Bangladesh health policy

The Bangladesh health policy was published in 2011 and adheres to the following principles:

Health is defined as "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."^[1]

1. Every citizen has the basic right to adequate health care. The State and the government are constitutionally obliged to ensure health care for its citizens.
2. To ensure an effective health care system that responds to the need of a healthy nation, health policy provides the vision and mission for development.
3. Pursuit of such policy will fulfill the demands of the people of the country, while health service providers will be encouraged and inspired. People's physical well-being and free thought process have proved to be a precondition for the growth and intellectual enrichment in today's human society
4. Bangladesh expressed agreement on the following declarations:

• • The Alma Ata Declaration (1978)
  • The World Summit for Children (1990)
  • International Conference on Population and Development (1994)
  • Beijing Women's Conference (1995)^[2]

In the absence of a written and approved Health Policy, the national Annual Development Program and Five Year Plans substituted for policy principles. The problems in the health services multiplied in the absence of a clear policy. Bangladesh is a developing country with the world's highest population density.

Demographics

• Population – over 150 million
• Rural population – 77%
• Population density – 881 square kilometres (340 sq mi)
• People below poverty line – 60%
• Population doubling rate – 25–30 years
• Per capita GDP – Tk. 18,896

Health indicators

• CDR – 5.2 /1000
• Annual Growth rate – 1.48%
• MMR – 1.94 /1000 live births (BMMS 2010)
• IMR – 43 /1000 live births
• Under 5 MR – 83 /1000 live births
• Total Fertility Rate – 2.9
• CPR – 53.8%
• Life expectancy at birth – 68 (m) and 69 (f)
• Fully immunized children – 52%
• TB (smear positive new) detection rate – 31.2%

Health care infrastructure

• Doctor to population ratio – 1:2,000^[3]
• Nurse to population ratio – 1:5,000^[3]

Process for formulation

The Ministry of Health and Family Welfare^[4] assembled a Committee in 1996 for the purpose of preparing a health policy, with members drawn from civil society and professional bodies, including technocrats and bureaucrats.

A further five sub-committees were formed to:

• Evaluate the existing health services and determining the goals
• Formulate policies to ensure essential services
• Formulate policies to ensure hospital-based services
• Design Strategies for HRD
• Integrate NGOs and the Private Sector and plan for resources and utilisation of funds

The sub-committees worked for more than a year and submitted their efforts/recommendations. A working group was formed and entrusted with the responsibilities for compiling the recommendations contained in the reports. The working group also organised workshops in all six Divisions to elicit opinions of cross-section of the society on these reports. Finally the working group presented the proposals and recommendations to the National Health Policy Formulation Committee. A report on the health policy was thus formulated on the basis of consensus. The Cabinet on 14 Aug 2000 approved the National Health Policy.

National Health Policy (NHP)

The Health Policy has 15 goals and objectives, 10 policy principles and 32 strategies.

Health care system

The health care are designated to meet the health needs of the community through the use of available knowledge and resources. The services provided should be comprehensive and community based. The resources must be distributed according to the needs of the community. The final outcome of good health care system is the changed health status or improve health status of the community which is expressed in terms of lives saved, death averted, disease prevented, disease treated, prolongation of life etc.

Health care delivery system in Bangladesh based on PHC concept has got various Level of service delivery:

• Home and community level.
• Union level,
• Union sub centre (USC) or Health and family welfare centre; This is the first health facility level.
• Thana level, Thana Health Complex (THC): This is the first referral level.
• District Hospital: This is the secondary referral level.
• National Level: This is the tertiary referral level.

A) Primary level health care is delivered though USC or HFWC with one in each union domiciliary level, integrated health and family planning services through field workers for every 3000–4000 population and 31 bed capacities in hospitals.

B) The secondary level health care is provided through 100 bed capacities in district hospital. Facilities provide specialist services in internal medicine, general surgery, gynecology, paediatrics and obstetrics, eye clinical, pathology, blood transfusion and public health laboratories.

C) Tertiary Level health care is available at the medical college hospital, public health and medical institutes and other specialist hospitals at the national level where a mass wide range of specialised as well as better laboratory facilities are available.

The referral system will be developed keeping in view the following.

1. A clearly spent-out linkage between the specialised national institutes, medical college and district hospitals to ensure proper care and treatment of patients from the rural areas served by lower level facilities.

2. Patients from the rural areas referred by lower level facilities to district and medical college hospitals and specialised institutions should get preferential treatment after admission.

Health problems in Bangladesh

The health problems of Bangladesh can be conveniently grouped under the following headlines:

1. Population problems
2. Communicable disease problems
3. Nutritional problems
4. Environmental sanitation problems
5. Health problems.

Communicable disease problems

Communicable diseases are still the major diseases in Bangladesh. Mortality & morbidity due to these disease are very high. Infectious diseases like cholera, typhoid, tuberculosis, leprosy, tetanus, measles, rabies, venereal diseases and parasitic diseases like malaria, filariasis, worm infestations are responsible for major morbidity. An expanded immunisation programme against nine major disease (TB, Tetanus, Diphtheria, Whooping cough, Polio, Hepatitis B, Haemophilus influenza type B, Measles, Rubella) was undertaken for implementation).

Nutritional problems

Bangladesh suffers from some of the most severe malnutrition problems. The present per capita intake is only 1850 kilo calorie which is by any standard, much below required need. Malnutrition results from the convergence of poverty, inequitable food distribution, disease, illiteracy, rapid population growth and environmental risks, compounded by cultural and social inequities. Severe undernutrition exists mainly among families of landless agricultural labourers and farmers with small holding.

Specific nutritional problems in the country are—

1. Protein–energy malnutrition (PEM): The chief cause of it is insufficient food intake.
2. Nutritional anaemia: The most frequent cause is iron deficiency and less frequently follate and vitamin B12 deficiency.
3. Xerophthalmia: The chief cause is nutritional

deficiency of Vit-A.

1. Iodine Deficiency Disorders: Goiter and other iodine deficiency disorders.
2. Others: Lethyrism, endemic fluorosis etc.

Environmental sanitation problems

The most difficult problem to tackle in this country is perhaps the environmental sanitation problem which is multi-faceted and multi-factorial. The twin problems of environmental sanitation are—

• Lack of safe drinking water in many areas of the country.
• Preventive methods of excreta disposal.

Health problems

• Indiscriminate defecation resulting in filth and water pond disease like diarrahoea, dysentery, enteric fever, hepatitis, hook worm infestations.
• Poor rural housing with no arrangement for proper ventilation, lighting etc.
• Poor sanitation of public eating and market places.
• Inadequate drainage, disposal of refuse and animal waste.
• Absence of adequate MCH care services.
• Absence and/ or adequate health education to the rural areas.
• Absence and/or inadequate communications and transport facilities for workers of the public health.
• Absence of control of communicable diseases.

References