Progress of health-related SDGs in Bangladesh: A mid-term evaluation study

(excerpts from proposal)

The 2030 Sustainable Development Goals, i.e., the SDGs have 17 Goals and 169 targets, was passed by UN General Assembly on 25 September 2015, and crafted the path of development for the next 15 years. Health is a key component of these goals (SDG 3), prioritizing healthy lives and promoting well-being for all to achieve universal health coverage (UHC). SDG 3 has 13 targets, with UHC at its centre, and is linked to many other goals and targets in an integrated manner. In order to move towards UHC, WHO recommends reorienting health systems using a primary health care (PHC) approach. ‘PHC is central to achieving UHC and health-related SDGs as enshrined in the 2018 Astana Declaration and WHO’s South-East Asia regional strategy’ respectively.

 

Thanks to the “pluralistic” health system, Bangladesh has made remarkable progress in human health and well-being rapidly in recent times, under resource constraints. This has also been reflected in the last SDG progress report. For example, under-five mortality declined from 36 per 1,000 live births in 2015 to 29 in 2018, and the neonatal mortality rate decreased from 20 in 2015 to 16 per 1,000 live births in 2018. This progress aligns with the Global Action Plan (GAP), which identifies seven accelerator themes (‘SDG accelerators are initiatives voluntarily undertaken to accelerate the SDG implementation by governments and any other non-state actors - individually or in partnership’) for advancing health-related SDG targets.

 

Bangladesh has made remarkable progress in human health and well-being in recent decades, however, there has been stagnation in the last decade, as reflected in various surveys conducted for assessing, e.g., maternal and neonatal health (MNH). These surveys also identified shortfalls in the quality of care (QoC) offered at Bangladesh’s primary health care (PHC) level. Globally, QoC is of concern as “more deaths in low- and middle-income countries are now occurring as a result of poor-quality care than owing to a lack of access to care”. Also, the rapidly changing socio-economic conditions in Bangladesh, urbanisation and population ageing have led to a shift in disease patterns and increased the burden of NCDs, another emerging public health problem in the country.  NCDs like hypertension (HTN) and diabetes mellitus (DM) put enormous pressure on health systems and society and risk congesting primary care and referral facilities while causing high out-of-pocket (OOP) expenditure for patients. PHC has been positioned as the cornerstone of the universal health coverage (UHC) movement. It emphasizes a “whole-of-government” and “whole-of-society” approach to health and combines “multisectoral policy and action, empowered people and communities, and integrated health services.

 

Blood transfusion (whole blood and components of blood) has become a critical healthcare service and has gained the status of essential medicine, especially in the LMICs. Blood transfusions are critical for treating severe anaemia, maternal haemorrhage, trauma-related injuries, supporting surgeries, managing chronic conditions, and improving overall healthcare quality. Despite their importance, there is a significant global shortage of blood and blood products, particularly in LMICs like Bangladesh, which requires over 900,000 units of blood annually. Currently, there are 204 BT centres in the public sector and 164 in the private sector in Bangladesh . These BT centres provide screened whole blood; only 24 centres provide blood components (e.g., packed blood cells, platelets and plasm concentrates).

Delivering non-communicable disease services through primary health care in selected south Asian countries: are health systems prepared?

In the South Asian region, delivering non-communicable disease (NCD) prevention and control services through existing primary health-care (PHC) facilities is urgently required yet currently challenging. As the first point of contact with the health-care system, PHC offers an ideal window for prevention and continuity of care over the life course, yet the implementation of PHC, to address NCDs is insufficient. This review considers evidence from five South Asian countries to derive policy-relevant recommendations for designing integrated PHC systems that include NCD care. Findings reveal high political commitment but poor multisectoral engagement and health systems preparedness for tackling chronic diseases at the PHC level. There is a shortage of skilled human resources, requisite infrastructure, essential NCD medicines and technologies, and dedicated financing. Although innovations supporting integrated interventions exist, such as innovations focusing on community-centric approaches, scaling up remains problematic. To deliver NCD services sustainably, governments must aim for for increased financing and a redesign of PHC service. (abstract).

1.                Ahmed SM et al. Delivering non-communicable disease services through primary health care in selected south Asian countries: are health systems prepared? Lancet Glob Health 2024;12: e1706–19. Published Online August 20, 2024.  https://doi.org/10.1016/2214-109X(24)00118-9