Using Evidence & Expertise to Build a Sustainable Health Service Delivery Network

The USAID-DFID nongovernmental organization (NGO) Health Service Delivery Project (NHSDP) is USAID/Bangladesh’s flagship clinical service delivery project, offering integrated family planning and health service coverage to 24 million people (17% of the country's population). During NHSDP, USAID and its partners used CLA to continuously improve project outcomes, successfully shift the project's focus to meet the needs of the poor and underserved in Bangladesh, and design an innovative follow-on project with an emphasis on service quality, sustainability, adaptive management, and health financing for the poor. In addition to robust monitoring and evaluation (M&E), the project collected a technical evidence base from a range of sources that helped to justify changes made during the project and provide evidence for best practices going forward. Technical evidence included a baseline impact evaluation, findings from a Regional Inspector General Audit, an assessment of universal health coverage and health financing in Bangladesh, a costing assessment of the essential services package, and a strategic study on strengthening the financial efficiency and sustainability of Bangladesh's health sector. In addition, the team used a collaborative approach throughout the project, working closely with NHSDP implementing partners, service providers, government representatives, and private sector stakeholders to collect feedback and collectively design sustainable solutions to address the evolving health service needs of Bangladesh's population. In 2016-2017, USAID/Bangladesh conducted its first Broad Agency Announcement (BAA) for the NHSDP follow-on design, which allowed external partners to co-create the project alongside USAID with input from a series of external experts. Pathfinder International, which leads the NHSDP contract implementation, emerged as a true leader and trusted partner in all aspects of CLA. They identified key gaps areas for improvement, showed agility and flexibility in their implementation, and initiated important studies to create a viable vision for the project's future beyond NHSDP.