Abstract

icddr,b in collaboration with JH-IIRU implemented a study to evaluate the effectiveness of interventions including community crèches in preventing drowning and other injuries among under-5 children in Bangladesh, 2013-till date. As part of the project different approaches were tested for sustaining community crèches. This paper describes the initiatives taken and challenges faced in sustaining crèches in four sub-districts of rural Bangladesh. Tested three models include – A. Pay-for-service (subsidized and unsubsidized), B. Parent-led cooperative agreement, C. Integration into primary health care centre (PHC)/primary schools. Feasibility was measured by the ability to generate partial or full funds to cover variable and fixed costs and support for overseeing crèche activities. A total of 174 crèches were sustained for six months. In the pay-for-service subsidized model, the expenditure for 65 selected crèches was shared by the project and community. Community essentially funded the variable costs. In the unsubsidized model, 68 crèches were completely commercial and supported by community leaders. Model B was not tested as parents did not agree to form a defined cooperative. In model C, Crèches could not be integrated with any GoB programme, but 41 crèches were personally monitored by union chairmen, councilors, school teachers. The average attendance in the crèches across all the models was about 65%. Communities expressed need for additional interventions such as monthly health check-up for children, issuing health card to help avail GoB healthcare services, training of crèche mothers on first-aid, government basic health worker package. Other challenges included inability to involve a central ministry, lack of MoU with GoB and insufficient enthusiasm from PHC and primary schools. In conclusion, to sustain crèches a multi-sectoral approach is required with a ministry to champion the activities. This requires development of plans detailing funding, partnerships, and approaches.