Bangladesh health policy The Bangladesh health policy was published in 2011 and adheres to the following principles: Health is defined as “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” [1] 1. Every citizen has the basic right to adequate health care. The State and the government are constitutionally obliged to ensure health care for its citizens. 2. To ensure an effective health care system that responds to the need of a healthy nation, health policy provides the vision and mission for development. 3. Pursuit of such policy will fulfill the demands of the people of the country, while health service providers will be encouraged and inspired. Peoples physical well-being and free thought process have proved to be a precondition for the growth and intellectual enrichment in todays human society 4. Bangladesh expressed agreement on the following declarations: The Alma Ata Declaration (1978) The World Summit for Children (1990) International Conference on Population and Development (1994) Beijing Womens Conference (1995) [2] In the absence of a written and approved Health Policy, the national Annual Development Programme and Five Year Plans substituted for policy principles. The problems in the health services multiplied in the absence of a clear policy. Bangladesh is a developing country with the worlds highest population density. Demographics Population – over 150 million Rural population – 77% Population density – 881 square kilometres (340 sq mi) People below poverty line – 60% Population doubling rate – 25–30 years Per capita GDP – Tk. 18,896 Health indicators CDR – 5.2 /1000 Annual Growth rate – 1.48% MMR – 3.92 /1000 live births IMR – 43 /1000 live births Under 5 MR – 83 /1000 live births Total Fertility Rate – 2.9 CPR – 53.8% Life expectancy at birth – 68 (m) and 69 (f) Fully immunised children – 52% TB (smear positive new) detection rate – 31.2% Health care infrastructure UHFWC – 3375 31–50 bed UHC – 397 Various types o district level hospitals – 80 Government medical college hospitals – 13 Postgraduate hospitals – 6 Specialised hospitals – 25 Doctor to population ratio – 1:4,719 Nurse to population ratio – 1:8,226 Hospital beds – 40,773 (over 29,000 in GOB) Process for formulation The Ministry of Health and Family Welfare [3] assembled a Committee in 1996 for the purpose of preparing a health policy , with members drawn from civil society and professional bodies, including technocrats and bureaucrats . A further five sub-committees were formed to: Evaluate the existing health services and determining the goals Formulate policies to ensure essential services Formulate policies to ensure hospital-based services Design Strategies for HRD Integrate NGOs and the Private Sector and plan for resources and utilisation of funds The sub-committees worked for more than a year and submitted their efforts/recommendations. A working group was formed and entrusted with the responsibilities for compiling the recommendations contained in the reports. The working group also organised workshops in all six Divisions to elicit opinions of cross-section of the society on these reports. Finally the working group presented the proposals and recommendations to the National Health Policy Formulation Committee. A report on the health policy was thus formulated on the basis of consensus. The Cabinet on 14 Aug 2000 approved the National Health Policy. National Health Policy (NHP) The Health Policy has 15 goals and objectives, 10 policy principles and 32 strategies. Objectives 1. To make necessary basic medical utilities reach people of all strata as per Section 15(A) of the Bangladesh Constitution, and develop the health and nutrition status of the people as per Section 18(A) of the Bangladesh Constitution. 1. To develop a system to ensure easy and sustained availability of health services for the people, especially communities in both rural and urban areas 2. Third To ensure optimum quality, acceptance and availability of primary health care, and governmental medical services at the Upazila and Union levels. 3. To reduce the intensity of malnutrition, especially among children and mothers; and implement effective and integrated programmes for improving nutrition status of all segments of the population. 4. To undertake programmes for reducing the rates of child and maternal mortality within the next 5 years and reduce these rates to acceptable levels; 5. To adopt satisfactory measures for ensuring improved maternal and child health at the union level and install facilities for safe and clean child delivery in each village: 6. To improve overall reproductive health resources and services; 7. To ensure the presence of full-time doctors, nurses and other officers/staff, provide and maintain necessary equipment and supplies at each of the Upazila Health Complexes and Union Health and Family Welfare Centres: 8. To devise ways for the people to make optimum usage of the opportunities in government hospitals and health service system, and to ensure quality management and cleanliness of service delivery at the hospitals; 9. To formulate specific policies for medical colleges and private clinics, and to introduce appropriate laws and regulations for the control and management of such institutions including maintenance of service quality; 10. To strengthen and expedite the family planning programme with the objective of attaining the target of Replacement Level of Fertility; 11. To explore ways to make the family planning programme more acceptable, easily available and effective among the extremely poor and low-income communities. 12. To arrange special health services for mentally retarded, the physically disabled and for elderly populations; 13. To determine ways to make family planning and health management more accountable and cost-effective by equipping it with more skilled manpower. 1. To create awareness among and enable every citizen of Bangladesh irrespective of cast, creed, religion, income and gender, and especially children and women, in any geographical region of the country, through media publicity, to obtain health, nutrition and reproductive health services on the basis of social justice and equality through ensuring everyone’s constitutional rights. 2. To make essential primary health care services reach every citizen in all geographical regions within Bangladesh. 3. To ensure equal distribution and optimum usage of available resources to solve urgent health- related problems with focus on the disadvantaged, the poor and unemployed persons; 4. To involve the people in planning, management, local fund raising, spending, monitoring and review of the procedure of health services delivery etc. with the aim of decentralising the health management and establishing people’s rights and responsibilities in the system; 5. To facilitate and assist in collaborative efforts between the government and the non-government agencies to ensure effective provision of health services to all; 6. To ensure the availability of birth control supplies through integration, expansion and strengthening of family planning activities; 7. To carry out appropriate administrative restructuring and decentralisation of service delivery procedure and the supply system, and to adopt strategies for priority-based HRD aimed at overall improvement and quality-enhancement of health service, and to create access of all citizens to such services; 8. To encourage adoption and application of effective and efficient technology, operational development and research activities to ensure further strengthening and usage of health, nutrition and reproductive health services; 9. To provide legal support with regard to the rights, opportunities, responsibilities, obligations and restrictions of the service providers, service receivers and other citizens, in connection with matters related to health service; and 10. To establish self-reliance and self-sufficiency in the health sector by implementing the primary health care and the essential services package, to fulfill the aspirations of the people for their overall sound health and access to reproductive health care. Strategies In keeping with the goals, objectives and principles, the following strategies were adopted: 1. Obtain mass-scale consensus and commitment to socio-economic, social and political development to facilitate appropriate implementation of the Health Policy. 2. Prevent diseases and promote health to achieve the basic objective of “Health for All”. The Health Policy focuses on provision of the best possible health facilities to as many people as possible using cost-effective methods, and will thus ensure effective application of the available curative and rehabilitative services. 3. Adopt PHC as the major component of the National Health Policy to ensure delivery of cost- effective health services. PHC is the universally recognised methodology to provide health services. 4. Liberalise and improve the Drug Policy in keeping with the Health Policy to fulfill the overall needs for health services. There is need to ensure smooth availability of essential medicines focusing on the current needs for such medicines and their efficacy, including their affordability by all people. 5. Maintain quality standards of the marketed medicines and raw materials and rationalise the use of medicines. In this line, the required number of skilled manpower will be acquired in drug administration. 6. Ensure distribution of birth control supplies and improve the management of the domestic sources, including encouragement of domestic entrepreneurs. 7. Integrate Epidemiological surveillance system with disease control programmes. A specific institution will be entrusted with the responsibility of such surveillance. 8. Adhere to quality standards in health care at health centres. Provide standard quality assurance guidelines including monitoring and evaluation mechanism to every health centre. 9. Form a Health Services Reforms Body based on the HPSS aiming at meeting the current demand. The role of this body includes reforms in infrastructure, acquisition of HR, inspection of supplies and logistics, and improve management. 10. Design an appropriate and need-based approach to develop HRD to maximise utilisation of the knowledge and skills of health-related personnel. Create positions with an appropriate career planning system, which will be formulated and implemented. Provide appropriate training. 11. Integrate the community and the local government with the health service system at all levels. 12. Install an integrated Management Information System (MIS) and a computerised communication system countrywide, to facilitate implementation, action planning and monitoring. The existing MIS will be further strengthened with skilled and efficient people. Extensive, but appropriate, training will be arranged for them to maintain the system. The number of people working in this system will be increased and their skill enhanced. 13. Restructure and strengthen the BMDC and the BNC to ensure strict supervision of professional registration and their quality of skills and related ethical issues. 14. Restructure and organise education and training of the pharmacists, medical technologists and other paramedics, the Pharmacy Council and the State Medical Faculty to maintain required performance standards. 15. Integrate professional organisations such as BMA, BPMPA, BNA, unani etc. with the countrys health service system. 16. Provide need-based, people-oriented, updated medical education and training. 17. Institutionalise management and administrative training for improving doctors management capabilities. 18. Establish a National Training Institute to provide regular training such as reorientation, continuing medical education, and administrative and management courses etc. to all staffs in the public and private sector. 19. Improve the management of medical colleges/ institutions and related hospitals with increased levels of financial and administrative delegation to ensure efficient hospital services. 20. Emphasise nutrition and health education since they are the major forces of health and FP activities. Establish one nutrition and one health education unit in each upazila, to reach every village. 21. Disseminate information on health education through incorporating the community leaders and other departments/ organisations of the government in the health system. 22. Charge minimum user fees at public hospitals and clinics and provide free care for the poor and disabled. 23. Encourage NGOs and Private Sectors to perform a complementary role to the public sector. 24. Develop infrastructure and transport systems to minimise the disparity in access to health services between rural and urban areas. 25. Pay non-practicing allowances to those doctors/trainee doctors who act as full-time and resident doctors thus refrain from private medical practices. 26. Provide clear policies governing those want to practice within public facilities. 27. Ensure accountability of all concerned in the health system. Design a procedure to strengthen accountability and ensure quick and strict legal disposal of negligence cases. 28. Form a National Health and Population Council under the Head of Government to provide support and advice on the implementation of the Health Policy and ensure effectiveness and accountability of health system. Empower local and regional councils to monitor health activities in their respective areas. 29. Intersect oral co-ordination and utilising resources of the concerned sectors to strengthen linkages. 30. Encourage research on management styles and their effectiveness, clinical services, approach to diagnoses, social and behavioural aspects, epidemiology, etc. Strengthen information dissemination systems, especially involving private organisations with an aim to reach grass-root level. Design, implement and supervise an effective referral system. 31. Avoid duplication of activities from different projects, programmes and activities. Establish a policy-planning cell in the MOHFW to ensure effective and sustainable co-ordination. 32. The goal of the Policy will be to provide client- center health and reproductive health services, so that an individual have the opportunity to select services as per need and choice. This approach of service delivery will be an important strategy of the National Health Policy and will contribute to reduce unwanted pregnancies. 33. Distribute budget from district to community level within reasonable flexibility to provide increased benefits to the poor and destitute communities, optimise expenses and ease accessibility to services. 34. Incorporate alternative health care services such as ayurvedic, unani and homoeopathic practices into the National Policy. Encourage an increased scientific basis for these three disciplines. 35. Deliver ESP from one-stop centres throughout the country. Train the UHCs. 36. Adopt a sector-wide management system. 37. Deploy an MBBS doctor in each UHFWC and equip them with residence facilities for doctors. Health Care System The health care are designated to meet the health needs of the community through the use of available knowledge and resources. The services provided should be comprehensive and community based. The resources must be distributed according to the needs of the community. The final outcome of good health care system is the changed health status or improve health status of the community which is expressed in terms of lives saved, death averted, disease prevented, disease treated, prolongation of life etc. Health care delivery system in Bangladesh based on PHC concept has got various Level of service delivery: Home and community level. Union level, Union sub centre (USC) or Health and family welfare centre; This is the first health facility level. Thana level, Thana Health Complex (THC): This is the first referral level. District Hospital: This is the secondary referral level. National Level: This is the tertiary referral level. A) Primary level health care is delivered though USC or HFWC with one in each union domiciliary level, integrated health and family planning services through field workers for every 3000–4000 population and 31 bed capacities in hospitals. B) The secondary level health care is provided through 100 bed capacities in district hospital. Facilities provide specialist services in internal medicine, general surgery, gynecology, paediatrics and obstetrics, eye clinical, pathology, blood transfusion and public health laboratories. C) Tertiary Level health care is available at the medical college hospital, public health and medical institutes and other specialist hospitals at the national level where a mass wide range of specialised as well as better laboratory facilities are available. The referral system will be developed keeping in view the following. 1. A clearly spent-out linkage between the specialised national institutes, medical college and district hospitals to ensure proper care and treatment of patients from the rural areas served by lower level facilities. 2. Patients from the rural areas referred by lower level facilities to district and medical college hospitals and specialised institutions should get preferential treatment after admission. Health Problems in Bangladesh The health problems of Bangladesh can be conveniently grouped under the following headlines: 1. Population problems 2. Communicable disease problems 3. Nutritional problems 4. Environmental sanitation problems 5. Health problems. Communicable Disease Problems Communicable diseases are still the major diseases in Bangladesh. Mortality & morbidity due to these disease are very high. Infectious diseases like cholera, typhoid , tuberculosis, leprosy , tetanus, measles, rabies, venereal diseases and parasitic diseases like malaria , filariasis, worm infestations are responsible for major morbidity . An expanded immunisation programme against nine major disease (TB, Tetanus, Diphtheria, Whooping cough, Polio, Hepatitis B, Haemophilus influenza type B, Measles, Rubella) was undertaken for implementation). Nutritional Problems Bangladesh suffers from some of the most severe malnutrition problems. The present per capita intake is only 1850 kilo calorie which is by any standard, much below required need. Malnutrition results from the convergence of poverty, inequitable food distribution, disease, illiteracy, rapid population growth and environmental risks, compounded by cultural and social inequities. Severe undernutrition exists mainly among families of landless agricultural labourers and farmers with small holding. Specific nutritional problems in the country are— 1. Protein–energy malnutrition (PEM): The chief cause of it is insufficient food intake. 2. Nutritional anaemia : The most frequent cause is iron deficiency and less frequently follate and vitamin B12 deficiency. 3. Xerophthalmia: The chief cause is nutritional deficiency of Vit-A. 1. Iodine Deficiency Disorders: Goiter and other iodine deficiency disorders. 2. Others: Lethyrism , endemic fluorosis etc. Environmental Sanitation Problems The most difficult problem to tackle in this country is perhaps the environmental sanitation problem which is multi-faceted and multi-factorial. The twin problems of environmental sanitation are— Lack of safe drinking water in many areas of the country. Preventive methods of excreta disposal. Health Problems Indiscriminate defecation resulting in filth and water pond disease like diarrahoea, dysentery , enteric fever, hepatitis, hook worm infestations. Poor rural housing with no arrangement for proper ventilation, lighting etc. Poor sanitation of public eating and market places. Inadequate drainage, disposal of refuse and animal waste. Absence of adequate MCH care services. Absence and/ or adequate health education to the rural areas. Absence and/or inadequate communications and transport facilities for workers of the public health. Absence of control of communicable diseases.
Posted on: Sat, 24 Jan 2015 07:39:16 +0000
Trending Topics
Recently Viewed Topics
© 2015