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Bangladesh Demographic and Health Survey:
A key source of informationfor health sector program
National Institute of Population Research and Training
Ministry of Health and Family Welfare
Background of BDHS surveys
BDHS as monitoring tool for health sector program
Utilization of BDHS data
BDHS data dissemination approaches
This presentation contains…
BDHS surveys are designed to provide estimates for HPNSDP program indicators for:
National level
urban and rural areas, and
seven administrative divisions
Aims
Bangladesh FertilitySurvey(BFS)
19751989
Bangladesh Contraceptive Prevalence Survey (CPS)
197919811983198519891991
Bangladesh Demographicand HealthSurvey(BDHS)
1993-941996-971999-2000200420072011
National surveys
Survey design and implementation goes through constant review process by Technical Working Group Sampling Committee Technical Review Committee
Ethical clearance from BMRC
How BDHS produces quality data?
Four weeks training for data collection staff
At least 3 days stay in each EA
Four stages of quality control Each team has Field Editor for spot editing Independent quality control team Field check table and debriefing Data consistency check and secondary editing
How BDHS produces quality data?
Produces demographic and health data to support MOHFW for monitoring and evaluation of HPNSDP
Collects and analyses socio-economic, programmatic and community information
Provides regional differentials, equity analysis, public-private-NGO contributions, and gender segregated data
Provides trends data
Provides compatible data with other countries
Provides data for advanced studies, postgraduate and doctoral research
BDHS
BDHS provides 6 out of 8 indicators
Monitoring progress of HPNSDP
Indicators
Baseline
BDHS 2011
Target 2016
Neonatal mortality rateInfant mortality rate (IMR)Under 5 mortality rateTotal fertility rate (TFR)Stunting among <5 children (%)Underweight among <5 children (%)
3752652.74341
3243532.34136
2131482.03833
Goal: Ensure quality and equitable health care for all citizens of Bangladesh
BDHS provides 8 out of 9 indicators
Monitoring progress of HPNSDP
Indicators
Baseline
BDHS 2011
Target 2016
Delivery by skilled birth attendantAntenatal care coverage 4+Postnatal care within 48 hours Contraceptive prevalence rateUnmet need for family planningMeasles immunization by 12 months<5 Children with ARI receiving antibioticsChildren (6-59 months) receiving Vitamin A in last 6 months
26%20%21%62%17%82%38%83%
32%26%27%61%12%84%71%60%
50%50%50%72%9%
90%50%90%
Result: Increase utilization of essential HPN services
BDHS provides 2 out of 3 indicators
Monitoring progress of HPNSDP
Indicators
Baseline
BDHS 2011
Target 2016
Proportion of births in health facilities by wealth quintiles Use of modern contraceptives in low performing areas
1:8
Syl:25% Ctg:38%
1:6
Syl:35% Ctg:45%
<1:4
Syl &
Ctg:50%
Result: Improve equity in essential HPN service
utilization
BDHS provides 2 out of 2 indicators
Monitoring progress of HPNSDP
Indicators
Baseline
BDHS 2011
Target 2016
Rate of exclusive breastfeeding in infants up to 6 months Children 6-23 months fed with appropriate IYCF practices
43%
42%
64%
21%
50%
52%
Result: Improved awareness of healthy behaviour
Targeted programming
3 of 7 divisions are at replacement fertility (RF = 2.1).
Sylhet is 48% and Chittagong is 33% above replacement fertility.
West divisions high CPR
Dhaka & Barisal medium CPR
Eastern divisions (Sylhet & Chittagong) below national CPR.
Targeted programming National
CPR = 61.2
Data on contraceptive method mix over time
shows no increase in use of long acting and
permanent methods (LAPM) like sterilization,
IUD and implants.
Findings resulted in a number of interventions to: improve the quality of service provision related to LAPM
create demand for LAPM through behavior change and communication activities
New health initiatives
Data showed that to reach MDG 4, Bangladesh needed to reduce neonatal mortality
This led to: advocacy for development
of the Bangladesh Neonatal Health Strategy 2009
introduction of programs to improve newborn care
New health initiatives
DHS shows high inequity in use of maternal health by wealth
Interventions on demand-side financing
being tried to increase use of maternal
health services by the poor.
Improving equity gap now a national target
DHS highlights that Bangladesh women
are marrying and bearing children at a very young age.
Led to strong advocacy for assess-ing interventions that can raise age of
marriage and delay childbearing.
New health initiatives
Data revealed drowning to be a major cause of child death
This led to: operations research
to test appropriate interventions
activities to raise awareness against child drowning
teaching swimming skills to children
New health initiatives
National Nutrition Services has launched a media campaign to focus feeding practices for infant and young children.
This is in response to BDHS, which showed little improvement in children’s malnutrition.
Currently 41% of children under age five are stunted or too short for their age.
Expansion of health campaigns
Data show no increase in exclusive breast- feeding practices between 1993 and 2007
Government enacted law increasing maternity leave for 6 months
Efforts continue to enforce a law against promoting infant formula and breast milk substitutes
Legislation
BUDGET SPEECH 2012:
“According to BDHS 2011, under-5 mortality rate has been reduced to 53 from 65 per thousand over the past four years. Currently, one third of women receive the assistance of the trained health workers during child birth. To increase this number further,
taking initiative to train 40,000 health workers of various tiers
‘Maternal Health Voucher Scheme’ will be expand to another 27 upazilas
24-hour emergency maternal care service will be provided in 96 upazila health complexes.”
High level responses
BUDGET SPEECH 2012:
“We want to increase the rate of contraceptive use by 80% within 2021 to address the problem arising from the growing population.
We have made adequate budget allocation We have built up sufficient stock of contraceptives Contraceptive use has increased to 61% from 56%
during the period from 2007 to 2011.”
High level responses
Using BDHS: Feedback from users
“BDHS has been used by the government and the development partners for annual review of the Bangladesh health sector program. …… I could not live without it”
Senior Health Economist, South Asia Region, The World Bank
“UNFPA uses BDHS for advocacy, in policy dialogue with government, and in reviewing program strategies. It is an invaluable source of information for us”
UNFPA Representative, Bangladesh
“BDHS is the Bible of the health sector. It gives us direction on where we need to focus to improve performance. Use it as your guide”
Director of Family Planning, Khulna Division, Bangladesh
Extensive Dissemination of BDHS
Release of preliminary results within 3-4 months of completion of field survey
National dissemination of final report and policy issues
Divisional dissemination
Special dissemination in all upazilas of Sylhet division
Extensive Dissemination of BDHS
Dissemination for targeted audience HPNSDP evaluation team Professional bodies Internee medical students Private medical practitioners (unqualified doctors,
pharmacists) Journalists
BDHS: Journalist Program 2010-11
31 articles in national newspapers, 37 articles in local newspapers and 5 television reports were made by the 20 national and local fellow journalists.
Success story One of the fellows, Mahbuba Zannat, staff
reporter for The Daily Star, received the World Population Day Media Award 2010 by Ministry of Health and Family Welfare for an article on maternal mortality which she published under the fellowship program.
BDHS: Journalist Program 2010-11
Success story Another fellow, Mintu
Deshwara, staff reporter of The Daily Shyamol Sylhet reported on shortage of health care providers that was limiting the effective -ness of the FP program at Sylhet.
Story prompted the upazila
authorities to begin active recruitment of new personnel.
BDHS: Journalist Program 2010-11
Conclusion
BDHS is a part of health sector program
Tries to produce quality data
Ensure participation of stakeholders and professionals in the implementation process
Comprehensive efforts have been made to increase utilization of data using targeted approach
Thank you
Bangladesh ….on the move to better health