An Assignment on An insightful assessment of essential services in Bangladesh, with special focus on health.Submitted byMohammad Shafiqul AlamDept. of EconomicsUniversity of Dhaka.
INTRODUCTION:One of the central insights of development economics is the importance ofhuman capabilities, both as end and as a means of development. At earlystages of development, capabilities related to nutrition and health is ofspecial importance. For instance, health makes wide-ranging contributionsnot only to economic growth but also to demographic change, social equality,political democracy, and many other aspects of development. Good health is afundamental basis of the quality of life as well as of social progress.Further, both theory and evidence point to the importance of public servicesin this field. Economic theory draws attention to pervasive “market failures”in the private provision (especially unregulated provision) of essential servicesuch as health care. Empirical evidence suggests that rapid reductions inunder nutrition, ill health and related deprivation are typically based onextensive public action.After partition from India in 1947, Bangladesh achieved full independence in1971 and became a parliamentary democracy in 1991 after 20 years ofmilitary regime. With rigid central government structures and disagreementbetween main parties largely inhibiting response to local health needs ,Bangladesh began a wide programme of reforms to address issues ofresponsiveness. The main reforms in Bangladesh aimed at integrating the twoseparate divisions of health services and family planning thus unifying the
two programmes with the intention of improving their efficiency andresponsiveness to the user population.This term paper presents an insightful assessment of essential services inBangladesh, with special focus on health. For instance, we are that manydevelopment experts in Bangladesh surprised and interested to learn thatmany people live far away from the nearest health center.Three hundred and forty children die every single day in Bangladesh due tountreated diarrhea, but in Sri Lanka can expect to live for 74 years. WhileBangladesh is witnessing unprecedented prosperity and growth, basic humandevelopment for the vast majority is not happening. The region is expectedto miss many of the Millennium Development Goal (MDG) targets, andgovernment need to uphold the basic rights to essential services. Well-planned actions need to be implemented on a mammoth scale to improve thedelivery of health, water and sanitation.CURRENT SITUATION OF HEALTH SECTOR IN BANGLADESH:“You can not talk in isolation about healthcare. It is linked with sanitationand drinking water” Aswini Kumar Nanda, Researcher, India.By following the speech of Aswini Kumar Nanda, we analyze health sector ofBangladesh with regarding the current situation of healthcare indicatorsaccessing safe water, and sanitation.HEALTHCARE INDICATORS:By analyzing some healthcare indicators, we can make us well informed aboutthe current situation of health sector of Bangladesh. Infant Mortality Rate (IMR) decreases to 46/1000(1973) from 140/1000(2005). Maternal Mortality Rate (MMR) decreases to 30/1000(1973) from 3.1/1000(2005). Crude Birth Rate (CBR) decreases to 47/1000(1973) from 18.2/1000(2005). Crude Death Rate (CDR) decreases to 17/1000(1973) from 3.2/1000(2005).
Life Expectancy at Birth (LEB) increases from 45 years to 65 years. Doctor/ Population Ratio increases from 1:6250 to 1:4105. Now immunization coverage under one year is 85%. 42% population is covered by essential health care. A trained person assists 14% delivery. Source: BMC International Health and Human Rights.ACCESS TO SAFE WATER:Water is central to the way of life in Bangladesh and the single mostimportant resource for the well being of its people. It sustains an extremelyfragile natural environment and provides livelihood for millions of people.Unfortunately, it is not infinite and cannot be treated as a perpetual freegift of nature to be used in any manner chosen. The unitary nature of watermakes its use in one form affect the use in another. Its availability forsustenance of life, in both quantitative and qualitative terms, is a basichuman right and mandates its appropriate use without jeopardizing theinterest of any member of the society.Availability of water, including rainwater, surface water, and groundwater, inusable forms calls for its sustainable development, a responsibility that hasto be shared collectively and individually by members of the society. Privateusers of water are the principal agents for its development and managementand private investments need to be actively promoted in the water sector,ensuring equal opportunity to all. However, development of water resourcesoften requires large and lumpy capital investment and generates economiesof scale, which justifies public sector involvement. Governments role alsobecomes important because of the necessity of protecting the needs of thesociety at large and addressing important environmental as well as socialissues such as poverty alleviation and human resources development.Water resources management in Bangladesh faces immense challenge forresolving many diverse problems and issues. The most critical of these arealternating flood and water scarcity during the wet and the dry seasons,
ever-expanding water needs of a growing economy and population, andmassive river sedimentation and bank erosion. There is a growing need forproviding total water quality management (checking salinity, deterioration ofsurface water and groundwater quality, and water pollution), andmaintenance of the eco-system. There is also an urgency to satisfy multi-sector water needs with limited resources, promote efficient and sociallyresponsible water use, delineate public and private responsibilities, anddecentralize state activities where appropriate. All of these have to beaccomplished under severe constraints, such as the lack of control overrivers originating outside the countrys borders, the difficulty of managingthe deltaic plain, and the virtual absence of unsettled land for building waterstructures.Some Data:Water: MDG STATUS of BangladeshBANGLADESH Targets Current % Target % Rural 72 96.5Ensure that 100% of urban and 96.5% of rural population have Urban 82 100access to safe water by 2015Water: Bangladesh Year 1990 2006 Rural 68 74% of population with access to improved drinking water sources Urban 83 83 Total 71 77Source: UNSTAT, December 2006, Millennium Indicator Database http://unstats.un.org/unsd/mi/mi_goals.aspSituation Analysis
In the case of Bangladesh the target is to increase coverage of safe waterfrom 99 percent to 100 percent in urban areas and from 76 percent(arsenic-adjusted estimate) coverage to 96.5 percent in rural areas by 2015.In the case of Bangladesh, MDG 7 - Target 10 was modified to highlight thecrucial role that access to water and to sanitation play in maintaining ahealthy and productive population. Besides the global indicator of theproportion of population with sustainable access to an improved watersource. Water: Bangladesh % Of population using improved drinking Total 97 water sources 2000 Urban 99 Rural 97Situation Analysis:This indicator is defined as the percentage of the population who use any ofthe following types of water supply for drinking: piped water, public tap,borehole or pump, protected well, protected spring or rainwater. By thisdefinition nearly 100 percent of the population in Bangladesh has access towater. However, over the last few years thousands of tube-wells have beenfound to be contaminated with naturally occurring arsenic at higher thanWHO-recommended levels. If quality is taken into account, access to safewater drops to only 72 percent in rural areas. In spite of the fact that thisis good coverage by developing country standards, it implies that 30 millionpeople remain without access to safe water. Coverage in urban areas is 82percent.PROPORTION OF POPULATION WITH SUSTAINABLE ACCESS TO ANIMPROVED WATER SOURCE:This indicator is defined as the percentage of the population who use any ofthe following types of water supply for drinking: piped water, public tap,borehole or pump, protected well, protected spring or rainwater. By thisdefinition nearly 100 percent of the population in Bangladesh has access to
water. However, over the last few years thousands of tube-wells have beenfound to be contaminated with naturally occurring arsenic at higher thanWHO-recommended levels. If quality is taken into account, access to safewater drops to only 72 percent in rural areas. In spite of the fact that thisis good coverage by developing country standards, it implies that 30 millionpeople remain without access to safe water. Coverage in urban areas is 82percent.SANITATION:The Government of Bangladesh has laid down ambitious plans to achievenationwide coverage of sanitation by 2010, well ahead of the time scale ofthe sanitation target of the Millennium Development Goals (namely to reduceby half the number of people without access to adequate sanitation by theyear 2015). Recent estimates of sanitation coverage in Bangladesh are 39%for the rural and 75% for urban populations. This implies accelerating therate of progress from the present 1% to 8% each year. Until recently therehas been relatively little work on the costs and benefits of sanitation; theseare often quantified in terms of benefits to health and in timesavings.For example it is estimated that in Bangladesh over US$80 million (Taka 500Cores) is spent on medicines, doctors fees and travel costs in relation toillness that can be associated with poor sanitation. What is rarely, if ever,mentioned are the potential wider benefits to the economy, particularly inrelation to the employment that can be generated for small-scaleentrepreneurs. These typically include builders and masons, and suppliers ofbuilding materials. This paper focuses on the Total sanitation Campaign(TSC) that has been in operation in rural Bangladesh since the late 1990s.The approach was pioneered by the Bangladeshi NGO, theVillage Education and Resource Center (VERC), with the support of theInternational NGO Water Aid. It takes a community based approach toachieving 100% sanitation coverage, working on the principle that thecommunity itself has the resources and ability to address sanitation (andassociated water and hygiene) problems. Involvement of community membersfrom the beginning, in awareness-raising and planning, through toimplementation and monitoring, is a key Supporting factor in the success ofthe approach. With appropriate external support from NGOs to identify the
current situation and need for improvement, the community plans andimplements solutions to meet that need.Some Data:Sanitation: MDG STATUS of Bangladesh Rural 29 55.5Ensure that 100% of urban and ruralpopulation have access to improved Urban 56 85.5sanitation by 2010Source: MDG: Bangladesh Progress Report, December2006, GOB-UNSanitation: Bangladesh % of population using adequate sanitation Total 48 facilities 2000 Urban 71 Rural 41 Source: UNICEFSituation Analysis: Access to improved sanitation must be increased from 75 percent to 85.5percent in urban areas, and from 39 percent to 55.5 percent in rural areasby 2015In the case of Bangladesh, MDG 7 - Target 10 was modified to highlight thecrucial role that access to water and to sanitation play in maintaining ahealthy and productive population. Besides the global indicator of theproportion of population with sustainable access to an improved watersource, a second indicator was included - the proportion of urban and ruralpopulation with access to improved sanitation.PROPORTION OF THE URBAN AND RURAL POPULATION WITHACCESS TO IMPROVED SANITATION:In rural areas access to improved sanitation has increased from 11 percent in1990 to 29 percent in 2002. In the case of urban areas however, thesituation has deteriorated, coverage dropping from 71 percent to 56percent. This is mainly due to unbridled and unplanned urbanization that hasbeen taking place in recent years. Although technologies such as sewers,septic tanks, pour-flush latrines, simple pit latrines, and ventilated improved
pit latrines contribute towards the achievement of target 10, additionalfactors also need to be taken into consideration. For example, it is essentialin the case of simple pit latrines that excreta are adequately treated beforebeing discharged into the environment. Even in towns and cities withsewerage systems, discharges are passed untreated directly into theenvironment. Solid waste disposal remains an environmental sanitationhazard, especially in the urban areas.The Government recognizes the importance of increasing access tosanitation. Following a major initiative that culminated in the SACOSANConference in Dhaka in October 2003, the Government declared its owntarget of achieving 100 percent sanitation coverage by 2010, and hasallocated two percent of its annual development budget for the task.EXPENDITURE ON HEALTH SECTOR:State commitment to health care has often been repeated. Article 12 of theInternational Convention on Economic Social and Cultural Rights(1966) statesthat „the state is obliged to attain the highest attainable standard of healthfor its population. States are required to adopt administrative, budgetary,judicial, promotional and other measures towards the full realization of thisright‟.For ensuring the above article of ICESCR and also ensuring the requirementsof PRSP, Bangladesh has to spend and handsome total for the health sector.The followings indicates the proportion of total budget expenditure onhealth sector from 2001-02 to 2006-07:Year % Of total Budget2001-02 6.742002-03 6.512003-04 6.772004-05 5.70
2005-06 6.732006-07 6.85Source: Shamunnay (NGO)In current situation, the targeted expenditure on health sector is very poorbecause per capita health service in only 341 taka thereby per day healthservice for an individual only .93 taka, which is not supported by MDG andPRSP.After the year of 2000, the death of mother has been declined 1 per lucks.In regard this rate, we need 156 years to ensure the aim of MDG!! On theother hand. In declining child mortality, we need 22 years!!.For this, the targeted expenditure on health sector should have 2% of GDP.Expenditure on health sector is much better for other South Asiancountries than Bangladesh.COMPARATIVE ANALYSIS OF SOUTH ASIAN COUNTRIES INREGARDING CURRENT SITUATION OF HEALTH SECTOR: Population without access to Improved water and sanitation.Country Drinking Water (%) Sanitation (%)Bangladesh 25 52Pakistan 10 46Nepal 16 73India 14 70Sri Lanka 22 9Afghanistan 87 92 A balance sheet for Human Development and Access to Essential . Services.
CountryCountry What has progressed What has progressed What remaiins depriived What rema ns depr vedBanglladeshBang adesh In Banglladesh.. The iinfant In Bang adesh The nfant There iis a 40% vacancy rate There s a 40% vacancy rate mortalliity rate dropped morta ty rate dropped iin doctor postiings iin poor n doctor post ngs n poor dramatiicallly:: from 145-to 46 dramat ca y from 145-to 46 areas wiith a concentratiion areas w th a concentrat on per1000 lliive biirth between per1000 ve b rth between of heallth workers iin urban of hea th workers n urban 1970 to 2003.. 1970 to 2003 centers.. centers Popullatiion wiith sustaiinablle Popu at on w th susta nab e Arseniic iin Shalllow tube-wellls Arsen c n Sha ow tube-we s access to iimproved access to mproved found iin 59 out of the 64 found n 59 out of the 64 saniitatiion iincreased from san tat on ncreased from diistriicts has exposed an d str cts has exposed an 23% to 48% between 1990 23% to 48% between 1990 estiimated 25 miillliion peoplle est mated 25 m on peop e to 2002.. to 2002 to toxiins.. to tox nsIndiiaInd a Increased successfull Increased successfu 80% of totall heallth fiinanciing 80% of tota hea th f nanc ng treatment of tubercullosiis treatment of tubercu os s iis from out-of-pocket s from out-of-pocket cases from 3 out of 10 cases cases from 3 out of 10 cases expenses of end-users and expenses of end-users and to 8 out of 10 between to 8 out of 10 between the poorest 20% have doublle the poorest 20% have doub e 1993and 2001.. 1993and 2001 the mortalliity rate of the the morta ty rate of the riichest quiintiille.. r chest qu nt e Water coverage iin rurall Water coverage n rura habiitatiions iincreased from hab tat ons ncreased from Even,, iif the MDG targets are Even f the MDG targets are 56% to 95% between 1995 56% to 95% between 1995 achiieved iin 2015,, 500 miillliion ach eved n 2015 500 m on and 2004.. and 2004 peoplle wiilll llack access to peop e w ack access to saniitatiion and 334 miillliion san tat on and 334 m on accesses to safe water.. accesses to safe waterSrii LankaSr Lanka 90% of chiilld delliiveriies take 90% of ch d de ver es take In jaffna.. The maternall In jaffna The materna pllace iin a publliic heallth p ace n a pub c hea th mortalliity rates have morta ty rates have faciilliity by a skiillled biirth fac ty by a sk ed b rth iincreased ten folld and are ncreased ten fo d and are attendant.. attendant ten tiimes than iin Collombo.. ten t mes than n Co ombo Hiigh mortalliity rate iin urban H gh morta ty rate n urban In 2002,, 22% of the In 2002 22% of the areas and estate pllantatiions areas and estate p antat ons popullatiion was wiithout popu at on was w thout were partiiallly addressed were part a y addressed access to iimproved driinkiing access to mproved dr nk ng through concerted efforts through concerted efforts water.. water to buiilld water and saniitatiion to bu d water and san tat on faciilliitiies.. fac t esCONCLUDING REMARKS:
Bangladesh, with the large concentration of poor people in South Asia, needsto make a huge step forward in this battle against backward health sector.Concerted action to provide universal healthcare, water supply, andsanitation of good quality has enabled dramatic strides in humandevelopment within some pockets of Bangladesh. The time now comes for theentire region to emerge as an influential global voice on the strength of itsoverall development- both economic and human. The annals of history eagerlyawait the erasure of poverty and inequality. The efficient delivery of freeand good quality essential services will be key.REFERENCES: 1. „Serve the Essentials‟ (what governments and donors must do to improve South Asia‟s Essential Services) by Oxfam-GB. 2. Human Development Report 2006(Bangladesh Rural sanitation Supply Chain and Employment Impact). 3. “Shifting millions from open defecation to hygienic latrines” by Village Education and Resource Center (VERC) 4. “Shifting Millions from Open defecation to Hygienic Practices” by Water Aid, prepared for the ADB, dated 15 August 2005. 5. MLGRDC, (2005), National sanitation Strategy, Local Government Division, Ministry of Local Government, Rural Development and Cooperatives, People‟s Republic of Bangladesh. 6. MDG: Bangladesh Progress Report, February 2005, GOB-UN.
7. Assignment on “Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect” by Syed Azizur Rahman. 8. UNDP. Human Development Report. New York: UNDP; 2004. 9. DFID. Bangladesh Health Briefing Paper. DFID Health Systems Resource Center: London; 1999. 10. Shamunnay (NGO)..