FEATURE STORY

Building a Healthier Nation

January 15, 2017

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HSDP aims to support the Government of Bangladesh to ensure equitable access to health care


Bangladesh has made remarkable progress in improving health outcomes. 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. However, despite the progress of recent years, many Bangladeshis still struggle to access quality health services, which is costing the economy millions of dollars in days lost due to poor health. The Health Sector Development Programme (HSDP) aims to support the commitment of the Government of Bangladesh to ensure equitable access to quality health services and to strengthen health systems with the ultimate goal to achieve better health outcomes, particularly for women, children, the poor and the marginalized.

Challenge

Significant development challenges remain in the health sector, including poverty, insufficient resources for health, changes in spectrum of diseases, malpractice, and poor health knowledge. The percentage as well as the absolute number of malnourished women and children in Bangladesh remains among the highest in the world. Added to this is the increasing and changing demand for health services, influenced by aspects such as population dynamics; urbanisation and climate change. The fiscal space of the country is restricted given the lowest tax-to-GDP ratios that limits the government’s capacity to translate this growth into public revenues. 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.

Approach

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 a $8 billion sector wide program, the Health, Population and Nutrition Sector Development Program, from 2011 to 2016. The HSDP of the World Bank, finances a slice of the Government’s program and is fully aligned with it, playing an important role in operationalizing commitments to improve essential health services and strengthen the systems.

HSDP supports the Ministry of Health and Family Welfare (MOHFW) in implementing the program. 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 health complexes. Health system strengthening includes interventions for better health sector planning and resource management, health financing system development, human resources development, health information systems and maintenance of health care facilities.

The MOHFW is also working towards improving the control and treatment of both communicable and non-communicable diseases. Communicable diseases are being addressed through: vaccination programs; 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.

The program is subject to annual audits and the Bank is working with the Government and other Development Partners to put in place appropriate mitigation measures, particularly on fiduciary aspects.  Independent internal and external financial audits are helping to identify areas of weakness and recommend measures to improve compliance with internal control mechanisms so as to mitigate risks and to build capacities in carrying out   financial management and procurement activities efficiently. Development Partners have created a joint-donor fund for a consolidated technical assistance, which is helping the Government to tap on to the required expertise.  

HSDP includes a Multi Donor and a Single Donor Trust Fund of $380 million and the World Bank’s IDA credit of $508 million. Seven development partners have pooled their finances in the Multi-Donor Trust Fund: the Government of Australia acting through the Department of Foreign Affairs and Trade (DFAT); the Government of Canada, represented by the  Global Affairs Canada  (GAC); the Federal Republic of Germany through KfW; the Government of Sweden, represented by the Swedish International Development Agency (Sida); United Kingdom of Great Britain and Northern Ireland represented by the Department for International Development (DFID); the Embassy of the Kingdom of the Netherlands (EKN); and  the United Nations Population Fund (UNFPA). The Single Donor Trust Fund includes resources from the U.S. Agency for International Development (USAID).

 


" My second son, Sunny was born 21 days ago at the upazila health complex near my home. I’m happy to have a healthy baby.  "

Roni

mother from Madhupur

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42% births attended by medically trained professionals in 2014, up from 21% in 2007.

 


Results in numbers

  • 40% reduction in maternal mortality, down to 194 deaths per 100,000 live births in 2010 from 320 deaths in 2000.
  • 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 after a decade-long plateau during the 1990s around 3.3 children per woman.
  •  62% contraceptive prevalence rate in 2014, up from 55% in 2007.
  • 13,006 Community Clinics are functional in 2014.
  •  86% coverage of measles immunization for children under 12 months in 2014.
  •  55% of children exclusively breastfed up to 6 months of age in 2014, up from 43 % in 2007.
  • 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.

 

Basic Information

Approval date

May 26, 2011

End date

June 30, 2017

Total original commitment (IDA credit)

$508.9

Implementing agency

Ministry of Health and Family Welfare

 

 

 

 

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