Bangladesh

Bangladesh has the seventh-largest population in the world with 160 million people. Although there has been considerable progress in reducing unintended pregnancies, projections forecast more than 50% growth, to approximately 250 million people over the next 40 years. Despite a decade of economic growth at more than five percent a year, almost half the population of Bangladesh lives in poverty and 35 million live in extreme poverty – living on less than $1 a day. Moreover, between one-fifth and one-third percent of the country floods each year and is prone to natural disasters.

These challenges pose significant problems for the protection of human health. More than 10 million children under the age of five suffer from malnutrition, which contributes to two in three child deaths. A weak public health system hampers delivery of care. The maternal mortality rate is one of the highest in the region, but recently witnessed a 40 percent decline to 194 deaths per 100,000 live births. Forty-nine percent of children under five and 46 percent of women are anemic. Tuberculosis (TB) is still the major cause of adult mortality – Bangladesh has the fifth-highest level of TB cases in the world. Incidence of HIV/AIDS is low, below one percent.

The Global Health Initiative represents a major shift in U.S. assistance in Bangladesh. A new U.S. and Government of Bangladesh partnership was launched in November 2010. At the request of the government of Bangladesh, it develops a multi-sector approach that empowers girls, women, and families about their reproductive health needs, with implications not only for the health of women and families, but also for fostering a stable, economically prosperous country. The partnership signals greater alignment of U.S. investments with Bangladeshi priorities, building on past successes and the comparative strength of U.S. global health and other development programs. In particular, the U.S. is supporting the government in brokering public-private partnerships, and more actively engaging other donors and non-governmental organizations in delivering integrated health services. Another focus is boosting Bangladesh’s own capacity to identify and characterize which health problems are the greatest burdens, where, and in what populations, through surveillance, epidemiology, and laboratory techniques. With increased capacity, Bangladesh can then design solutions and monitor health to ensure solutions continue to work or are redesigned. These efforts include helping the Ministry of Health to build and sustain skills of the public health and health services workforce.

GHI is working closely with the Feed the Future initiative on food security – envisioned to reach 45 percent of Bangladeshi households that suffer from persistent poverty and food insecurity – to encourage exclusive breastfeeding, enhanced nutrition, and dietary habits for more than one generation of Bangladeshis. U.S. investments will support Bangladeshi efforts to empower women and girls by: increasing their contribution to Bangladesh’s long-term development; addressing gender-based violence; and improving their access to health information and services by creating advocacy through partnerships with male leaders and mothers-in-law.

Country Leadership: National Health Plan Priorities and Challenges

The Government of Bangladesh’s vision is “to see the people healthier, happier, and economically productive to make Bangladesh a middle-income country by 2021” (Vision 2021). The government finances 70 percent of the $4.2-billion five-year Population, Health, and Nutrition Sector Strategic Program. The goal of the next sector program, covering 2011-2016, is to ensure quality and equitable health care for the citizens of Bangladesh. Revitalizing social services is a core focus of the Bangladeshi government, including a commitment to: rebuild the health system at the community and district levels; improve access to services for the most disadvantaged, including women; and increase governance, accountability, and credibility in addressing the country’s remaining health challenges.

GHI Bangladesh Strategy: Focus Areas

The overarching GHI country goals in Bangladesh are to stabilize population and improve health and nutrition by increasing the equitable use of evidence-based, high- impact population health and nutrition services. Three areas of focus have been identified to guide U.S. investments in Bangladesh:

1) Revitalize nationwide family planning to increase the use of effective family planning and reproductive health services

2) Increase the use of integrated population, health, and nutrition services

3) Strengthen health systems governance at the national and local levels.

The Bangladesh national strategy includes explicit goals to address GHI health targets, including preventing unintended pregnancies; saving mothers’ lives by increasing the number of women who use a skilled birth attendant; encouraging public, private, and non-governmental organization partners to integrate health services; and promoting adherence to one health plan by national and local health systems.

Improving Effectiveness and Efficiency through GHI Principles

The Bangladesh GHI Strategy outlines specific steps that will be taken to advance the GHI principles. The rationale for these steps includes the following:

• Investing in gender equality for women and girls is important for maternal and child health, but also for social status, livelihood, and participation of women in the economy.
• Focusing on helping families stay healthy by making family planning and other services available not only affects the health of women and families, but has implications for Bangladesh’s long-term economic stability.
• Strengthening health systems at national, district, and sub-district levels improves and sustains public health outcomes.
• Brokering public-private partnerships maximizes existing resources to improve coverage and access to essential health services.
• Leveraging U.S. investments in Feed the Future, Food for Peace, Global Climate Change, and other sector programs expands the reach of health and nutrition investments at a marginal cost.
• Strengthening alignment of U.S. investments with Bangladeshi health plans increases the long-term sustainability of U.S. investments.
• Strengthening monitoring and evaluation identifies what works, and what doesn’t.

GHI in Action:

Helping Babies Breathe

When Minara Khan of Bangladesh started having labor pains, she called Jubayda Shirin, one of the community’s skilled birth attendants, who found Minara’s baby in the breech position. Jubayda delivered the child, but as she wrapped the small body, she heard no cries and felt no breath. As Minara and her family looked on, Jubayda did what she had been trained to do – resuscitate the newborn using a bag and mask. Shifa is now a healthy baby girl.

Every year an estimated four million newborns die during their first month of life. Half of these deaths occur during delivery and within the next 24 hours, often as a result of inadequate or lack of breathing. Simple means to stimulate breathing, including drying and rubbing the baby, or ventilation with a bag and mask, could save most of these babies. But such lifesaving care is currently available to fewer than one of four newborns.

Jubayda knew what to do because she had been trained as part of a pilot study supported by a Global Development Alliance initiated by USAID with Laerdal Medical, American Academy of Pediatrics, Save the Children, and the National Institutes of Health with the objective of rolling out Helping Babies Breathe, a simplified newborn resuscitation curriculum. The successful study was conducted by Bangabandhu Sheikh Mujib Medical Hospital, with the help of USAID and Save the Children.

As a result of the study, Bangladesh is planning a national scale-up of the program, with a goal of training close to 30,000 providers in newborn resuscitation. Currently only 23 percent of the deliveries in Bangladesh take place in institutions and only 4 percent use a medically trained provider to attend deliveries at home. USAID will collaborate with other development partners to support the Government in building skills and equipping skilled birth attendants to make them more effective in saving the lives of mothers and newborns.