Bangladesh outperforms Asian neighbours despite low spending on health care

December 9, 2013

Exceptional improvements in the survival of infants and children under 5 years of age, life expectancy, immunisation coverage, and tuberculosis control in Bangladesh are part of a remarkable success story for health in the South Asian country, according to a major new Series published in The Lancet. This is despite low spending on health care, a weak health system, and widespread poverty.

But the nation still faces considerable problems, including deep poverty and malnutrition, and this is being exacerbated by an evolving set of 21st-century challenges (eg, massive and rapid urbanisation, an upsurge in chronic and non-communicable diseases, and increasing vulnerability to climate change).

The six-part Series takes a comprehensive look at one of the “great mysteries of global health”, investigating a story not only of “unusual success” but also the challenges that lie ahead as Bangladesh moves towards universal health coverage.

“Over the past 40 years, Bangladesh has outperformed its Asian neighbours, convincingly defying the expert view that reducing poverty and increasing health resources are the key drivers of better population health”, explains Series co-leader Professor Mushtaque Chowdhury from BRAC in Dhaka, Bangladesh. “Since 1980 maternal mortality has dropped by 75%, while infant mortality has more than halved since 1990, and life expectancy has increased to 68.3 years—surpassing neighbouring India and Pakistan.”

According to the Series, what sets Bangladesh apart is its pluralistic health system in which many stakeholders including the private sector and non-governmental organisations (NGOs) have been encouraged to thrive and experiment. This has led to rapid improvements in access to essential services such as diarrhoea treatment, family planning, vitamin A supplementation, and vaccination coverage.

“Promoting an open culture of research-based innovation has made Bangladesh a pioneer in scaling up community-based approaches that have brought key health interventions to every household, making huge inroads into improving maternal and child health and reducing population growth”, explains Series co-leader Professor Abbas Bhuiya from the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh.

One striking example is tuberculosis treatment. By mass deployment of community health workers, cure rates escalated from less than 50% to more than 90%—among the highest in the world. Another is contraceptive use. By recruiting female health workers to deliver door-to-door family planning services, Bangladesh has achieved high (62%) contraceptive prevalence and a rapid fall in fertility from 6.3 births per woman in 1971 to 2.3 in 2010—a rate unparalleled in other countries with similar levels of development.

Source: News Medical
Published: 21 Nov 2013

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