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.
Wednesday, 14 December 2016
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.