Wednesday, 7 June 2017
We are aware about the recent laudable performance of Bangladesh in achieving the health related MDGs in the country, despite the existence of a health system frequently characterized as ‘weak, fragmented and poorly resourced.’ During the last decade, Bangladesh has managed to expand health service coverage, reduce disease burdens, and improve overall population health outcomes, at a ‘low cost’ compared to its neighbours of comparable socioeconomic conditions. Key to these changes has been sustained commitment for health sector over the years in situations of political unrest, economic crises, and natural disasters. Consistent and coordinated policy and programme inputs in the health sector, investments enhancing women’s empowerment (e.g., girls’ education, microcredit, and garments manufacturing), interventions for WASH and poverty reduction, improving nutrition and food security, and infrastructure development (e.g., roads and highways improving accessibility) played key roles in attaining such achievements.
Activities facilitating UHC in Bangladesh has gained new momentum following the commitment of the Prime Minister in the 64th World Health Assembly in May 2011 to achieve universal health coverage (UHC) by 2032. Some strategic initiatives undertaken since then include the formulation of the Health Care Financing Strategy 2012-2032, Communication strategy for UHC 2014-2016, and Bangladesh National Health Accounts 2015. Further, the National Health Policy which was first promulgated in 2000 has been revised in 2013/14 incorporating the principle of the ‘right to health’ for all. Besides, the Health Workforce Strategy 2015 and the Health Protection Act 2014 are finalized for implementation.
The support of the Rockefeller Foundation through its Transforming Health Systems (THS 2010) initiative in 2009 (RF) (to facilitate UHC in LMICs countries like Bangladesh through a ‘multi-pronged’ approach) was crucial in taking up the above initiatives. A recently published Working paper delineates how investments in strategic areas of health sector in the initial stages can generate a momentum for UHC in a LMIC like Bangladesh. To further catalyse the process, RF funded the establishment of the Centre of Excellence for Universal Health Coverage (www.coe-uhc.org) in 2011 at the JPGSPH, BRAC University. The centre works to generate essential evidence on UHC in the context of Bangladesh, develop core competencies for implementing UHC, and provide a forum for disseminating and sharing knowledge, experiences and best practices around UHC and related issues.
Thursday, 20 April 2017
Non-communicable diseases (NCD) constitute a major challenge for the low- and middle-income (LMIC) countries. Globally, the NCDs are receiving increasing attention from the policy-makers and practitioners, as reflected in the new 3.4 Sustainable Development Goals (SDG) target (“reduce mortality from NCDs and promote mental health”). The LMICs like Bangladesh are fast undergoing “epidemiological transition”, thanks to the spectacular success of modern medical science, substantial control of the communicable diseases from improved water and sanitation, and economic development. So far so good! But, the flip side of the coin is that these countries are becoming “old before they are rich”, and burdened with the rapid rise of non-communicable diseases (NCDs). Bangladesh is no exception. This is posing a major challenge to its existing health systems (primarily geared to address communicable diseases of women and children) as the government is yet to pick up the momentum for the ever expanding needs for policies and plans, services, and infrastructures for preventing NCDs.
Bangladesh Health Watch, a civil society initiative since 2006, is producing analytical reports on issues related to improvement of the health system from a critical perspective, and do the relevant advocacy activities. So far, five reports on equity (BHW, 2006), health workforce (BHW, 2007), governance (BHW, 2009), universal health coverage (BHW, 2011), and urban health (BHW, 2014) have been published. In 2016, this emerging problem of NCDs for health and health system of Bangladesh in the era of the SDGs is taken up for analysis and discussion. We limited our inquiry to the four major NCDs responsible for major chronic disease burdens e.g., cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases. Each NCD is discussed critically around four central themes: current epidemiology and prevalence of risk factors, existing policies and strategies including challenges of implementation, inventory of ongoing NCD programmes and finally, an assessment of the current health infrastructure preparedness vis-a-vis addressing the challenge of NCD management in the coming years. Based upon these, challenges are identified and recommendations made for addressing the NCD agenda in Bangladesh in the context of universal health coverage and SDGs.
Thursday, 16 February 2017
According to WHO, mental health is “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”As is evident from the above, mental health disorders are also becoming an increasingly important public health problem in the low-income countries, thanks to the fall-outs from the very competitive globalized economy as well as the socio-politcal instability which is a spin off from the former. The magnitude of the problem is reflected in the Call by WHO (2014) for... ‘the promotion, protection and restoration’ of mental health so that we can ‘think, emote, interactwith each other, earn a living and enjoy life.’
Besides biological and psychological factors, various social,economic and environmental factors (‘conditions in which people are born, grow, live, work, and age’) also come into play to determine mental health status, together called the ‘social determinant of mental health’. These determinants act throughout the life-cycle starting from in-utero to old age. These determinants or risk factors for disorder(s) of mental health include poverty and exclusion, education, gender and violence, employment status, work and living environment, and social capital.
Poverty, exclusion, education and mental health
In low-(and middle-)income countries [henceforth, LAMICs], poverty and exclusion is intimately associated with common mental health disorders such as anxiety and depression. Poverty results in economic deprivation, income in-equalities, and poor level of education; and thus, low probability of gainful employment and high probability of indebtedness, ultimately leading to mental disorders. These two are related in a vicious circle: poverty perpetuates mental disorders and the latter interferes with engagement in productive activities and income-earning, therefore exacerbating poverty.
Tuesday, 10 January 2017
For improved performance as well as realise the rights and entitlements of citizens to public goods such as health, improving the accountability of institutions and systems is essential. Social accountability approaches at the micro or meso level may mitigate the effects of poor service organisation and governance. It may also provide the means to address corruption. In the health sector a variety of public-representation or “social accountability” mechanisms have been developed including public hearings and community monitoring of health facilities. As a social accountability tool, public hearings aim at promoting transparency and accountability of public authorities in addressing the needs of the citizens. It can be thought of as a way of removing asymmetric information and thereby, empowering citizens with information, who can be expected to be in a better bargaining position than before. Also, presence of a large number of citizens in the public hearing creates a collective pressure on the public officials, who respond to the grievances expressed by the citizens and try to address these.
In the public hearings, usually a Corruption Prevention Committees (CPCs) invites public officials of a few government agencies and the citizens of the same locality and allows the citizens to express grievances regarding public service delivery to the concerned government officials, and service providers take necessary measures to resolve it. The committee consists of people from across the society including teachers, religious leaders and former government officials. However, there is almost no empirical research on the reach, process, and consequences of the hearings for evidence-informed evaluation.