Improving the provision for gynaecological health care in Bangladesh using Essential Gynaecological Skills implementation package: a stakeholder-driven approach in public health facilities.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.