Despite still low social indicators and continuing prevalence of poverty (40% of the population lives below the poverty line), the health sector in Bangladesh has shown impressive progress. We improved in sectors such as pharmaceuticals, increasing number of doctors, increasing number of hospitals and medical colleges. COCCID’S etc. The government of Bangladesh has shown policy continuity and commitment to improving health conditions, placing particular emphasis on improving the health conditions of its citizens and targeting the poor, women and children. Where as many of the problems still remains unsolved.
The ministry of health and family planning is responsible for the health service of the country should take necessary steps to solve those problems. Objective: The main objective Of this whole research is to evaluate the health condition of Bangladesh. From 1971 to 2013 health condition of Bangladesh has radically changed. We are here to present that the number of health centers, hospitals, medicals colleges and other institutions related to health development of our country. We have also seen numerous amount of development in since 1971 regarding heath.
Inspire of those development we till face a lot of challenges. It is our failure that we still have numerous problem related to health. We are here to focus our objective of our research paper is to show the number of institutions engaged in the health service of our country, mortality rate, development of pharmaceuticals, number of doctors present in our country, condition of maternal health, condition of combat diseases, family planning condition, life expectancy of the people of our country and international recognition of CDR, B.
We are also going to the most important role played by Government and No’s. The goals that Millennium Development Goal (MEG) related to health are also one of our objectives. We are also going to show the sectors where we are facing challenges in and some relevant solutions to those problems. Methodology: The research paper is an exploratory one by nature and is based on mainly secondary data sources available from libraries, information available from different websites in internet and surveys by different institutions.
Data collected were then analyzed, sorted and represented to represent findings and arrive at a conclusion. Four Decade of Health Condition of Bangladesh (1971-2013): From 1971 till 201 3 the health condition of Bangladesh has changed drastically. There has been a lot of improvement in health sector of our country. People no more die due to diseases like cholera, diarrhea, fever, flu etc. The condition of the health service sector is shown in the following time line: 1971-1980: * 1971: War of Independence-?time Of reconstruction with high aid dependence * 1974-1975: Low point of economical and political condition.
Devastating famine * 1979: Following Alma Ata Declaration a decentralized health sector started emphasizing access to primary education, strong family landing with recruitment of outreach services. * Grahame Bank, BRACE and a handful of other Nags begin work on a very small scale 1 981-1990: * Continued to emphasis on family planning and health sector policies included a strong health policy that regulated doctors and drug sales through enforcement of an essential drug list * Mandatory rural services for doctors. * Gradual growth of the MONGO sector which remained small scale in terms of national impact. Fertility rate declined rapidly * 1985: launching of the Expanded Program of Immunization (PEP) * Aggressive family planning program with doorstep delivery of services. Widespread malnutrition, inadequate sewage disposal, and inadequate supplies of safe drinking water. * fertility rate was also extremely high * Morbidity and mortality rates for women and children were high * 1986: the Universal Immunization Program was initiated * 1 982: adapted National Drug Policy (National Drug Control Ordinance 1982) 1991-2000: * 1994 Cairo agenda argued for reform in up towards broader emphasis on Reproductive Health. National immunization days were instituted, to deliver two doses of polio vaccine a year * 1997: Health and Population Sector Strategy (HIPS) was adopted * 1 998: Health and Population Sector Programmer (HIPS) was launched for duration of five years * 2000: first National Health Policy * Fertility decline stagnant for most of the decade, but contraceptive use continued to increase. * Micro-finance grows from about 12% membership of all reproductive age women to 30% membership. 2001-2010: * Increased funding for HIVE-AIDS prevention despite low prevalence. 003: launched its successor the Health, Nutrition, and Population Sector Programmer (H NAPS), conceived within the sector-wide approach * 2004: National Nutrition Programmer (NP) was launched * Newborn survival has evolved as a national health priority * The water low from upstream rivers has been reduced * Fertility decline resumes in 2004. Low emphasis on family planning and primary health care services. Governments Role in Development of Health Service: Health Care System of Bangladesh is governed by Ministry of Health and Family Planning.
The government is responsible for building health facilities in urban and rural areas. For example, in the late sass’s in Bangladesh, the rural health facilities that existed in the rural areas were mostly sub-district health centers, rural dispensaries and family welfare centers. Urban health centers also had problems with inadequate medical supplies. The scenario has changed now. The Government of Bangladesh vision is ‘to see the people healthier, happier, and economically productive to make Bangladesh a middle-income country by 2021″ (Vision 2021 The government finances 70 percent of the $4. -billion five-year Population, Health, and Nutrition Sector Strategic Program. The goal of the next sector program, covering 2011-2016, is to ensure quality and equitable health care for the citizens of Bangladesh. Revitalization social services is a core focus of the Bangladesh government, including a commitment to: rebuild the health system at the community and strict levels; improve access to services for the most disadvantaged, including women; and increase governance, accountability, and credibility in addressing the country’s remaining health challenges.
No’s Role in Development of Health Service: As Bangladesh is still a developing country there are a good number of No’s in our country. There are 2209 Nancy in our country among them BRACE, ASH, Prosthesis, Sanitary Bangladesh etc are leading. No’s of Bangladesh are providing training and education service in field of health and nutrition. In some specific area of primary health care sector like diarrhea control, connation against six hazardous diseases, campaigning for health consciousness, expansion of water and sanitation services , reproductive health care and family planning services etc. He Nags have achieved extensive success. In order to develop the health and nutrition situation, around 350 brought in sanitary toilets for 14 lack people and safe water for 1. 5 core people through establishment of 1. 5 lack tube-well, 186 rural sanitation centers and 2. 5 lack latrine. Nags are playing notable role in changing poverty state by bringing in primary and other health and nutrition care services within the reach of poor people.
Millennium Development Goal (MEG): Globally agreed all eight Millennium Development Goals (Megs): eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality rate, improve maternal health, combat HIVE/AIDS, malaria, and other diseases, ensure environmental sustainability and develop a global partnership for development by 201 5, are closely connected and all the targets might be achieved if the targets of the health related Millennium Development Goals are achieved. By reviewing literature related to health related Millennium
Development Goals in Bangladesh issue this paper finds that progress made by Bangladesh on the Megs, especially those related to health, has been extremely slow. With only five years left, it might be quite difficult to achieve the health related Millennium Development Goals as in most Of cases the progress is not on track rather far away from the desired target. MEG-a: Reduce Child Mortality Rate If the current trend continues, the Nanny Nonsense projection reveals that under-five mortality might stand at 53 deaths per thousand live births in 2015 against the targeted rate of 48 in 2015.
Under-five mortality rates steadily clines from 146 deaths per thousand live births in 1 990 to 67 per thousand in 2009 (Go’s progress report 2010). Projected infant mortality rate might reach to 43 deaths per thousand live births by 201 5, which is higher by 12 deaths per thousand live births against the target. Infant mortality rate was 45 live births per thousand in 2009 (Bangladesh Progress Report, 2010). The average annual reduction between 1991 and 2009 was 2. 84 percent against a target Of 2. 76 percent. Estimated one-year-old children minimized against measles might not reach to 100% by 2015 rather only 75% might be attained.
The rate of improvement of immunization coverage increased from 54 percent in 1991 to 88 percent in 2006(GoB’s progress report 2010). In that period, the average increase in the coverage of child immunization between 1991 and 2006 was 3. 25 percent: 0. 65 percent above the targets annual rate of 2. 6 percent. MEG-5: Improve Maternal Health nanny Oneness’s projection on health related Megs indicates that Bangladesh may possibly reach to 280 deaths per 100,000 live births by 201 5 while the target is to reduce to 143. In 2006 the estimated maternal mortality ratio was 290 per 1 O,OHO live births (BEDS, 2007).
It was 348 in 2008 (Bangladesh Progress report 2010). Proportion of births attended by skilled health personnel might increase to 23% against the target of 50% by 2015. Between 2002 and 2006 the proportion of assistance during delivery by medically trained providers increased to 18 percent, at an annual average of 16. 25 percent. Due to pregnancy and childbirth-related causes, principally because of skilled birth attendants, 21 ,OHO mothers die annually. If this trend is maintained, Bangladesh may be far behind to achieve the MEG targets by 2015. MEG-6: Combat HIVE/AIDS, malaria, and other diseases
HIVE/Lads-positive individuals have increased steadily since 1994 to approximately 7,500 people in 2005 (CDR, B). UNAIDED estimate the number to be slightly higher at 1 1,000 people. At the end of February 2010, 12,000 people in Bangladesh had HIVE/AIDS and 500 deaths occurred due to the fatal disease (CIA World Fact book). But this is a strong apprehension that the actual figure would be far higher as Wealds-infected people are afraid to disclose that they have the disease. Over 98 percent of all malaria cases in the country are concentrated in 13 districts out Of total 64 that belong to the high sis malaria zone.
It is said that from 1 955 to 1 958, 47,500 people died of malaria each year, while 1. 5 million were affected. In 2007 there were 50634 reported cases of malaria and 239 deaths. Bangladesh has made significant progress in preventing and reversing the spread of tuberculosis (TAB) during the last two decades. The TAB prevalence rate has reduced from 406 per 100,000 per year in 2006 to 391 in 2007. TAB mortality rate also reduced in this period from 47 to 45 per 1 00,000 per year. To further decrease incidence and prevalence of TAB, the momentum must be maintained to reach the MEG argue.
It is pertinent to mention that theoretically many of the strategic documents and policy papers are sound and seems to be implantable. Though, the govern of Bangladesh and some several other organizations are very much hopeful to achieve the MEG targets by 2015. However, the foregoing discussion indicates that it may be quite difficult for Bangladesh to achieve the health related Megs, if the government does not give top priority on the MEG 4, 5, 6, and if the compliance and accountability of the developed world are not ensured. MEG- 4 Reduce Child Mortality Target for Bangladesh
To achieve the goal, Bangladesh must reduce under-five mortality from 146 deaths per thousand in 1990 to 48 by 2015, infant mortality rate from 92 deaths per thousand live births in 1990 to 31 by 2015. Another target is to enhance the proportion of minimized one-years-olds for measles from 54% in 1 990 to 100% by 2015. Current Situation and Future Projection Under-Five Mortality If the current trend continues, the estimated under-five mortality might stand at 53 deaths per thousand live births in 2015 against the targeted rate of 48 in 201 5, which is higher by 5 deaths per thousand per year.
Under-five mortality rates steadily declined from 1 46 deaths per thousand live births in 1 990 to 67 per thousand in 2009 (GoB’s progress report 2010). Current situation demands under-five mortality rates to be reduced annually by three deaths per thousand between 2000 and 2015 (Figure 1) to achieve the target. The report highlighted the need to focus attention on neonatal and prenatal causes of death, deaths due to pneumonia, diarrhea, injuries, poor care- seeking practices, malnutrition and low birth-weight (LBS.). However, the decline was about 10 percent among 1-4 years old children and about 2. % annually among post neonates (1-11 months) and also 2. 2 percent in neonates (Bangladesh Demographic and Health Survey, 2007). It is obvious that if substantial red suctions in post neonatal and neonatal mortality are not achieved, Bangladesh may not achieve MEG 4. Infant Mortality Rate Nanny Nonsense projection reveals that the projected infant mortality rate might possibly reach to 43 deaths per thousand live births by 201 5, which is higher by 12 deaths per thousand live births against the target. In 2009, the rate was 45 per thousand live births must be reduced annually by at least four deaths per thousand between 1999 and 2015.
Infant mortality rate in Bangladesh, like under-five mortality rate, has also decreased impressively from 1 990 to 2009 (Figure 4). The average annual reduction between 1991 and 2009 was 2. 84 percent against a target of 2. 76 percent. Major Causes of Infant Mortality The major causes of infant deaths are acute respiratory infections, neonatal and prenatal problems, diarrhea, pneumonia etc. Neonatal and prenatal causes amount one-half or two-thirds of under-five mortality or infant mortality (GOB and LLC, 2005).
According to the Bangladesh Demographic and Health Survey (BEDS) 2007, each year 1. lack newborn babies died within 28 days. Neonatal deaths now substantially amount 57 percent to overall mortality of children aged less than five years (BEDS, 2007). So, neonatal and prenatal care for the mother is very important. Around four in ten women receive no antenatal care. In rural areas, about 90 percent natal practices occur at home; while in urban areas, little over one-fourth of this practice is done at health care center (BEDS, 2007).
Only 24. 4 percent of births are delivered by skilled health personnel (MISS, 2009). There is a strong association between under-five mortality and mother’s education. It ranges from 32 deaths per 1 ,OHO live births among children of women with secondary complete or higher education to 93 deaths per 1 ,OHO live births among children of women with no education (BEDS, 2007). Birth spacing is another variable associated with under-five mortality. As the birth interval becomes shorter, infant mortality chances rise sharply.
Both infant and under-five mortality rate are lower for those in the highest wealth quintile. Malnutrition After the first month of birth, malnutrition becomes an important contributing factor to infant and child mortality. But in Bangladesh, it often curs early because of improper feeding practices which play a pivotal role in determining the optimal development of infant. Poor breastfeeding and infant feeding practices have adverse consequence for the health and nutritional status of children. Only two-thirds among the infants, less than 2 months old, (64 percent) are exclusively breastfed.
The remainders are given water, other milk and liquids in addition to breast milk, and 6 percent even receive complementary foods. From about six months of age, the introduction of complementary foods is critical for meeting the protein, energy and encountering needs of children. Among children age 6-9 months, only three in four children receive complementary food (DEEDS, 2007). Malnutrition passes from one generation to the next because malnourished mothers give birth to malnourished infant. If they are girls, these children Often become malnourished mothers themselves and the vicious cycle continues.
Health experts disclose that Bangladesh has one of the highest rates of child and maternal malnutrition in the world. State of World’s Children (SOWS) Report 2008, issued by EUNICE, indicated that 48 percent of all the children under-five are under-weight. New born deaths make up nearly Alfa of all under-five deaths (57 percent) and 71 percent of infant mortality. One neonate dies every year, according to EUNICE (ARIN, November 19, 2008). Immunization against Measles The current trend of one-year-old children minimized against measles suggests that it might not reach to 100% by 201 5 rather only 75% might be attained.
The rate of improvement in immunization coverage was 88 percent in 2006 (Millennium Development Goals Progress Report of Bangladesh, 2010). If the immunization coverage rate from 1991 is maintained, it will not achieve the target within 2015. However, the rate of improvements from 2000 n the immunization coverage explore different scenario, I. E. If this can be continued it will reach the target within 201 5 years (Figure 5). In that time, the average increase in the coverage of child immunization between 1 991 and 2006 was 3. 25 percent that is 0. 65 percent above the target annual rate of 2. 6 percent. Figure 6 is a fluctuated figure.
However Bangladesh is on the track to achieve MEG 4, the government should give top priority to achieve MEG 4 within 201 5, otherwise not. MEG 5 Improve Maternal Health The global target under this goal is to reduce the maternal mortality ratio by here-quarters between 1 990 and 2015. This goal has one target and two indicators; I) maternal mortality ratio; and birth attended by skilled health personnel. To achieve the goal, the targets of Bangladesh are: I) reduce maternal mortality from 574 deaths per 100,000 live births in 1990 to 143 by 201 5; and ii) increase the proportion of birth attended by skilled personnel to 50 percent by 2015.
Current Situation and Future Projection Maternal Mortality Ratio Nanny Oneness’s projection on health related Megs indicates that Bangladesh might reach to 280 deaths per 1 00,000 live births by 201 5 while the target is to reduce to 143. In 2008, the rate was 348 (Millennium Development Goals, Bangladesh Progress report 2010). The estimated maternal mortality ratio in 2006 was 290 per 1 O,OHO live births DEEDS, 2007).
Bangladesh estimated maternal mortality rate between 320 and 400 per 100,000 live births (GOB and LLC, 2005), in 2002 was the highest in the world at that time and is still high relative to many developing countries. Government claims the decline rate is on track for achieving the goal, however the rate of reduction from 1999 does not indicate so (Figure 7). In Bangladesh maternal mortality ratio has decreased from 574 per 100,000 live artist in 1990 to 315 live births in 2001 Causes of Maternal Mortality Most maternal deaths occur due to hemorrhage, unsafe abortion and natal problems.
Over half of all pregnant women do not receive any institutional health service during childbirth, while significantly fewer received institutional post-natal health care (BEDS, 2007). About four in every ten women receive no antenatal care. Eighty percent of the deliveries still take place at home. The percentage Of deliveries with assistance from qualified professionals is also very low, 18 percent deliveries are attended by medically trained personnel while 10. 8 percent births are attained by trained birth attendants.
Only 15 percent births take place at health facility. Malnutrition, particularly chronic energy deficiency (CEDE) and anemia, contribute to poor maternal health and pregnancy outcomes for both the mother and her children. Severe anemia increases the risk of maternal mortality, which accounts for over one-thirds of maternal deaths. Recent data indicates that 40 percent of adolescent girls, 46 percent of non-pregnant and 39 percent of pregnant women are chronically malnourished (DEEDS, 2007).
MEG- 6 Combat HIVE/AIDS, Malaria and Other Diseases Bangladesh target for achieving the goal is also to stop and reverse the spread of HIVE/AIDS, malaria and other diseases by 2015. Current Situation HIVE/AIDS prevalence Rate AIDS is caused by infection of a virus named Human Immunodeficiency Virus (HIVE). This virus is transmitted through blood and sexual contact. In addition, infected pregnant women can pass HIVE to their offspring during pregnancy and deliver as well as through breastfeeding.
Overall HIVE/AIDS prevalence in Bangladesh is expected to be extremely low and insignificant. In reality, HIVE/ AIDS-positive individuals have increased steadily since 1 994 to approximately ,500 people in 2005 (CDR,B). UNAIDED estimated the number to be slightly higher at 1 1 ,OHO people while CIA World Fact book anticipated 1 2,000 people in Bangladesh had HIVE/AIDS at the end of February 2010 and 500 died due to the pandemic. A strong apprehension is that the actual figure would be far higher as the infected people are afraid to disclose their status.
The level of knowledge on HIVE/AIDS and its prevention among the people is increasing but 85 percent Of men and only 67 percent Of women have heard Of it (BEDS, 2007). Though, there is a variation of estimated figure of HIVE/Lads-positive people among different sources, the increasing trend of HIVE/AIDS positively indicates that country is on the brink of a nationwide crisis. Government initiatives Bangladesh HIVE/AIDS prevention program started in 1985 with the establishment of the National AIDS and Sexually Transmitted Disease Program under the overall policy support of the National AIDS Council (MAC).
The national AIDS/SST Program has set guidelines on key issues including testing, care blood safety, sexually transmitted infections, and prevention among youth, women, migrant population, and sex workers. In 2004, a six- ear National Strategic Plan (2004-2010) was approved. The country’s HIVE policies and strategies are based on other successful family planning programs which include participation from schools, as well as religious and community organizations. The AIDS Initiative Organization was launched in 2007 in order to combat the virus. But the government has yet to show any good success.
The activities of various organizations of UN and Nags working on this issue are limited. The government is expected to produce and market cheap sterile syringes and needles that will automatically be damaged after one use. But it has not been implemented yet. In addition, blood screening facilities are not developed by the public or the private sector until now. Condom use Rate The Bangladesh Demographic and Health Survey data 2007 indicate that overall 55. 8 percent of currently married women are using a contraceptive method, with only 4. 5 percent of men are using condom.
Use of condom increased slowly from 3 percent in 1989 to 4. 5 percent in 2006 (Figure 12). There is no data available on the contraceptive prevalence rate among the HIVE/AIDS high-risk groups. UNAIDED estimate consistent condom use is only 2 recent and 4 percent for brothels and street based sex workers. Among their clients 75 percent of truck drivers reported that they did not use condoms the last time they purchased sex, and only 2 percent of rickshaw- pullers reported using condoms consistently while having sex with sex workers (GOB and LLC, 2005).
Contraceptive Prevalence Rate The contraceptive prevalence rate in Bangladesh increased from 44. 6 percent in 1989-93 to 55. 8 percent in 2006 at an annual average rate of 1. 56 percent. However, the contraceptive prevalence according to BEDS was 58. 1 percent in 2004 and it reduced to 55. 8 percent in 2007 (Figure 13). Deeper analysis shows that there was no decline in use of modern methods but use of traditional methods reduced in this period without adversely affecting the TFH which declined from 3. 0 in 2004 to 2. 7 in 2007.
Prevalence and Prevention of Malaria Bangladesh target for achieving the goal is to stop and reverse the spread Of Malaria which is one Of the major public health problems in Bangladesh because 13 out of total 64 districts belong to the high-risk malaria zone. Over 98 percent of all malaria cases in the country are concentrated in these districts. It is said that between 1 955 and 1 958, 47,500 people died of malaria ACH year while 1. 5 million were affected. In 2007 there were 50634 reported cases of malaria and 239 deaths.