Global Advocacy Initiatives. 

Tdh teams continued to contribute to improved access for children under five and pregnant women to good quality primary health services by working in conjunction with local health authorities and communities. With a focus on our flagship projects in perinatal and digital health, Tdh supported more than 4.2 million people with health projects in 14 countries, the majority of whom were children under five years old.

Following the nexus approach, Tdh integrated development and emergency response activities in Burkina Faso (the country in which we supported the highest number of people) through the eHealth Surge project. The project uses health data to strengthen local health services’ capacity to respond to the needs of communities in times of crisis and aims to improve communication and coordination between health and humanitarian response teams.

In Bangladesh, health activities were incorporated into Tdh’s humanitarian response for Rohingya refugees and the host community, with two primary healthcare centres established. Tdh finalised its global Digital Health Strategy, a key part of the expansion of our digital health projects and started rolling it out in Asia. We will continue this work at regional levels in 2024, starting with Africa. In 2023, three million children and members of their communities were supported by Tdh-trained people, mainly in the form of a medical consultation using digital tools.

Another significant achievement: the training of birth attendants in remote areas through the SIMESON project was made a part of Mali’s national health policy following several years of Tdh’s work in the country alongside long term advocacy efforts.

In 2024, Tdh’s health activities will increase, and the organisation will strengthen collaboration with local partners. We will prioritise reinforcing country health systems using digital health tools. Our teams will support health initiatives in the Middle East and North Africa region, consolidating long-standing projects in Afghanistan and designing health projects to respond to the current crisis in Gaza.

Some Flagship Projects. 

SIMESON

Tdh implemented a project funded by Marguerite Foundation, improving the quality of care at birth through a Mobile Medical Simulation Unit (The SIMESON Mobile Unit: Simulation of Essential Skills for Obstetrical & Neonatal care) in the health district of Kurigram, Bangladesh. It involves 21 health centers, including BEmONC and CEmONC facilities. This focuses on strengthening the access to primary health for rural communities in Kurigram and Barguna districts by improving physical infrastructure, health knowledge, and community management of Community Clinics (CCs) and Family Welfare Centres (FWCs). 

This project builds on that work through addressing strengthening the capacity of the secondary health care system to integrate with the primary health care system to provide access to safe delivery and other key MCH functions for rural communities. The project worked to build capacity in the Upazila Health Complexes (UHCs) and Family Welfare Centres and to improve community access through an integrated outreach process.

The results of this project were to (1) Strengthen human resource capacity in Kurigram district, to deliver improved perinatal health services to children and their mothers. (2) Greater community engagement with health service providers and facilities to ensure increased access to perinatal care services for children and their mothers.

Direct beneficiaries included:

• Approximately 20,000 women per year who deliver either at a government institution or with the support of a government trained health worker at home, and benefit from higher skilled medical providers.
• Approximately 20,000 children per year who benefit from births supervised by higher skilled medical providers.
• Approximately 110,000 women of fertility age who benefit from increased access to ANC and PNC information through outreach activities by the FWCs.
• 68 mid-wives and skilled birth attendants who are trained through the SIMESON approach.
• 92 Family Welfare Assistants who increase their knowledge on peri-natal health.

Grant Amount – CHF 250,000

BPRM

Tdh is currently implementing a BPRM funded project in the Cox’s Bazar region (Teknaf Upazila) of Bangladesh where the goal is to enhance the safety and dignity of refugees and host communities in the targeted areas through an integrated, multi-sectorial humanitarian response that will continue to increase access to quality health and nutrition, child protection and WASH services. The objectives are:

• Objective 1: To improve access to essential health and nutrition services through integrated clinic- and community-based services, focusing on women and children under 5.
• Objective 2: To increase access to quality WASH services by means of expanding facilities and strengthening community participation and awareness-raising activities.
• Objective 3: To enhance access to quality integrated child protection services in order to prevent and effectively respond to cases of child abuse and empower children to better protect themselves.

To improve access to essential health and nutrition services for women and children under 5, Tdh will continue to operate two PHCs in camps 26 and 27. Approximately 239,075 patients will be served in a year. Tdh will provide the full essential package of health services at Tdh’s two Primary Healthcare Centers (PHCs), including mental health support, basic emergency obstetric and new-born care (BEmONC), Integrated Management of Childhood Illness (IMCI), Non-Communicable Diseases (NCD) and nutrition. Tdh has expanded services by establishing one ENT, dermatology, ophthalmology, and dental unit near each of the PHCs. These clinics will serve the needs of both the Rohingya and host communities and will be supported by a total of 8 specialist doctors under the supervision of Tdh’s PHC Managers.

The established multi-skilled community outreach team will continue integrated community outreach activities, benefiting approximately 15,000 individuals. The team will update community- level service mapping and referral pathways and conduct sessions to disseminate information on health, child protection and hygiene awareness in both the camps and host communities. This approach has already demonstrated increased efficiency and reduced outreach costs.

Tdh will continue to provide high quality antenatal care (ANC) and postnatal care (PNC) including ultrasound services at both PHCs, as well as Sexual and Reproductive Health (SRH), 24/7 BEmoNC and family planning services. The project will adhere to key protocols such as Helping Babies Breathe and Helping Mothers to Survive. Training will be provided to physicians, nurses, and midwives on new-born treatment protocols. Exclusive breastfeeding will be promoted for children under 6 months along with appropriate supplementary feeding thereafter through ongoing outreach sessions delivered by the IYCF Counsellors. Through nutrition screening and the treatment and referral of children with severe and moderate acute malnutrition, Tdh’s outreach team will ensure 100% referral and follow up of malnourished children within the catchment area, while disseminating awareness-raising messages on nutrition.

Total Beneficiaries – Direct: 46,614. Indirect: 24,128. Total: 70,742

Grant Amount – USD 3,936,006

SWSC

Tdh is currently implementing a SDC funded project in the Cox’s Bazar district (Teknaf Upazila) of Bangladesh where the overall objective is to provide (a) Sanitation and Hygiene services in the camp and host community, and (b) strengthen health system related to Water Sanitation & Hygiene (WASH) through innovation and advocacy. Tdh is implementing WASH interventions (along with health and child protection) in the sub-district of Teknaf covering – WASH in 2 PHCs run by Tdh, Rohingya refugee camp and the host community – along with faecal sludge and solid waste management. 

The main activities of this project were:

In the camp and host community:

• Operation and maintenance of 620 toilets with faecal sludge management (including construction of 60 new toilets with solar light) for 12000 people also covering their solid waste management.  
• Hand washing stions with hygiene kits to 1000 households. 

In the Health Care Facilities (HCFs):

• Construction/renovation of toilets in about 5 HCFs; distribution of bins for solid waste management and installation of handwashing stations in about 12 HCFs. 
• Design of toilet will consider climate resilience, usability, and inclusiveness (male, female, child, people with physical disability, and menstrual hygiene).
• Sustainability of WASH facilities will be ensured through proper design that would need less maintenance and initiation of simple O&M policy.
• To address the scarce water situation, appropriate treatment methods will be tested for demonstration and advocacy.  
• Five of the HCFs will also be covered by the FSM and solid waste management implemented under the project.

The community part comprised of – 

(a) Camp: 12000 (2400 households) residents of Camp 26 and 27 that take sanitation services provided by the project (operation and maintenance of 620 toilets with FSM services including 60 new toilets with solar light that will be installed; and solid waste management services). In camp 26, F block, its 1000 households were provided the following items – hand washing stations (bucket with tap, cover, and stand), hygiene kits, and menstrual hygiene management kits. 

(b) Host Community: 760 inhabitants around camp 26 and 27 that all take their healthcare services from the Tdh operated PHCs. In addition to general hygiene related messages, the project promoted installation of dedicated handwashing stations.

At the HCFs

The project provided WASH services to 138,000 people, that seek healthcare from the targeted 17 HCFs. (13 community clinics x 6,000 population = 78,000, 02 Tdh primary healthcare centres x 20,000 = 40,000 and 02 union sub-centres x 10,00 population = 20,000 making a total population of 138,000). HCFs covered under system strengthening will be 17, those covered under the sub-district WASH in HCF plan (universal coverage roadmap).

Total Grant Amount – CHF 1,178,174.

• In 2014, Tdh gained formal partnership agreement with Revitalization of Community Health Care Initiative Bangladesh (RCHCIB), and Institute of Public Health & Nutrition (IPHN) under Directorate General of Health Services (DGHS), MoHFW for supporting to the community clinic activities including nutrition services, rehabilitation and renovation of community clinic building with extension of shed in front or side of the community clinic, installation of water and sanitation system in the clinics. 
• Tdh has been continuing formal partnership agreement with two directorates – Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP) under the ministry of health and family welfare (MoHFW) for the period of 2018 – 20. The partnership agreement with the MoHFW covers operation plan (OP) – MNCAH, MCRAH, NNS, CBHC for strengthening the health and family system in providing quality service delivery from different facilities – district hospital, Upazila health complex, community clinics, and Union Health & Family Welfare Center.

• Tdh has been continuing rehabilitation of community clinics, and Union Health & Family Welfare, necessary training for the service providers – CHCP, HA, FWA, FWV, Midwife/Nurses on; maternal and neonatal cares, basic nutrition training including screening of under five children and PLWs, IYCF and Growth monitoring of under five children, Facility level SAM management, Community based management of severe acute malnutrition (CMAM), BCC and counseling.