2010年-世界发展银行全球_Bangladesh_Health_Sector_Profile_2010_194页_3mb

Bangladesh Health Sector Profile 2010 Summary

Core Content

This document provides an overview of the health sector in Bangladesh, including its structure, performance, and dynamics, based on publicly available data and reports from 2009 to 2010. It serves as a reference for stakeholders, including the Ministry of Health and Family Welfare (MOHFW), to understand the current state of the health system and guide future planning and collaboration.

Main Points

1. Socio-Economic and Demographic Overview

• Population: Bangladesh is the most densely populated country in the world, with an estimated population of 160 million in 2010 and a density of over 920 people per square kilometre.
• Urbanization: The country has experienced rapid urbanization, with about 24.6% of the population now living in urban areas.
• Economic Status: Bangladesh is classified as a low-income country with a per capita GNI of $520 in 2008. It ranks 146th out of 182 countries in the Human Development Index (HDI) and 112th out of 135 in the Human Poverty Index.
• Poverty Trends: The proportion of people living on less than $1 per day decreased from 58.8% in 1990 to 40.8% in 2007, but recent economic shocks, such as natural disasters and rising food prices, have slowed progress in poverty reduction.

2. Health Status and Trends

• Under-5 Mortality: Reduced by almost 60% from 146 per 1,000 live births in 1991 to 65 in 2007, placing Bangladesh on track to meet MDG 4.
• Infant Mortality: Declined from 92 to 43 per 1,000 live births, a 53% reduction.
• Neonatal Mortality: Fell from 52 to 37 per 1,000 live births, but the rate of decline is slower compared to under-five and infant mortality.
• Maternal Mortality: Decreased from 574 to 320 per 100,000 live births, but progress has not been sustained. The MDG target of 144 is unlikely to be achieved by 2015.
• Child Malnutrition: Still prevalent, with over 40% of children under five undernourished. The rate of decline in child underweight has slowed since the 1990s.
• Gender Equity: A Gender Equity Strategy was adopted in 2001, but a systematic approach to gender issues in the Health Nutrition and Population Sector Programme (HNPSP) is still lacking. There is a need for more women-friendly services and an enabling environment for gender equity.

Key Health Services and Infrastructure

3. Health Sector Organisation

• The health sector is organized under the MOHFW, which includes the Directorate General of Health Services (DGHS) and the Directorate General of Family Planning (DGFP).
• Other government ministries, such as the Ministry of Local Government, Rural Development and Cooperatives (MOLGRD), are also involved in health delivery.
• The private sector and NGOs play a significant role in health service delivery, especially in rural and urban areas.

4. Health Services

• Utilisation: Institutional deliveries are low, with only 15% of births occurring in health facilities. Most births happen at home.
• Service Network: A structured health service delivery network includes facilities at the upazila level and beyond.
• Special Populations: Health services for women, children, and the elderly are highlighted, with specific attention to maternal and child health.

Human Resources for Health

5. Human Resources

• Workforce Gap: There is a significant gap in the health workforce, particularly in the number of doctors and nurses.
• Production and Training: The production of health workers is insufficient to meet current and future needs. There are challenges in professional regulation and development.
• Staffing: The public sector has a limited number of qualified health professionals, with disparities in distribution by region and type of service.

Health Information, Monitoring, and Evaluation

6. Information Systems

• The health sector relies on various data collection and reporting mechanisms, including the Bangladesh Demographic and Health Survey (BDHS) and the Health Nutrition and Population Sector Programme (HNPSP) results framework.
• There are ongoing efforts to improve data management and information systems for better monitoring and evaluation.

Health Financing and Expenditures

7. Health Financing

• Funding Sources: The health sector is funded through both domestic and external sources, including government budgets, donor agencies, and private contributions.
• Trends: Health expenditure has increased over time, with a shift in funding sources and a growing role of external partners.
• Challenges: There are concerns about the efficiency and sustainability of funding flows, especially at the upazila level.

Medicines and Supply Chain

8. Medicines and Procurement

• Procurement: The public sector has a structured procurement process, but challenges remain in logistics and supply chain management.
• Regulation and Manufacturing: Pharmaceuticals are regulated by the Bangladesh Medical and Dental Council (BMDC), and there is a growing sector for pharmaceutical manufacturing.
• Access: Limited access to medicines, especially in rural areas, and a need for improved distribution and availability.

Sector Response and Reform

9. Sector Reform

• Reform Rationale: The need for reform is driven by the desire to improve service delivery, address gender equity, and enhance the health system's effectiveness.
• Donor Coordination: There is a need for better coordination among donors and government agencies.
• National Health Policy: A draft National Health Policy 2010 was prepared, outlining key goals and challenges, including strengthening health services, improving workforce planning, and enhancing information systems.

Conclusion

The health sector in Bangladesh has made significant progress in reducing child and infant mortality, improving vaccination coverage, and increasing contraceptive prevalence. However, challenges remain in maternal health, gender equity, and the sustainability of health financing. The sector requires continued investment in human resources, improved data systems, and better coordination among stakeholders to achieve its goals and meet the Millennium Development Goals (MDGs). The document serves as a baseline for future planning and reform efforts.

Key Information

• Population: 160 million, highly urbanized, with 76% in rural areas.
• Health Indicators:
  • Under-5 mortality: 65 per 1,000 live births in 2007 (on track to 48 by 2015).
  • Infant mortality: 43 per 1,000 live births in 2007 (on track to 31 by 2015).
  • Maternal mortality: 320 per 100,000 live births in 2001 (off track to 144 by 2015).
  • Underweight children under five: 46.3% in 2007 (off track to 33 by 2015).
• Health Financing:
  • Total health expenditure increased over time, with a growing role of external funding.
  • There is a need for more efficient and sustainable financing mechanisms.
• Human Resources:
  • There is a significant gap in the health workforce, particularly in doctors and nurses.
  • Training and professional development are critical to addressing this gap.
• Gender Equity:
  • A Gender Equity Strategy was adopted in 2001, but implementation is lacking.
  • The HNPSP needs to adopt a more systematic approach to addressing gender issues.
• Health Services:
  • Institutional deliveries are low, with most births occurring at home.
  • The private sector and NGOs are key players in service delivery.
• Medicines:
  • The public sector has a structured procurement system, but challenges in logistics and availability persist.
  • Regulatory bodies oversee the pharmaceutical sector, but there is a need for stronger oversight and quality control.

Key Agencies and Initiatives

• MOHFW: Central authority for health and family welfare, responsible for policy and governance.
• DGHS and DGFP: Key directorates for health services and family planning.
• BDHS: Provides critical data on health and demographic trends.
• HNPSP: A sector-wide initiative aimed at improving health, nutrition, and population outcomes.
• NGOs and Private Sector: Play a vital role in health service delivery, especially in underserved areas.