HEATH SECTOR AND IT’S DEVELOPMENT OVER FOUR DECADES

7/29/2019 HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

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Research Paper

On

HEATH SECTOR AND

ITS DEVELOPMENT OVER FOUR

DECADES

Submitted to:

Md. Shams-ud-doha

Submitted by:

Md. Nafis Hasan Siddque


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HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES 2

Introduction:

It is the responsibility of the government for many countries to assure health care provision for

the whole population. But the public health issue has become so large that the governments of

these countries have been unable to provide adequate health care. Moreover, to reach the poor

with health services there is a mutual agreement within the government and internationalorganizations that the involvement of all stakeholders is needed if are needed. Different research

evidence showed that working individually can result less accomplishment of health goals but

collaboration among health care providers can establish a good development in facilities,

information and synergy10

. As health sector is an important issue so for every country the

development of this sector is much needed for every country. Development of this sector shows

how much a country has developed and also indicates the achievement of the governments of

those countries. Although there are many challenges and places for more development but

ensuring the proper health service is more important than any other issue of a country.

Bangladesh is a developing country. At the beginning of our country the economical,educational, health and every other condition was not good. We gain our independent in 1971

and we got our new government in 1972 after the new government came their main concern was

to develop our country from the adverse effect of war. For this purpose government has set up

different policy and rules to develop the condition of all sector of our country. In this

development many NGOs and other organization participated. At that time one of the main

issues was developing the health sector. Now after four decades the development of the health

sector has reached a new height. We are now more developed then previous time and still

developing this health sector. If we look at the statistic below then we will see the development

of health sector.

Table 1: Key health indicators in Bangladesh,

Then and now9

Then Now

Life expectancy 44 (1970) 69 (2011)

Under-5 mortality rate

Per 1,000 live births 233 (1975) 48 (2011)

Immunization coverage 1% (1980) 89% (2008)

Underweight children

Under 5 70.5% (1985) 41.3% (2007)

Maternal mortality ratioPer 100,000 live births 648 (1986) 340 (2008)

Total fertility rate 7 (1978) 2.55 (2011)

Contraceptive prevalence 7.7% (1975) 55.8% (2007)

Antenatal care coverage 25.7% (1994) 52.2% (2007)

Births attended by skilled

Health personnel 9.5% (1991) 24.4 % (2009)


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As we can see that now we have achievement in our health sector. Previously the condition was

not up to the mark but after collaboration of other organization and public health care service the

status of the health care service has upgraded a lot. There are still some barriers and places that

need to be more developed but comparison between the four decades, at present we are at a

better position. Hence, the achievement of the government, the policy of the government, the

MDGs, collaboration of public and private health service provider and the overall development

of the health sector is scenario of our health sector and also the subject of our discussion at

present.

Objective:

The objective of the research was to find out some important issue, development of the health

sector, different achievement and also get the proper information of the current condition of the

heath sector in our country. As we know that our country is a developing country and in

development one of the vital parts is health. So our main objectives of the research are given

below:

1. To compare the history of the health sector;2. Notify everyone about the previous and present condition of the health sector;3. Role of our government in health sector;4. Development in the health sector;5. Different health policy;6. Role of NGOs and other private or international organization;7. Highlight the different achievement of our government in health sector;8. Development of health sector in the last four decades;9. Our lacking in the health sector;10.Identify the location of improvement in health sector of our country.

Hence, these objectives are the main focus of our research and through our research we tried to

fulfill our objective.

Methodology:

The methodology of our research is Secondary Research Methodology. As we have no sufficient

material for the research so we had to rely on secondary research methodology. We also had to

use different statistic and survey report from different website and we also use different journal

and article of prominent writer to conduct the research.

Description:

History

Medical science has reached a new height as the time passes by. Now we can do wonders with

medical science. If we look at the previous history of our world then we will find that it was not

that much praise worth situation before. In the pre-historic age and in the Stone Age the medical


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science was not born. Then people had to die for normal diseases like dysentery, fever, food

poisoning and all other basic diseases. People at that time period was not that much developed.

At last when the wheel of time turns the development of medical science was developed.

Although previously they used to believe in supernatural healing power, village doctor or a

person who had no medical education but he was the person they seek when anyone get sick.

Due to this miss-treatment many people died. Another reason of death was malnutrition, plague,

lack of proper care and treatment. Now that time has passed and people all over the world have

learned new things about medical science and they now understand what they need to do if

someone get sick. If we look in the aspect of our country then we will see that there was three

kinds of medical help in our country one was ojha or village doctor, second was Jhar-fuk or

the blessing of religious elders and last one was allopathic or the herbal medicine. These were

the previous condition of medical help of our country. People used to believe them and seek help

to them when anyone in the family got sick. This unethical practice of medical science and

treatment had lead many people to their death. After the liberation war in 1971 we got ourselves

a free country. As we were recently got our independent so the main concern of the newgovernment was to develop the country from different aspect. In those aspects one of the main

concerns was health issue. At that time the condition of health sector was not good. If we look at

the chart below we will see the difference between past and present condition1.

GROWTH OF MEDICAL FACILITIES AND PERSONNEL:

1985/86 - 2008/09Number of persons per

Hospital bed Medical personnel

Public

Private

Total Doctor

Nurse

1985/86 4300 21000 3600 6600 15000

1990/91 4100 16000 3200 5400 12000

1995/96 4100 15000 3100 4500 8700

2000/01 3900 11000 2800 4000 7200

2005/06 4000 8600 2700 3300 6900

2008/09 3500 4000 1900 2800 6000

Now the condition changed and the sector of health has improved a lot. Government has

achieved various goals and successful to fulfill the need of the people. The condition started

improved as the public service started working for the general people and other local and

international organization came forward to help in the development of health sector. At present

there are many public and private organizations that are supporting and helping the people in our

country in health issue. They are emphasizing the health issue of the people living in the ruralarea where the health service and the condition of health are below the line of poor.

The health sector of the last four decade has developed a lot. If we look the decades then we can

distinguish the four decade in a serial manner at first it was from 19721982, second it was

from 19821992, third it was from 19922002 and lastly it was from 2002present. In this

four decade the development has reached a new height.


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In the First decade there was some significant development and achievement such as, a five

year plan was took by the government to help and develop the condition of health and give

proper facilities to the rural people. This plan was for the proper development of rural people

health condition including maternal and child health (MCH) services at the Thana Health

Complex (THCs) and Rural Health Centers (RHC) or sub-centers in each rural union. In order to

increase access to safe water and improve environmental sanitation of the rural area proper

implementation of this plan was necessary2. Then this initiativeencouraged the private sector

and the NGOs to share some responsibilities for reaching healthcare services to the masses, Such

as BRAC and other NGOs participated in the development of health care service. As a result,

private sector facilities started rising rapidly, especially after the government relaxed the existing

restrictions on private laboratories, clinics and hospitals. Second, the Plan sought to make

Primary Health Care (PHC) the main focus of health sector activities, with a view to ensuring at

least a minimum level of healthcare to all3.

Second decade were more advance and developed. Maternal and Child Health (MCH) as a

means of population control was introduced. A new range of programmers such as the ExpandedProgramme on Immunization (EPI), vitamin A distribution, and control of diarrhea were

intensified. This was the starting of the development of the health condition of our country6.

Third decade was the continuation of the second decade. The development and the

achievement was a positive sign so the renovation of health sector and also the increase of doctor

and other medical personal occurred in this decades. The main development that continued withthe two-pronged emphasis on Primary Health Care (PHC) on the one hand and Mother and Child

Health (MCH) on the other. For the first time a sector-wide approach (SWAp) to health sector

programming in the form of the Health and Population Sector Strategy (HPSS) was introduced

and the first National Health Policy in 2000. The operational plan of HPSS, called the Healthand Population Sector Programme (HPSP), was launched in 1998 for duration of five years.

HPSP represented a major shift in the governments approach to the provision of health care7.

At last the decade the development of medical sector was more cherished. The use of new

technology and the flow of information were more frequent. People were getting more healthcare service and with the collaboration of the public and private organization the health care

service was more improved. In the development the NGOs played a vital role and other

international organization also support a lot. The achievement of this sector was vaster andgovernment was also efficient and made different policy to support the development sector of the

health sector. In this decade new pharmaceutical companies were introduced and the supply of

medical resources and other product was easier then before.

In every country there are some specific goals that need to be fulfilling to become a

developed country in every sector. In 2000 with the permit ion and cooperation of 189 countriesall over the world there was a set of goals was set up. This was called the Millennium

Development Goal. This was a set of goals that every country will achieved within a certain time

period. The time limit was 2015 and many countries are trying their best to complete the goal.Our country is also trying their best to achieve the goals and to some extent they have achieved

it. Never the less there are many barriers and challenges in the path of completing this goals. In

The MDG there are three specific goals that are solely related to health. Those are goals 4, 5 and6.


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Goal 4 is Reduce child Mortality rate. Chile mortality is important issue. Child safety is more

important and it should be maintain closely. Bangladesh has made considerable progress in child

survival rate over the last several decades. The recent Millennium Countdown ReportCountdown to 2015 (UNICEF 2008) places Bangladesh among only 16 countries in the world

that are on track to achieve MDG 4 on child mortality. The successful programmes for

immunization, control of diarrhoeal diseases and vitamin-A supplementation are considered to bethe most significant contributors to the decline in child and infant deaths.

Current status of the 4th

goal is5:

Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.

Under five mortality rate (per 1,000 live births)

Benchmark: 146 in 1991

Current status: 53.8 (SVRS 2008)Target: 48

Status: Likely to be met*

Infant mortality rate (per 1,000 live births)Benchmark: 92 in 1991

Current status: 41.3 (SVRS 2008)

Target: 31Status: Likely to be met*

Proportion of 1 year-old children immunized against measlesBenchmark: 54 in 1991

Current status: 82.8 (CES 2009)

Target: 100

Status: Likely to be met**

This are the current status of our country and government and other organization are trying theirbest of improve the condition and get up from the condition and fulfill the goals.

Goal 7 is about improve maternal health. Maternal health is important issue and the rate of

maternal health was very much poor. Due to lack of proper health care facilities and other

services the maternal condition was bad. The Maternal Mortality Ratio (MMR) in Bangladesh

declined significantly from 574 in 1990 to 391 in 2002, followed by a modest decline to 348 per100,000 live births in 2008. The major causes of pregnancy related deaths are post-partum

hemorrhaging, eclampsia, obstructed labor and unsafe abortion (BMMS 2001)6. The current

status of the goal according to the MDG report of 2009 is5:

Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.

1.

Maternal mortality ratio (per 1,000 live births):Base year 1991: 574 (SVRS 1990)

Current status: 348 (SVRS 2008);320 (BMMS 2001)

Target: 143Status: Lagging behind

2. Proportion of births attended by Skilled Health Personnel (percent):Base year 1991: 5


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Current status: 24 (MICS 2009)

Target: 50

Status: Lagging behindAchieve, by 2015, universal access to reproductive health.

1. Contraceptive prevalence rate (%):Base year 1991: 40 (CPS)Current status: 60 (UESD 2008)

Target: 100

Status: Lagging behind2. Adolescent birth rate (per 1,000women):

Base year 1991: 77 (SVRS)

Current status: 60 (SVRS 2008)

Status: Lagging behind3. Antenatal care coverage (at least 1 visit) (%):

Base year 1991: 28 (BDHS 1993-94)

Current status: 60 (BDHS 2007)

Target: 100Status: Lagging behind

4. Antenatal care coverage (4 or more visits) (%):Base year 1991: 6 (BDHS 1993-94)Current status: 21 (BDHS 2007)

Target: 100

Status: Lagging behind5. Unmet need for family planning (%):

Base year 1991: 19 (BDHS 1993-94)

Current status: 17 (BDHS 2007)

Target: 7.60

Status: Lagging behindThese are the current issue and the situation of the MDG 5 and the development and the

improvement of this sector are much needed. If our government can achieve the goal then wewill surely become a developed country.

GOAL 6 is about Combat HIV/AIDS, Malaria and Other Diseases. The Bangladesh National

HIV/AIDS Strategic Plan (2006-2010) is focused on five key areas: (i) provide support andservices for priority groups; (ii) prevent vulnerability to HIV infection; (iii) promote safe

practices in the health care system; (iv) provide care and treatment services to people living with

HIV; and (v) minimize the impact of the HIV/ AIDS epidemic. The National Malaria Control

Programme pursues the achievement of the MDG targets aligned with the targets set in the

Strategic Plan (2007-2015). The programme envisions a 60% reduction of malaria deaths by20155.

The current status of the MDG 6 according to the report of MDG annual report 2009 are5:

Have halted by 2015 and begun to reverse the spread of HIV/AIDS.

1. HIV prevalence among population aged 15-24 years:Base year: 0.005Current status: 0.319 (2007)

Target: Halting


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Status: On track

2. Proportion of population aged 15-24 years with comprehensive correct knowledge ofHIV/AIDS:Base year:

Current status: 15.8 (2006)

Target:Status: need attention

Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases.

1. Incidence of malaria per 100 000 population:Base year: 776.9 (2008)


Target: 310.8 (By 2015)

Status: On track2. Death rate associated with malaria per 100,000 population:

Base year: 1.4 (2008)


Target: 0.6 (By 2015)Status: On track

3. Proportion of children under-5 sleeping under insecticide-treated bed nets:Base year: 81% (2008)Current status: 81% (2009)

Target: 90% (By 2015)

Status: On track4. Proportion of children under-5 with fever who are treated with appropriate antimalarial

drugs:

Base year: 60% (2008)

Current status: 80% (2009)

Target: 90% (By 2015)Status: On track

5. Prevalence of tuberculosis per 100,000 population:Base year: 639 (1990)

Current status: 412

Target: 320 (50% reduction)

Status: 36% reduction6. Death rate associated with tuberculosis per 100,000 population:

Base year: 76 (1990)

Current status: 50 (2008)

Target: 50% reduction

Status: 35% reductionSo as we can see from the statistic and the research data the MDG goals are on track. To fulfill

the MDG goal the participation of public and private international companies and also awarenessand participation of general people is much needed.

Hence, the development of the health sector is an important issue and it is a responsible of thegovernment to ensure proper healthcare service and the facilities. The government are alsoresponsible for the completing the MDG and to develop in the health sector these are the

important issue. Comparing with the history of previous condition of the health sector and the


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development occurred during this four decades are noticeable. There are still more places to

improve and there are also many challenges to overcome but if the government, other

organization and the people work together then we will surely achieve the highest margin of thedevelopment.

Challenges:The health sector of our country has improved a lot but still it has some challenges to overcome.

As we are a develop country and there are many lack of resource so it is a matter of time and

participation for the development of this sector. Some of the significant challenges that plays are

vital role of hazard in the development of health sector are,Lack of improvement in maternal and neonatal health: In our country there is lack of

improvement in maternal health. Maternal health is as important issue. According to the research

data of USAID in 2010 the maternal mortality rate is very high in Bangladesh and 320 of 10,000

dying in live birth. This cannot be excepted as it should be reduce more. The neonatal birth is

also another important thing. The time period of neonatal birth is very crucial and everyone

should look after those mothers and children very carefully. According to the statistic of USAID

in 2010 the death rate of children in neonatal stage was 57%. It is a very high rate and it should

be reduced. Hence, there should be improvement in these sectors.

Lack and shortage in policy making: Our government is playing very effective role on making

different policy to help the people and they are trying to reduce the death rate of our country. On

the other hand our policies are sometimes not very much effective and many policies in health

sector are improper. As the time passes by the policy goes older and it need to be remake and

there are also shortage of policy as the number of health problem has increased. So it is another

challenge that we are facing at present.

Inadequate supply of subsidies by health system: The supply of the subsidies is also

inadequate. There are many hospital in our country and there lots of health complex in the rural

side of our country. But the supply of subsidies in those locations is very poor. Hence, many

cannot have proper treatment. Even in the hospital in urban are we sometimes face this problem.

So to improve the health sector the health system must ensure the proper distribution and

sufficient supply of the subsidies.

Lack of medical and surgical resource allocation: Lack of medical and surgical resources is

another challenge for our health sector. As it is very important for every person to get proper

medical support and it is also our human rights but most of the time we cannot get those

resources in time. Improper allocation and distribution of resources hamper most of the treatment

which leads to a permanent damage to the patient.Inadequate addressed gender issues: Gender issue is another factor in health sector.

Inadequately addressed in gender is decreasing the number of patient. As in the public hospital

the lack of manner and lack of addressing sense according to the gender is often seen by us.

Lack of training and service delivery: Most important lacking in the health sector is lack of

training and service delivery. There are many doctors, sisters, word boy and technicians those


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who have only minimum knowledge of health training and service delivery. This lack sometimes

leads to a disaster and improper treatment.

These are the some main challenges that health sector of our country is facing currently. If these

challenges can be overcome then we can surely make a healthy nation and a healthy country.

Recommendation:

The health sector of our country is very important for us. As the time changes the world is

developing also the problem of health is increasing with it. To prevent these health problem and

to improve the health sector there are some recommendation and they are:1. Improve the present condition of health sector2. Reduce the maternal death and neonatal death by proper care and treatment3. Aware everyone about the health issue4. Fulfill the goals set by the MDGs5. Fulfill the shortcoming and make better health policy6.

Proper allocation of medical and surgical resources7. Give proper training to the doctor, nurse , word boy and other technicians

8. Introduce new technology in the health sector9. Give proper treatment and medicine10. Adequate supply of subsidies by health system11. Family planning12. Improve sanitation13. Proper vaccination and treatment for child disease14. Public and Private sector combinedly ensure the best quality of treatment15. Give emphasize in rural and underprivileged area and give sufficient treatment in a

proper way.According to our research and after a brief discussion these are the recommendation that

came up and if these are fulfilled then the problems of our health sector will be over. It will

also help the people and play a vital role in the improvement of the health sector.

Conclusion:

At last we can say that according to our research there are many developments in our health

sector and if we see then we will find that our health sector has gradually improved in the last

four decades. Although this improvement may not be enough as there are some places for

improvement but the concern authority is trying their best to improve. We made manyachievement and more to come and we were also able to achieve some goal of MDGs. Hence,

there are some recommendations in our research and if authority can completely fulfill those

recommendation and achieve the MDGs then we will surely become more developed than ever.

As we are in 21st

century where we live in the age of modern science so it is only a matter of

time to enrich our Health sector and ensure proper and healthy treatment to make a better society

and brighter future.


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Reference:

1. www.who.int/net/2012/bd.com2. Bangladesh Health Watch Report 2011

Moving Towards Universal Health Coverage

Bangladesh Health Watch, James P Grant School of Public Health, BRAC University,

Mohakhali, Dhaka 1212, Bangladesh

3. Alam N.S.M (2007), Whos Public Action? Analyzing Inter-sectorial Collaboration forService Delivery. Bangladesh Country Review History of State-NSP relation.

International Development Department (IDD). ISBN: 0704425491/9780704425491

4. Jahan A. N. (2011). A Situation Analysis report on Health (MDG 4, 5 and 6) Bangladesh.A baseline for Needs Assessment and Costing.

5. Millennium Development Goals Progress Report 2009. General Economic division,Planning Commission, Government of the peoples Republic of Bangladesh.

6. Jahan. R. (2007). Maternal and Health in Diverse Setting. American Journal of PublicHealth. Vol 97, No 7.

7. Rodriguez. R & Samuels. F (2010). Healthy Partnerships and effective pro-poortargeting. Bangladesh Progress in Health. Overseas development Institute.

Web:www.developmentprogress.com

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9. Data from World Databank, MDG Indicators and Child and Mother NutritionSurvey of Bangladesh.

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HEATH SECTOR AND IT’S DEVELOPMENT OVER FOUR DECADES