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Thursday, 16 February 2017

Social determinants of mental health in low income countries

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

Social accountability in health sector

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.

Wednesday, 14 December 2016

Celebrating Universal Health Coverage Day 12.12. 2016 "Act with ambition"

Universal Health Coverage (UHC) is said to exist when ‘every person, everywhere, has access to quality health care without suffering financial hardship’. The three cardinal dimensions of coverage include population (‘who is covered’), services (‘which services are included’), and financial (‘what proportions of the cost is covered). The goal of UHC is rooted in the concept of human rights to health, which also makes sense economically.
As elsewhere, the movement towards achieving Universal Health Coverage (UHC) is gaining momentum in Bangladesh, especially its endorsement by the WHA in December 2012 and by the UNGA in September 2015, and approval of SDGs in September 2016. The day of endorsement of UHC by WHA, the 12th of December 2012, is now celebrated as UHC Day since 2014. The Centre of Excellence for UHC unde the JPG BRAC School of Public Health, BRAC University, has celebrated the first and the second UHC day in 2014 and 2015 respectively.

This year, it also took part in observing the day, with some financial help from the Global Health Strategies as a member of the global UHC Coalition (739 organizations in 117 countries). Below is a short description of the activities by the Centre on UHC Day 2016, including a description of additional activities on the day undertaken by the Centre.

·         Rally for UHC

The Centre started the UHC Day celebration on Monday, 12 December 2016 morning with a rally led by the CoE-UHC. Besides the participants from JPG BRAC School of Public Health, over 150 participants from diverse organizations/institutions joined the rally. Participants included students of medical association named PLATFORM; doctors from Gonoshasthaya Medical College; students from Department of Midwifery, BRAC University; students from University of Dhaka; public health specialist; health program peoples; public health advocates; members of youth organizations named United Nations Youth and Students Association of Bangladesh (UNYSA Bangladesh); representatives from field level implementers like Sajida Foundation; BRAC; Social Education Development & Research Organization (SEDRO) joined the rally. Representatives from enlisted organization in UHC Coalition like Work for a Better Bangladesh Trust, U Chicago Research Bangladesh etc. also joined the rally. A few participants from outside the city also came to join the rally voluntarily. Some passer-by expressed curiosity and joined the rally.

The assembly point for the rally was in front of the National Museum in Shahbag. The participants started assembling from 09:00 am onwards. T-shirt, cap and placards prepared especially for UHC day rally was distributed among the participants by 10:30 am. Under the theme of  this year’s UHC Day “Act with Ambition,” the participants carried placards and banners bearing slogans that reflected the mentioned theme, including “Health for All is a right, not a privilege”, “Universal Health Coverage - every person, everywhere, has access to quality healthcare without financial hardship”, and “No one should go bankrupt when they get sick”.

By 10:30 am the rally started from Shahabag and the procession headed towards Shahid Minar and ended by 11:30 am at Shahid Minar with short speech of participants from various organizations expressing solidarity and demand for UHC in Bangladesh. All the speakers’ emphasized on collaborative efforts and government stewardship to achieve UHC in the country. The rally ended with note of thanks by the organizers expressing solidarity to work together to accelerate this momentum for UHC in Bangladesh. The news of the rally was well covered by the prominent Bangla newspapers like The Daily Ittefaq and Bhorer Kagoj.


Monday, 7 November 2016

Key themes discussed in the orientation sessions for top policy makers, health managers, academia, professional bodies of doctors and non-doctors, and journalists under the Building Awareness for Universal Health Coverage (UHC) in Bangladesh: Advancing the Agenda Forward in 2016

These included the followings:

Level of commitment and awareness varies among different groups of stakeholders

          “We need commitment for UHC first and it has to be within our capacity, affordability and limited budget.” [DGHS, 3 Oct 2016]

          “We blindly can’t follow other countries path… we need to understand our situation and based on our country context create our own path for UHC.” [DGHS, 3 Oct 2016]

          “ We feel shy to interact and discuss because of limited orientation in this regard… but we need to come out of our shyness and participate” [Professional Bodies of Doctors, 6 Sep 2016]

          “Journalists are aware about UHC, mostly through different programs arranged by PIB. We expected to learn new thing through this session…specific and updated data on related issues can be helpful for health reporting.”  [Journalists, 24 Oct 2016]

Health system preparedness in the context of epidemiological and disease transition

          “Medicine provided from the government sector are mainly for communicable diseases but we need to think about the burden arising from the NCDs also...” [DGFP, 16 Aug 2016]

          “…the government facilities are not well prepared to address people’s need. As an alternative, the care seekers are moving towards private facilities.”  [DGHS, 3 Oct 2016]

          “Health services are mostly focusing on curative care but less on preventive care…Government of Bangladesh should do the other way round, e.g., initiating mass awareness program on preventive care in our country.”  [Journalists, 24 Oct 2016]

Health workforce motivation, career prospect, relationship between health and allied professionals

“We need to have highly motivated health workforce and it is mainly their responsibility to take forward UHC..” [Senior government official, 11 Aug 2016]

     “Career planning for professionals need to be specified in the public sector. Career prospect of allied medical professionals in the private sector is not clear…” [Professional Bodies of Non-Doctors, 27 Sep 2016]

     “Mutual respect among health professionals such as between doctor-nurses, doctor-physiotherapists ,etc., could help to achieve UHC.” [Professional Bodies of Non-Doctors, 27 Sep 2016]