CONSTRAINTS AND CHALLENGES. .1 The Consultant will be required to become familiar with the project site and obtain local information as required.
CONSTRAINTS AND CHALLENGES. Challenges and constraints that were beyond the control of the ACCESS/MCHIP Project to remedy were well documented in the Mid-Term Evaluation and these pretty much continued through the LOP. Rapid turn-over of SMOH and facility staff, as well as insufficient numbers of skilled birth attendants continued to plague the project. The FMOH’s MSS scheme and continued single-year posting of newly graduated medical doctors (NYSC) provided some additional staff, but placement and deployment of staff remained outside the influence of the project. Continual turn-over required continuous skills and SBM-R training. Insufficient basic infrastructure (facilities, electricity and water), constant shortages of equipment and stock-outs of commodities, drugs and contraceptives, particularly the IUD and Jadelle, continued to constrain achievement of project objectives. Several challenges and constraints were partially addressed through the project with some success. The project was able to make impressive inroads in creating awareness, acceptance and demand for FP and EmONC services in the very conservative Northern area of the country. Faced with poor record keeping and non-existent data management systems in most of the project-supported areas, the ACCESS/MCHIP Project was also able to put into place procedures and tools for improved record keeping and data management at the state level in all three project states.
CONSTRAINTS AND CHALLENGES. .1 The Consultant is expected to be familiar with prairie setting materials and construction techniques and will be required to become familiar with the project site and obtain local information as required.
CONSTRAINTS AND CHALLENGES a) Constraint: Inadequate and Unmotivated MHS Issue: With the exception of Rangpur and Joypurhat Municipality, the remaining six municipalities are facing up to a 70% shortage of MHS. One or more of the following situations are true for the five municipalities facing shortages: Not enough positions have been allocated; positions are vacant; MHS staff are sharing their time with other departments. In addition, many MHS are receiving low pay and/or their pay is often delayed for months. Although many MHS staff, especially those trained as trainers/facilitators, are showing increasing pride in their positions, the significant increase in responsibilities resulting from MHPP interventions combined with low and/or irregular pay has become a major demotivating factor for a large number MHS. Exacerbating the situation, are is the fact that 50% of MHS who are on Master Roll, meaning they are contractors with no benefits and no job security. The position of Medical Officer, which serves as the head of the MHD, has caused the most concern, as it is often left vacant due to the lack of opportunity for upward mobility, and worse no one is put in charge during the interim. Two years ago XxXXXX recruited Medical Officers for all nine municipalities (including original two), today five of those positions are vacant. Impact: The shortage and lack of motivation of MHS staff is impeding the timely implementation of activities. The slow progress in training CHVs (less than 40% have been trained to date) is one example of activities negatively impacted by the shortage of staff. The lack of Medical Officers and therefore an effective leader for the MHD has also slowed progress and effected oversight of WHCs. Actions to Overcome: Continuous advocacy by the MHPP team, at Municipal and higher levels, has yielded some results as follows: - The Municipal Authority’s of several municipalities approved the rearrangement of responsibilities, relieving some congestion - Regular MHD meetings have resulted in increased job satisfaction by creating a forum for staff to voice concerns (i.e. lack of desks or allotted space to work) - Nilphamari municipality has made an official request to Mo LGRD for additional staff Advocacy to ensure regular pay for MHS is ongoing.
