Jabeen Sabrina, Hasan Mehedi, Acharya Santanu, Rahman Md Mahiur, Rafii-Tabar Elizabeth, Hall Sarah, Dewan Farhana, Alim Azizul, Akhter Sayeba, Chowdhury Shahin Rahman, Mahmud Mustufa, Prodhan Md Jahangir Alam, Rouf Salma, Chowdhury Sameena, Nasreen S K Zinnat Ara, Hossain Fawzia, Begum Ferdousi, Chandrima Rubaiya Matin, Al-Zubayer Md Akib, Sarwar Golam, Khan Mahbuba, Akhter Farida, Rubayet Sayed, Ahmed Anisuddin, Shehata Hassan, El Arifeen Shams, Thakar Ranee, Rahman Ahmed Ehsanur
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Royal College of Obstetricians and Gynaecologists, London, UK.
J Glob Health. 2025 May 5;15:04132. doi: 10.7189/jogh.15.04132.
Gynaecological health and its related service delivery have long been neglected in Bangladesh. In response to the high burden and improvements in the provision of gynaecological health care, the Essential Gynaecological Skills (EGS) implementation package was developed. It includes comprehensive in-service training for upskilling the non-specialised health care providers and introduces the first structured data recording system for gynaecology in the outdoor of public health facilities in Bangladesh. We outline how the stakeholder engagement process was integrated into the implementation research related to this pioneering initiative.
Based on literature review, expert consultation and prior experience, we adopted the identification, sensitisation, involvement, and engagement (ISIE) framework of stakeholder engagement and process documentation. After identifying national and local level stakeholders via a power-interest mapping exercise, we sensitised them to the gaps in gynaecological health service delivery. High-power and high-interest stakeholders were involved and engaged in developing the EGS implementation package, which was then introduced in selected public health facilities and evaluated through implementation research.
Acknowledging the urgent need for gynaecological health care services, the identified and sensitised stakeholders supported the development of the EGS implementation package. This resulted in the development and implementation of the EGS implementation package under the Government of Bangladesh's leadership, highlighting government ownership. These outcomes reflected the potential for scalability and sustainability of the package. However, stakeholder engagement remains a time and resource-intensive process that requires an innovative, research-backed approach with committed implementation.
Our experience of using the ISIE framework showcased the potential of this framework in achieving sustainability and scalability at the national level. However, further initiatives from the government can ensure nationwide scale-up, setting an example for other lower and middle-income countries.
在孟加拉国，妇科健康及其相关服务的提供长期以来一直被忽视。为应对妇科医疗保健的高负担问题并改善其服务提供情况，制定了基本妇科技能（EGS）实施包。它包括为非专业医疗保健提供者提升技能的全面在职培训，并在孟加拉国公共卫生设施的户外引入了首个结构化的妇科数据记录系统。我们概述了利益相关者参与过程如何融入与这一开创性举措相关的实施研究中。
基于文献综述、专家咨询和以往经验，我们采用了利益相关者参与和过程记录的识别、宣传、参与和介入（ISIE）框架。通过权力 - 利益映射活动确定国家和地方层面的利益相关者后，我们向他们宣传了妇科健康服务提供方面的差距。高权力和高利益的利益相关者参与并介入了EGS实施包的制定，该实施包随后在选定的公共卫生设施中引入，并通过实施研究进行评估。
认识到对妇科医疗保健服务的迫切需求，已识别并得到宣传的利益相关者支持EGS实施包的开发。这导致在孟加拉国政府的领导下开发并实施了EGS实施包，突出了政府主导。这些成果反映了该实施包具有可扩展性和可持续性的潜力。然而，利益相关者参与仍然是一个耗时且资源密集的过程，需要一种创新的、有研究支持的方法以及坚定的实施。
我们使用ISIE框架的经验展示了该框架在国家层面实现可持续性和可扩展性的潜力。然而，政府的进一步举措可以确保在全国范围内扩大规模，为其他低收入和中等收入国家树立榜样。
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