Research Paper On

HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

Submitted to: Md. Shams-ud-doha

Submitted by: Md. Nafis Hasan Siddque

HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

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 international organizations 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 ratio Per 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)

HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

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

HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

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 new government 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 - 2008/09 Number of persons per Hospital bed Public 1985/86 1990/91 1995/96 2000/01 2005/06 2008/09 4300 4100 4100 3900 4000 3500 Private 21000 16000 15000 11000 8600 4000 Total 3600 3200 3100 2800 2700 1900 Medical personnel Doctor 6600 5400 4500 4000 3300 2800 Nurse 15000 12000 8700 7200 6900 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 rural area 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 1972 1982, second it was from 1982 1992, third it was from 1992 2002 and lastly it was from 2002 present. In this four decade the development has reached a new height.

HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

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 initiative encouraged 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 Expanded Programme 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 with the 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 Health and 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 health care 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 and government 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 countries all 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 and 6.

HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

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 Report Countdown 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 be the 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: 31 Status: Likely to be met* Proportion of 1 year-old children immunized against measles Benchmark: 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 their best 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 per 100,000 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: 143 Status: Lagging behind 2. Proportion of births attended by Skilled Health Personnel (percent): Base year 1991: 5

HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

Current status: 24 (MICS 2009) Target: 50 Status: Lagging behind Achieve, 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 behind 2. Adolescent birth rate (per 1,000women): Base year 1991: 77 (SVRS) Current status: 60 (SVRS 2008) Status: Lagging behind 3. Antenatal care coverage (at least 1 visit) (%): Base year 1991: 28 (BDHS 1993-94) Current status: 60 (BDHS 2007) Target: 100 Status: 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 behind 5. Unmet need for family planning (%): Base year 1991: 19 (BDHS 1993-94) Current status: 17 (BDHS 2007) Target: 7.60 Status: Lagging behind These 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 we will 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 and services 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 by 20155. 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: 0.005 Current status: 0.319 (2007) Target: Halting

HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

Status: On track 2. Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/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) Current status: 586.0 (2009) Target: 310.8 (By 2015) Status: On track 2. Death rate associated with malaria per 100,000 population: Base year: 1.4 (2008) Current status: 0.4 (2009) 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 track 4. 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% reduction 6. Death rate associated with tuberculosis per 100,000 population: Base year: 76 (1990) Current status: 50 (2008) Target: 50% reduction Status: 35% reduction So 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 awareness and participation of general people is much needed. Hence, the development of the health sector is an important issue and it is a responsible of the government to ensure proper healthcare service and the facilities. The government are also responsible 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

HEATH SECTOR AND ITS DEVELOPMENT OVER FOUR DECADES

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 the development. 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 sector 2. Reduce the maternal death and neonatal death by proper care and treatment 3. Aware everyone about the health issue 4. Fulfill the goals set by the MDGs 5. Fulfill the shortcoming and make better health policy 6. Proper allocation of medical and surgical resources 7. Give proper training to the doctor, nurse , word boy and other technicians 8. Introduce new technology in the health sector 9. Give proper treatment and medicine 10. Adequate supply of subsidies by health system 11. Family planning 12. Improve sanitation 13. Proper vaccination and treatment for child disease 14. Public and Private sector combinedly ensure the best quality of treatment 15. 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 many achievement 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.com 2. 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 for Service 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 Public Health. Vol 97, No 7. 7. Rodriguez. R & Samuels. F (2010). Healthy Partnerships and effective pro-poor targeting. Bangladesh Progress in Health. Overseas development Institute. Web: www.developmentprogress.com 8. Ullah. Z. A.N, Newwell. J, Ahmed. J. A, Hyder. M. K. A, & Islam Akramul (2006). Health Policy and Planning. Oxford Journal. 21 (2): 143-155. 9. Data from World Databank, MDG Indicators and Child and Mother Nutrition Survey of Bangladesh. 10. World Bank 1996; UNICEF 1999; Begum 2000; Barkat and Islam 2001; Thomas and Curtis 2001; Hurtig et al. 2002; WHO 2003; Gomez-Jauregui 2004; Mercer et al. 2004; Newell et al. 2004