Context
Bangladesh has made remarkable progress in improving health outcomes over the last decades. The country has achieved the Millennium Development Goal (MDG) of reducing the under-five mortality rate and received the United Nations Millennium Development Goal Award 2010. But despite the progress of recent years, many Bangladeshis still struggle to access quality health services. This is costing the economy millions of dollars in days lost due to poor health.
The World Bank has been a long-standing partner in the health sector. The World Bank has committed $358.9 million for the Health Sector Development Program (HSDP), started in 2011, which aims to provide essential health services to 150 million people, mainly rural and poor Bangladeshis.
Challenge
Since 1990, infant and child mortality rates have declined by more than two-thirds and the country is also on track to reach the MDG of improving maternal health. Still, significant development challenges remain in the health sector, including the double burden of non-communicable and communicable diseases. The percentage as well as the absolute number of malnourished women and children in Bangladesh remains among the highest in the world. The increasing and changing demand for health services, influenced by aspects such as population dynamics, urbanisation and climate change, adds further to the challenge. Public spending on health is low in comparison to other countries. Many patients are paying out of their own pockets to access medical services. The high health expenditure pushes poor people further into poverty.
The Program
HSDP is a follow-on program to the long standing World Bank support for the Government’s sector wide programs in the health sector. Based on the successes and lessons learned from the past programs and in recognition of the challenges ahead, the Government initiated an $8 billion sector-wide program: the Health, Population and Nutrition Sector Development Program (2011-2016). The HSDP finances a slice of the Government’s program and is fully aligned with it, playing an important role turning commitments into reality to improve essential health services and strengthen systems.
HSDP supports the Ministry of Health and Family Welfare (MOHFW) in implementing the sector-wide program in the following areas:
- Essential services include improving reproductive health, from family planning and antenatal care to scaling up emergency obstetric and newborn care services and ensuring 24/7 services in selected district hospitals and upazila (district sub-unit) health centres.
- Improving the control and treatment of both communicable and non-communicable diseases. Communicable diseases are being addressed through: vaccination; scaling up HIV/AIDS interventions for the most-at-risk groups; improving the quality of treatment for tuberculosis; and strengthening malaria control and treatment in 13 highly endemic areas. For non-communicable diseases, interventions are aimed to improve awareness of cardio-vascular disease risks, provide better diagnosis and management of diabetes and improve screening for cancer.
- Health system strengthening includes interventions for better health sector planning and resource management, human resources development, health information systems and maintenance of health care facilities.
The HSDP is scheduled to end on December, 2016.
Achieved Results
- 29% reduction in under-five child mortality, down to 46 deaths per 1,000 live births in 2014 from 65 deaths in 2007.
- 42% births attended by medically trained professionals in 2014, up from 21% in 2007.
- 62% coverage of Vitamin A supplementation among children under five years in 2014.
- 84% of children under 23 months receiving basic vaccination in 2014.
- 2.3 children per woman in 2014 reduced from around 3.3 children per woman the 1990s.
- 62% contraceptive prevalence rate in 2014, up from 55% in 2007.
- 12,577 Community Clinics are functional in 2014.
- 86% coverage of measles immunization for children under 12 months in 2014.
- 64% coverage receiving Ante Natal Care (ANC) from a medically trained provider in 2014, up from 53% in 2007.
- 33% children underweight in 2014, decreased from 41% in 2007.
- 40% reduction in maternal mortality, down to 194 deaths per 100,000 live births in 2010 from 320 deaths in 2000.
Safeguards
The World Bank maintains due diligence to ensure the money in its projects is spent for the purpose intended: to benefit the people of Bangladesh, particularly the poor. HSDP is subject to annual audits. The World Bank is working with the Government and other Development Partners to put in place appropriate measures, particularly on fiduciary aspects. The World Bank has made regular audits of its health projects in Bangladesh and where it has found irregularities it has asked for the return of funds. All development partners are kept informed of these measures as they occur. Independent internal and external financial audits are helping to improve internal control mechanisms in MOHFW and overcome weak financial management and procurement capacities. Development partners have created a joint-donor fund for consolidated technical assistance, which is helping the Government to draw on the required expertise.
Financing
HSDP includes a Multi Donor and a Single Donor Trust Fund of US$ 341 million and the World Bank’s credit of $359 million. Seven development partners have pooled finances in the Multi-Donor Trust Fund: the Government of Australia; the Government of Canada; the Federal Republic of Germany through KfW; the Swedish International Development Agency; the Department for International Development; the Embassy of the Kingdom of the the Netherlands; and the United Nations Population Fund. The Single Donor Trust Fund includes resources from the U.S. Agency for International Development.
Last Updated: May 20, 2015
