecting mothers access health services and provide health education. CPI has also implemented a solar-light incentive program that encourages facility delivery through education and incentives. Finally, a Traditional birthing attendant (TBA) partnership program has also been initiated to encourage expecting mothers to seek facilities for delivery. Understanding cultural barriers to facility delivery has been an integral component to designing programs in-tune with the needs of the community.

Objective: Gain community insight into the demand-side barriers to health facility delivery at the Rohingya refugee camp.

Methods: Rohingya CHV’s interviewed thirty recently delivered mothers using a structured questionnaire. The survey included questions regarding location of delivery, assistance received, and opinions about health services. Participants were from the CPI catchment of camp 1W.

Results:

• 27% of births occurred at a health facility, 67% occurred at home with a TBA, at 6% occurred at home without any assistance.
• 38% of TBA’s received payment, 37% of TBA’s received a gift, and 25% received no payment or gifts for services.
• When asked, “Who decides where you give birth” 0% of recent mothers identified themselves.
• 47% of participants stated they believe the health facility would try their best to help them.
• 90% of participants stated they had visited a health facility for at least 1 ANC prior to delivery.

Conclusion:

Members of the Rohingya community are not involved in the planning of humanitarian-aid in the Rohingya refugee camps. Therefore, it is vital that organizations planning interventions in the community gain deeper insights into cultural beliefs and practices to inform programs. Rohingya community health volunteers (CHV) network is an effective resource to gain insight into the community. Insights gained from this survey include;

• TBA’s at the household continue to be the preferred method of delivery.
• TBA’s provide an opportunity for the promotion of facility-based delivery.
• In-law’s and spouse play the primary role in determining delivery location.  
• High Antenatal care (ANC) compliance rates alone are not correlated with facility deliveries.