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Bangladesh with a population of more
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than 158 million people it is one of the
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world's poorest countries an estimated
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40% of its population live on less than
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$1 a day and over the past three decades
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Bangladesh has experienced one of the
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highest Urban population growths in the
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world an estimated 37% of daca's
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residents live in overcrowded slums
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often without access to Safe Drinking
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Water or adequate nutrition and without
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Primary Health Care Services the picture
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is similar across the entire country
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today uh Bangladesh we know that Daka is
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one of the fastest growing city in the
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world and by 2050 I think it will be
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third largest city in the whole world
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the major challenge is is fa will be
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facing the migration from rural to arban
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people do come to Dhaka because of the
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jobs because their livelihoods and this
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migration is putting a huge threat in
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terms of infrastructure and particularly
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on health issues and in the slam areas
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the major challenge is the
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infrastructure we do not have any
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infrastru the Islams are not even
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recognized they do not have access to
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Primary Health Care they do not have
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access to Water Sanitation and this
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poses a major threat not only to the
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Islam people it poses a major threat to
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the country's development as a
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whole and yet amongst all this the
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country has made enormous advances in
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life expectancy child health literacy
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and disaster
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preparedness over the last 40 years the
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fertility rate has been dramatically
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reduced and high levels of immunization
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coverage have been achieved which in
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turn has led to unprecedented reductions
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in maternal and child mortality
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it's even on track to achieve mdg5 to
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improve maternal
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Health every mother of the country I
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think every man or woman know the
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vaccination program we get a success
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story by combined effort of the award
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people and also the activity uh through
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from the government side and the
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contribution of the
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voluntary Bangladesh's basic population
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and health indicators are on a par with
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or better than its
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neighbors these achievements have been
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made with low total health expenditure
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and even lower Health expenditure
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financed by the public
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sector this means that Bangladesh has
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managed to achieve relatively good
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health at a low cost over the last 3 to
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four decades and is featured in the
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recently public published good health at
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lowcost book edited by the London School
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of hygiene and tropical medicine and
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funded by the Rockefeller
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foundation in Bangladesh the rate of
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homebased delivery continue to be
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extremely high over 80% and um
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International programs donor assistance
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has not changed that people continue to
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deliver at home with traditional birth
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assistance and this is the cultural norm
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however what has changed is access to
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emergency obstetric care which is now
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increasingly better this is due to
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better facilities for secondary care
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better practices better treatment
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protocols better quality and better
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roads so people when they need to have
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access to emergency obset care they're
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able to obtain this care this has led to
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dramatic improvements in outcomes so
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women are much less likely to die in
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child birth than they were 20 years ago
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but how did Bangladesh do it what
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factors were at play and is there
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anything the rest of the world can learn
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from what has become known as the
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Bangladesh Miracle as a citizen of the
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country we can feel proud in the south
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Asia and we can we are at par or
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outshine the neighboring countries in
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terms of the uh declining fertility in
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reducing metal mortality and child
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mortality because of the right steps
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taken by the each successive government
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right from the' 70s Bangladesh has an
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amazingly resilient health system that
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has
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transcended poverty over a long period
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of time and it has U also survived all
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political changes since Independence
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over the last 40
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years interestingly it has uh all the
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all the health health sector
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successes uh were
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achieved much ahead of economic
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development of the country this is what
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we call Bangladesh
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Miracle after a violent and bloody war
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of Liberation Bangladesh achieved its
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independence in
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1971 but it came at a
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price the infrastructures were already
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uh in datus because of the long War
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throughout the period of 1990
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1971 U roads Bridges uh River
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communication rail communication
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everything was
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tosyy other challenges facing the new
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nation were frequent natural disasters
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including seasonal flooding Cyclones and
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devastating famines such as that of
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1974 mortality rates were high life
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expectancy and literacy were low and
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poverty was rampant the fledgling
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government also suffered from widespread
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inefficiencies on the political side uh
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this was a provincial
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government assuming uh the role of a
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national
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government so there were everybody
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suffered from
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inexperience yet in
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1972 a political commitment to health
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was enshrined in the new Constitution
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and since then the health of the
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country's population has been a
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political
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priority Bangladesh has transcended all
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political changes over time Bangladesh
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health system has transcended poty for
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for a prolonged period of
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time Bangladesh has
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been uh Lucky in being able to maintain
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reasonable continuity of policy and
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programs irrespective of political
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changes throughout the period whether it
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was elected government or non-elected
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government or whether a party which was
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elected once was defeated the next
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election that has been the tradition in
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Bangladesh so the basic uh continuity in
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programs in the mode of delivery of
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service and in financing mode in all
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these three categories that have been
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conting in essence politicians and their
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many unseen but effective civil servants
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and technocrats have become key
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stakeholders in the country's Health
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System playing an doubtedly critical
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role in transforming the health of their
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population I think they play a vit role
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to develop our health sector because now
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the technocrat like uh any technical
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person uh working in the health sector
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they play now they they are the policy
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maker one thing we identified in all of
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the countries was the existence of very
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able technical people who were able to
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put in place the right policies and to
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ensure that those were implemented down
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to the local level but I think it's also
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important to recognize that they need
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political backing that they can't do
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everything on their own and
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therefore a political level that gives
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priority to health is absolutely
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critical as
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well for Bangladesh getting Health
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Services down to the local level became
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a priority population growth was was a
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key problem that the government had to
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face and along with that there was a
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clear realization that this was a rural
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population where Services had to be
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delivered at the
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doorstep so it was the government's
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decision partly out of political
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conviction and partly out of his
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historical necessity to provide Primary
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Healthcare Services in the rural
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areas during the 1970s the government
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developed a public health system along
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the health for all model with a
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nationwide network of hospitals Health
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complexes family welfare centers
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subcenters and Outreach
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clinics at the same time a parallel
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network of Family Planning and maternal
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and child wealthfare centers was
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established in fact the Bangladesh
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government was one of the first
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developing countries to strongly endorse
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a national Family Planning
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program what we've seen through programs
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that were implemented over the course of
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the last 30 4 years is that total
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fertility rate has gone from about 6.3
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births per woman to a much lower and
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more rational 2.7 births per woman and
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it's been done through really the Health
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Care system which has had sort of the
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unique structure in Bangladesh of having
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a Ministry of Health and Family welfare
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that's divided into two Wings one that
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focuses on health services and one that
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focuses almost exclusively on Family
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Planning through this directorate
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general for Family
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Planning women from The Villages were
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trained so not medical doctors and not
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nurses were trained to Go door Todo
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delivering Family Planning services and
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really educating women about the their
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ability to control when they would
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reproduce and this enabled this amazing
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miracle to happen in
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Bangladesh empowering women at the
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village and Community level was to
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become part of a strong political commit
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commitment in Bangladesh as a result an
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army of Health assistants and family
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welfare assistants have been trained to
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carry out health promotion and disease
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prevention activities from contraception
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advice to the importance of personal
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hygiene they can also deliver medicine
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report early signs of infectious
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diseases and register births and deaths
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government of Bangladesh was very smart
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in making the decision in the 70s to
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recruit the female field workers to work
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on the family planing front
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and they recruited uh over 20,000 female
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uh female family welfare workers who are
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high school passed and in a time when
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there are not many girls available who
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are high school pass so that was a bold
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decision made by the government of
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Bangladesh the community health workers
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they are the backbone of the Bangladesh
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Healthcare System they really are those
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ladies the family welfare assistants and
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the men who are the health assistants
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they're out there every day in the
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Fields where it's hot teaching people
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and empowering people how to take care
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of themselves and their families
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whilst the success of government
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intervention policies certainly needed
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the impetus of committed community
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health workers civil servants and
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politicians the coverage of the policies
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would not have been as widespread in
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terms of geography and Outreach to
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disadvantaged communities were it not
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for additional non-state resources and
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non-government
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organizations large NOS have high levels
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of political autonomy and flexibility
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and they have been able to play an
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important role in improving in health as
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well as in reaching populations that
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have been excluded because of isolation
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stigma or lack of
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resources Bangladesh is a developing
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country for this reason the government
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recognized the NGS and people also
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recognize the NS and and the activity of
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the NS and I think it is a very very
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positive sign for the uh country the
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government recognizes that there's this
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large population and there's no way that
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one public health system could meet the
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needs of everyone in the country and
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then the NOS recognize that they do need
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to follow the edicts that are given from
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the Ministry of Health and Family
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welfare and be compliant with policy in
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Bangladesh and with in the best of NOS
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there there's great partnership there
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some 2,000 NOS work in Bangladesh
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including some of the largest and most
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reputable in the world bra for example
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was created in the early '70s after the
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war of Liberation to deal with small
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scale relief efforts today it has grown
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into the largest NGO in the world and
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its scope has widened to include multi-
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sector programs for the poor and
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landless including health and
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education BR started with the whole
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issue of poty evation and empowering the
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poor that's the br's overall mission BR
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always believed that they work with the
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national government and National
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government's priority is bre given the
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first priority like in the 70s and 80s
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the Family Planning program the
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immunization program so BR partnered
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with the national government in
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addressing those National issues but
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learn from the communities how to do it
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so we work at the community level we
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bring uh involve our workers community
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volunteers and our workers at the
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community level with the house at from
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the household to the community leaders
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earn the trust of the people and the
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trust is our capital
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bra's 64,000 Village health workers
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touch the lives of more than 110 million
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people and all this without drawing on
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public facilities which does not weaken
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capacity in the public sector since 2006
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bra has been using trained birth
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attendants health workers and volunteers
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to deliver maternal neonatal and child
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health care in urban slums so br's
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Vision that whatever we learn from the
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community test it
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Pro evidence that it works and if it
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proven evidence is there then go to
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scale learning from the work in the
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community testing and then scaling up
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has led to the development and
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adaptation of Innovative lowcost
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Technologies and proven
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interventions with a history going back
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before the war of Liberation the
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International Center for diarrheal
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disease research
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icddrb has become a global leader in
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population and health research with a
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worldwide reputation for developing
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Innovative lowcost Technologies that
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have led to improvements in health
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icddrb is perhaps best known for its
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groundbreaking work on oral rehydration
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solution for the treatment of chera os
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is oral rehydration solution it's a fist
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full of sugar and a pinch of salt mixed
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in a liter of water so you can buy it
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now in Bangladesh it's it's sold
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everywhere in packets and you can mix
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that with clean drinking water ORS came
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into existence and was invented during a
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huge famine and crisis and color
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outbreak in the country through the NGS
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with with the support of the government
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and the approval of the government with
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icddrb as a research partner and with
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Brack then as the delivery partner
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someone in each household was taught how
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to do this and that's really the first
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great example of innovation in
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Bangladesh more recently icddrb is
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credited with the introduction of zinc
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for the treatment of childhood diarrhea
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delivered in a soluble Tet form this
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lowcost Innovative solution was
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developed and scaled up in Bangladesh
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and is now being used in many other
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developing countries if we look at the
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Copenhagen convention scaling up zinc
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and vitamin A these are the number one
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and number two lowcost big payback
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Health Solutions on the planet no one
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can argue that all of Bangladesh's
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health challenges have been met nor will
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be met in the future however some key
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players within Bangladesh see Universal
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coverage as a vital and attainable goal
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we talk a lot about a whole of
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government whole of society approach and
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I think that for many parts of Health in
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Bangladesh this exist it's commitment to
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health that transcends political party
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what I also think can most readily be
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translated from Bangladesh is that you
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don't need a doctor or a nurse to help
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people learn how to manage their chronic
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conditions whatever the future holds
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Bangladesh has shown and can build on
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key successes in the past and the hope
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is that they can continue to deliver
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good health at low cost for their people
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he
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