Bangladesh An Example In Child And Maternal Health

Reduced Rate of Child and Maternal Mortality: Keeping Everyone Safe

Bangladesh made the most significant progress in reducing child mortality. In 2010, the UN recognized the country for its exemplary progress towards Millennium Development Goal (MDG) 4 in child mortality, and for being on-track to achieve the maternal mortality reduction goals of MDG5. In November, 2013, a British medical journal, Lancet described Bangladesh as an example of “good health at low cost”.

Progress in infant, child, and maternal mortality has been substantial and steady during the past four decades. The steepest gains have been made in maternal mortality and mortality of children younger than 5 years, and slower gains have occurred in infant mortality. Bangladesh has the lowest under-5 child mortality rate in South Asia, 41 per 1000 live births from 144 in 1990. Infant mortality rate slide down to 32 per 1000 live births in 2012 from 40 in 2009. According to World Bank, neonatal mortality rate stood at 24.4 per thousand live births. According to the British medical journal, Lancet, these rates place Bangladesh as the leader in health scenario of South Asia.

Maternal mortality was reduced from 574 deaths per 100 000 live births in 1991, to 170 deaths per 100,000 live births in 2013. The rate was 194 per 100,000 live births in 2010. Government has set target to reduce the mortality to 145 by 2015 and 63 by 2030. As a surprise to many skeptics, Bangladesh also had pronounced reductions in birth rate (fertility) from about 7 children per woman in 1970, 2.4 in 2007 to 2.24 children per woman in 2012.

Use of contraceptives in prevention of unwanted pregnancy increased from less than 10% of all couples in 1970, to 61% in 2010 (modern contraceptive 52%; traditional method 9%). This great reduction of fertility rate undoubtedly contributed to the speed and magnitude of improvements in mortality, particularly in women.

Reduction in fertility rate contributed in slowing down the population growth. The population growth rate is now 1.59 percent. This achievement has also contributed in improving maternal mortality rate. Because of these mortality and fertility rate, major causes of death have also been shifted. Countries with similar epidemiology and demography are way behind Bangladesh in declining infectious diseases and non-communicable chronic diseases.

Over the past 20 years, Bangladesh has made some of the biggest achievements in the basic condition of people’s lives ever seen anywhere. Between 1990 and 2010, life expectancy rose by 10 years, from 59 to 69 years. The life expectancy rate of the people has been increased to 70.3 years by 2012 with 68.2 years for male and 70.2 for female. The rate was 61 years on an average in the year 2000. It has been possible because of the growing rate of using contraceptives and family planning. Peoples’ income in rural areas has been steady and satisfactory which has also contributed here.

Factors Behind the Success

The achievements in health sector didn’t happen overnight. Forming a modern health system, increasing education of women, scaling up of innovations are factors that contributed.

Easy Access to Quality Health Service: Better Service in Less Time

Studies showed that rural people were deprived of quality health. To address the situation Bangladesh Awami League established 10,723 community clinics around the country in 1996. It was targeted to provide a clinic for every 6000 people. These community clinics are the distinctive example of effective management of government facilities with active engagement of local people. By 2013, the number of the community clinics has reached to 15,500 along with 13,500 health care service providers. More than 120 million patients have received services from these clinics and medicines.

Increased Number of Health Workers: Bringing Service at Doorstep

To provide quality service government has appointed 160,000 community health workers to upazilla and union levels. These paraprofessionals are providing primary health services which were previously provided by credentialled health professionals. There are thousands of informal health workers, private medicine retailers throughout the rural countryside who are working alongside the professionals service providers.

Countrywide Immunization Program: Ensuring Healthy Children

The current Awami League government on its last term successfully increased immunization program throughout the country. Government organized the biggest immunization program for Measles-Rubela vaccination campaign. The 3-week long campaign ended on 13th February, 2014 which engaged thousands of vaccinators and covered 170,000 schools and 150,000 immunization centers. Bangladesh has been declared Polio-free on March, 2014 along with other 10 countries. World Health Organization said Bangladesh followed ‘Think Globally, Act Locally’ which resulted in this much awaited outcome.

Strengthening Service Delivery

The Ministry of Health and Family Welfare (MOHFW) is implementing the Health Population and Nutrition Sector Development Program (HPNSDP) for a period of five years from July 2011 to June 2016. This program has taken initiatives to strengthen delivery of health, population and nutrition (HPN) services, with considerable increase in service provision at the lowest tier (Community Level) as a result more people are able to access a comprehensive package of health services. The Government has committed to end preventable child deaths by taking up an accelerated program through scaling up high impact maternal, neo-natal and child healthcare (MNCH) interventions. Access to diagnosis and treatment of tuberculosis and drug resistant tuberculosis has increased significantly resulting in reduction of TB mortality.

Looking Ahead

The current Bangladesh government has now embarked on the plan of designing and implementing a universal health insurance scheme. The plan envisages quality healthcare for all without financial hardship to any. The first target will be people below the poverty line, some 48 million now. The government will pay their premiums as subsidy. For this programme, the government has designed the Healthcare Finance Strategy 2012-2032 and currently a law is being drafted. Before the formal launch of the programme, a four-year pilot scheme will be run as a test case in three Upazilas of Tangail from the end of 2014. Under the scheme, free health cards will be issued to around 100,000 households living below the poverty line.

Additionally, the human resources in the health sector have also been revamped. In the largest recruitment drive in the public healthcare sector, the government has newly appointed 6,221 new doctors to ensure health services at everyone’s door. The Prime minister has personally instructed the Health Ministry to appoint 10,000 new nurses for dynamic healthcare services. Another 4,133 assistant surgeons are to be appointed on ad-hoc basis too.

To reduce the maternal mortality rate and to achieve MDG-5, government has taken several initiatives, one of which is to provide 24/7 service for the pregnant women around the country. According to Family and Health Welfare Ministry, government is to enable 4,000 family welfare centres (FWC) to provide assistance and service round-the-clock.

Government is also planning on developing a national electronic database titled “Civil Registration and Vital Statistics (CRVS)” from next year to record and document vital health information of people.