Upload File

health transcends poverty: the bangladesh experience

  • Home
  • Documents
  • Health transcends poverty: the Bangladesh experience
2
Key messages • Bangladesh became a nation in 1971 with the transition to independence acting as an important catalyst for health reform. • Health policy in Bangladesh has endured political change while constantly adapting to address new issues. • As a young country Bangladesh was a pioneer in its strong national family planning programme, which resulted in a dramatic drop in fertility. • Government engagement with non- governmental organisations (NGOs) and non-state providers has helped to meet the needs of a large population. • Bangladesh is an innovator in health policies and in testing and adapting low- cost technologies in the health sector. • Other contributing factors to Bangladesh’s health achievements have been improved literacy, economic development and disaster preparedness. First published in 1985, the Good health at low cost report sought to describe how some developing countries were able to achieve better health outcomes than others with similar incomes. An iconic publication of its day, it highlighted the linkages between the wider determinants of health and their impact on health outcomes using country case studies. In an extension to the original analysis, recent research explores five new countries asking why some developing countries are able to achieve better health outcomes. With chapters focusing on Bangladesh, Ethiopia, Kyrgyzstan, Tamil Nadu (India) and Thailand, ‘Good health at low cost’ 25 years on has identified a series of inter-linking factors, within the health system and beyond. This first briefing in the series focuses on findings from Bangladesh. ‘Good health at low cost’ 25 years on During the past 40 years, Bangladesh has made enormous advances with basic population and health indicators, which are now on a par with, or better than, its neighbours who have higher per capita income. Bangladesh’s health gains can be attributed to a series of effective health sector strategies and policy processes, and to a strong emphasis on delivery of health and family planning services at the community and household level. Bangladesh has promoted low-cost targeted technologies and proven interventions and policies that have played a significant role in improving health outcomes. Bangladesh’s health gains have been made with relatively low total health expenditure when compared regionally, 3.4% of GDP or US$ 12 per capita in 2007. Achieving better health in Bangladesh ‘Good health at low cost’ 25 years on What makes an effective health system? Page 01 ‘Good health at low cost’ 25 years on What makes an effective health system? Since becoming a nation in 1971, Bangladesh has made huge strides in improving its population’s health. Compared with other countries in the region, Bangladesh has among the longest life expectancy for men and women, the lowest total fertility rate and the lowest infant, under-5, and maternal mortality rates. Between 1994 and 2008, life expectancy increased from 58 years to 66 years. Infant mortality has declined dramatically from 85 deaths per 1000 live births in the late 1980s to 52 deaths per 1000 live births between 2002 and 2006. ere has been a dramatic decrease in total fertility among women aged 15–49 years. Huge improvements in under-5 mortality mean that Bangladesh is on track to achieve MDG 4 to reduce under-5 mortality. Paths to Success Our research shows that a fundamental factor in better health outcomes in Bangladesh has been political continuity. Bangladesh has demonstrated a strong commitment to health as a national priority and as a human right. is political commitment has transcended Chittagong Dhaka Khulna NEPAL MYANMAR BANGLADESH INDIA BHUTAN Health transcends poverty: the Bangladesh experience © 2006 Bangladesh Center for Communication Programs, Courtesy of Photoshare

Upload: others

Post on 11-Feb-2022

4 views

Category:

Documents


0 download

Report

TRANSCRIPT

Page 1: Health transcends poverty: the Bangladesh experience

Copyright © Westminster European 2011

Key messages

• Bangladeshbecameanationin1971 withthetransitiontoindependence actingasanimportantcatalystfor healthreform.

• HealthpolicyinBangladeshhas enduredpoliticalchangewhile constantlyadaptingtoaddressnew issues.

• AsayoungcountryBangladeshwas apioneerinitsstrongnationalfamily planningprogramme,whichresultedin adramaticdropinfertility.

• Governmentengagementwithnon- governmentalorganisations(NGOs) andnon-stateprovidershashelpedto meettheneedsofalargepopulation.

• Bangladeshisaninnovatorinhealth policiesandintestingandadaptinglow- costtechnologiesinthehealthsector.• Othercontributingfactorsto Bangladesh’shealthachievements havebeenimprovedliteracy,economic developmentanddisasterpreparedness.

First published in 1985, the Good health at low cost report sought todescribe how some developing countries were able to achieve betterhealth outcomes than others with similar incomes. An iconic publicationof its day, it highlighted the linkages between the wider determinantsof health and their impact on health outcomes using country casestudies. In an extension to the original analysis, recent research exploresfive new countries asking why some developing countries are able toachieve better health outcomes. With chapters focusing on Bangladesh,Ethiopia, Kyrgyzstan, Tamil Nadu (India) and Thailand, ‘Good healthat low cost’ 25 years on has identified a series of inter-linking factors,within the health system and beyond. This first briefing in the series focuses on findings from Bangladesh.

‘Good health at low cost’ 25 years onDuringthepast40years,Bangladeshhasmadeenormousadvanceswithbasicpopulationandhealthindicators,whicharenowonaparwith,orbetterthan,itsneighbourswhohavehigherpercapitaincome.Bangladesh’shealthgainscanbeattributedtoaseriesofeffectivehealthsectorstrategiesandpolicyprocesses,andtoastrongemphasisondeliveryofhealthandfamilyplanningservicesatthecommunityandhouseholdlevel.Bangladeshhaspromotedlow-costtargetedtechnologiesandproveninterventionsandpoliciesthathaveplayedasignificantroleinimprovinghealthoutcomes.

Bangladesh’shealthgainshavebeenmadewithrelativelylowtotalhealthexpenditurewhencomparedregionally,3.4%ofGDPorUS$12percapitain2007.

Achieving better health in Bangladesh

‘Good health at low cost’ 25 years on What makes an effective health system? Page 01

‘Good health at low cost’ 25 years onWhat makes an effective health system?

Sincebecominganationin1971,Bangladeshhasmadehugestridesinimprovingitspopulation’shealth.Comparedwithothercountriesintheregion,Bangladeshhasamongthelongestlifeexpectancyformenandwomen,thelowesttotalfertilityrateandthelowestinfant,under-5,andmaternalmortalityrates.Between1994and2008,lifeexpectancyincreasedfrom58yearsto66years.Infantmortalityhasdeclineddramaticallyfrom85deathsper1000livebirthsinthelate1980sto52deathsper1000livebirthsbetween2002and2006.Therehasbeenadramaticdecreaseintotalfertilityamongwomenaged15–49years.Hugeimprovementsinunder-5mortalitymeanthatBangladeshisontracktoachieveMDG4toreduceunder-5mortality.

Paths to SuccessOurresearchshowsthatafundamentalfactorinbetterhealthoutcomesinBangladeshhasbeenpoliticalcontinuity.Bangladeshhasdemonstratedastrongcommitmenttohealthasanationalpriorityandasahumanright.Thispoliticalcommitmenthastranscended

Copyright © Westminster European 2011

Chittagong

Dhaka

Khulna

NEPAL

MYANMAR

BANGLADESH

INDIA

BHUTAN

Health transcends poverty:the Bangladesh experience

© 2006 Bangladesh Center for Communication Programs, Courtesy of Photoshare

Page 2: Health transcends poverty: the Bangladesh experience

‘Good health at low cost’ 25 years on What makes an effective health system? Page 02

Further readingChapter 3, Health transcends poverty: the Bangladesh experience. In Balabanova D, McKee M and Mills A (eds). ‘Good health at low cost’ 25 years on. What makes an effective health system? London: London School of Hygiene & Tropical Medicine, 2011. Available at http://ghlc.lshtm.ac.uk

AcknowledgementsICDDR,B gratefully acknowledges the contributions of the Rockefeller Foundation and of our partners from the London School of Hygiene & Tropical Medicine for making this work possible. The authors are grateful to the many past and present health leaders in Bangladesh who served as key informants to this work as well as the grassroots level workers who shared their valuable time and knowledge with us.

The opinions expressed are those of the authors and do not necessarily reflect the views of the London School of Hygiene and Tropical Medicine.

Readers are encouraged to quote material from this briefing in their own publications by acknowledging the original source.

This policy briefing was edited by Pamoja Consulting www.pamoja.uk.com

politicalpartypoliticsand,despiterapidchangesinthepoliticallandscapeandinkeyactors,manypolicieshavebeensustainedforasignificantperiodoftime.AnotherfactorinBangladesh’ssuccesshasbeenthegovernment’sabilitytocollaboratewithnon-stateactors.ThegovernmentviewsNGOsasawayofextendingtheirreach,particularlyintheimplementationofnationalstrategiesandpolicies.NGOshavedevelopedstrongcapacityandinnovativedeliverymodelsthathavepromptedatwo-waylearningexchangebetweengovernmentandnon-governmentalentities.

Policiesthathavebeenpivotalinimprovingthepopulation’shealthinclude;thePopulationPolicy(1976),whichpioneeredacommunitybasedinterventionthatbroughtfamilyplanningservices,includingcontraceptivesandeducation,directlytoindividualhouseholds.TheDrugPolicy(1982),whichincludedcategorisingandprocuringessentialmedicinesandtheestablishmentoftheEssentialDrugsCompanyLimited.Thisledtothedomesticproductionofdrugsappropriatetolocalneeds,savingthecountryapproximatelyUS$600000million.Finally,theSectorWideApproach(SWAp)(1998),facilitatedbytheWorldBank,hasreducedduplicationandfinancialwasteinthehealthsectorandhassimplifiedtheprocessofprogrammedevelopmentandimplementation.

Bangladesh’shealthsystemwasdevelopedalongtheHealthforAllmodelwithnationwidenetworksofhealthcarefacilities,

familyplanningandchildwelfarecentresandanimmunisationprogramme.Insightfulinvestmentsinhumanresourcesandinnovativedeliverymethodshaveresultedinuniversalcoverageofprimaryhealthcareservices;with21,000healthassistantsand23,500familywelfareassistantsservingcommunitiesandruralhouseholdsacrossthecountryprovidinghomevisits.

Bangladeshisagloballeaderindevelopinglow-costinterventionssuchastheuseofzincinthetreatmentofchildhooddiarrhoea,oralrehydrationsolution,deliverykits,tetanusvaccinationsforpregnantwomen,andiodizedsalt.Theseinterventionshavebeenrolledoutlocally,scaledupandevenusedinotherdevelopingcountries.Bangladesh’sstrongemphasisonchildhoodimmunizationhasprovidedalmostuniversalaccess.

Finally,non-health,povertyreductioninitiativeshaveplayedanimportantfactorinBangladesh’sprogress.Participationinmicrocreditprogrammeshasbeenconnectedtobetterchildsurvivalandtheexpansionofelectricitycoverage,androadinfrastructurehasassistedtherolloutofimmunizationprogrammestoruralareas.Anincreaseinnetprimaryeducationenrolmentfrom74%in1991to87%in2005hasresultedinimprovedliteracyrates.Theeconomicandsocialpositionofwomenhasimprovedinlinewitheducation,income-generatingactivities,accesstomicrofinanceandemploymentinthegarmentindustry.Bangladesh’sdisasterpreparednesshasshowntheworldthatithastheabilitytoplan,coordinateandimplementcrisisaction.Thisdemonstratesthegoodgovernancestructuresthatexistacrosspublicsectors.

Lessons learned and future challengesConsideringthatBangladeshcameintobeingasoneofthepoorestnationsintheworld,ithasmaderemarkableprogressinimprovingthehealthofthepopulationsince1971.Thishasbeenachievedagainstabackdropofstrongpoliticaldirection,leadershipandeffectivehealthstrategies,whichhasdriventhehealthagendaforwardresultinginawidereachingprimaryhealthprogramme.Notablesuccesseshavebeenachievedinreducingfertility,andimprovingaccesstovaccinationsandotherbasicinterventions,oftendeliveredbyNGOs.

Theseriesofinter-linkingfactors,asintheotherstudycountries,thathavemadeBangladesh’shealthsystemsuccessfulinrealisingbetterhealthforitspopulationcanbeexpressedbyfourwordsallbeginning

withC–referredtoasthe4C’s.TheyareCapacity(theindividualsandinstitutionsnecessarytodesignandimplementreform),Continuity(thestabilitythatisrequiredforreformstosucceed),Catalysts(theabilitytoseizewindowsofopportunity)andContext(theabilitytotakecontextintoaccountinordertodevelopappropriateandrelevantpolicies).

Whilegreatprogresshasbeenmade,newapproachesthatincorporateinnovation,whilerespondingtochangingculturalandsocioeconomicrealities,mustbedeveloped.InordertocontinuemakingimprovementsinthehealthofthepopulationBangladeshmustre-committorelativelylow-costandlesscomplexinterventionsthataddressanincreasinglyagingpopulationandasignificantincreaseinnon-communicablediseases,whicharecurrentlynotprovidedforinthepublichealthcaresystem.Thenumberofskilledbirthattendantsneedsbeincreasedandimprovementsmadeinthedeliveryofbasichealthinterventionstohard-to-reachurbanslumcommunities.

© London School of Hygiene & Tropical Medicine, 2011

© 1

996

Har

vey

Nel

son,

Cou

rtesy

of P

hoto

shar

e

© 2

002

Sheh

zad

Noo

rani

, Cou

rtesy

of W

orld

Ban

k


Bangladesh Poverty Assessment: Building on Progress

Growth trend of poverty in bangladesh

Bangladesh Poverty Assessment · Bangladesh has an inspiring story of reducing poverty and advancing develop-ment. Since 2000, the country has reduced poverty by half. In the last

Sustainable Investment to End Poverty: Bangladesh Perspective

Poverty and it's impact on bangladesh

Extreme poverty in Bangladesh: lessons, learnings and reflections

Poverty and Inequality in Bangladesh

Poverty Reduction strategy in Bangladesh : Estimating and

Growth, Poverty Reduction and Inequality in Bangladesh€¦ · Growth, Poverty Reduction and Inequality in Bangladesh –feasible pathways to zero-poverty by 2030 Willem van der Geest

Bangladesh Country Poverty Assessment Report

Poverty Problem of Bangladesh & It’s Solution

Trends of poverty in bangladesh

Poverty Reduction strategy in Bangladesh : Estimating and ... · Welcome to the presentation on Poverty Reduction strategy in Bangladesh : Estimating and Monitoring of Poverty Mu

Renewable Energy for Poverty Alleviation- Bangladesh Perspe

Partnership for Development: Alternative Approaches to ... Approaches to Poverty Alleviation in Bangladesh ... in Bangladesh as poverty alleviation ... in Bangladesh’, 13th International

Urban Poverty in Bangladesh A Country with Enormous Potentials Dr. Salehuddin Ahmed Bangladesh

Practices of Poverty Measurement and Poverty Profile of Bangladesh

Bangladesh Poverty Assessment - World Bankdocuments.worldbank.org/curated/en/793121572582830383/... · 2019-11-04 · V Foreword Bangladesh has an inspiring story of reducing poverty

Zakat and Poverty Alleviation - Bangladesh

Poverty and alliviation in Bangladesh

Striving for a Caring, Resilient and Poverty Free Bangladesh · Striving for a Caring, Resilient and Poverty Free Bangladesh Islamic Relief Bangladesh. Our vision We envisage a caring

Assignment on Poverty Alleviation in Bangladesh

Overcoming Poverty in Bangladesh: Search for a New Paradigm 1.2 Issue Saminul Islam.pdf · poverty reduction in Bangladesh. POVERTY DISCOURSE IN BANGLADESH Although poverty of this

Bangladesh Poverty (1)

Poverty Reduction strategy in Bangladesh : Estimating and ... · Bangladesh Poverty Database: An Effective Way to Identify the Hardcore Poor Households Poverty reduction is the priority

Thesis on Rural Poverty Alleviation Programe in Bangladesh

Bangladesh Poverty Assessment

Chittagong Health transcends poverty: the Bangladesh ...rpcc.dghs.gov.bd/pdf/7_Good_health_at_low_cost.pdf · the establishment of the Essential Drugs Company Limited. This led to

Digital Bangladesh for Poverty Reduction and Good Governance

Impact of Globalization on Poverty in Bangladesh

Poverty in Bangladesh: Building on Progresssiteresources.worldbank.org/BANGLADESHEXTN/...Report No. 24299-BD Poverty in Bangladesh: Building on Progress December, 2002 Poverty Reduction

Eradicating Extreme Poverty in Bangladesh: National

Trends and Patterns of Poverty in Bangladesh

Poverty of bangladesh

PRC's Poverty Reduction Success: Implications for Bangladesh (Presentation)