Bangladesh

Population:

  • 161,376,708 (2016) [1]

  • Infant mortality rate: 25.14 per 1,000 live births (2020 estimate) [2]

Economy:

  • Relatively large economy (33rd in the world by GDP), chief exports being textiles. [3]

  • A low-income country, with per capita GDP ranked at 144 of 188 countries. [3]

Politics:

  • The rise of the Awami League in contested elections during recent years has fueled concerns that Bangladesh is becoming a one-party state. [4]

  • The ruling party’s brand of Islamism fuels concerns about nationalism and religious intolerance. [4]

Sources:

  1. United Nations (UN), “World Population Prospects 2019”

  2. UN Inter-agency Group for Child Mortality Estimation, “Bangladesh” (2020)

  3. Observatory of Economic Complexity (OEC), "Bangladesh”

  4. Observer Research Foundation, “Bangladesh now one-party democracy” (2019)

HEALTHCARE

Highly unregulated system comprised of four key actors [1]:

  • The public health system is run by government, private for-profit systems, private not-for-profit systems (mostly NGOs), and informal providers (especially in rural areas). [1]

Public system subsidized by government, but drastically underfunded [1]

  • Only 2.64% of the country’s GDP is spent on healthcare; the lowest in the region. [1]

  • Health insurance is almost non-existent, millions of people face financial stress due to medical costs. [1]

Source for all stats:

  1. Advances in Public Health, “Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions” (2019)

 ONGOING ISSUES

Lack of healthcare facilities and natal care [1]

Rural areas underserved [1]

Cultural skepticism of healthcare workers [1]

Poverty and related effects (e.g. poor nutrition) [2]

Shortages of healthcare worker [1]

Child marriage [3]

Sources:

  1. Asian Journal of Medical and Biological Research, “Maternal and child health in Bangladesh: a critical look at the policy and the sustainable development goals” (2017)

  2. Advances in Public Health, “Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions” (2019)

  3. Journal of Biosocial Science, “Teenage motherhood and infant mortality in Bangladesh: Maternal age-dependent effect of parity one” (2000)

 OBSERVED SOLUTIONS

Recruiting, training, and retaining female community healthcare workers (CHW) [1]:

  • Current systems are impeded by high attrition rates [1]

    • Main reasons linked to low pay, cultural stigma against women working, and better opportunities in other fields. [1]

  • Suggested improvements include: increasing compensation, group discussions with families hesitant to have female members in workforce, clearer explanations of tasks and responsibilities. [1]

Promoting family planning and vaccination programs, especially in rural communities [2]

  • Collaborative efforts among the WHO, national government, and NGOs [2]

  • Focusing on direct interactions between healthcare workers (including CHW) and residents, especially pregnant women and those with children. [2]

  • Emphasising on birth spacing (i.e. time between childbirths) and immunization against diseases like tetanus. [2]

Antenatal, natal, and neonatal care programs implemented by CHW3

  • Successfully piloted by “Improved Maternal Newborn and Child Survival” (IMNCS) project in rural Bangladesh. [3]

  • Trained CHW significantly increased the number of attended births (whether at home or in public facilities), to ensure proper umbilical cord care, delayed bathing of newborns, and reduce infant mortality in general. [3]

Digital health training resources for mothers (delivered by CHW)

  • Previously used with success to promote contraception use among mothers with children under two years old.

  • A study found that health applications used by trained CHWs were able to drive significant changes in client behaviors and improve general awareness.

Sources:

  1. Human Resources for Health, “Factors affecting recruitment and retention of community health workers in a newborn care intervention in Bangladesh” (2010)

  2. Development + Cooperation, “Successful family planning in Bangladesh” (2014)

  3. PloS One, “Assessing Community Based Improved Maternal Neonatal Child Survival (IMNCS) Program in Rural Bangladesh” (2015)

  4. Clinical Obstetrics, Gynecology and Reproductive Medicine, “Utilizing digital health applications as a means to diffuse knowledge to improve family planning outcomes in Bangladesh" (2017)

 KEY QUESTIONS FOR FURTHER INVESTIGATION

Does the data take into account marginalized communities like the Rohingya refugees? 

How should cultural barriers (e.g. religious superstition) be addressed effectively, but respectfully? 


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