Actual Bangladesh

In Bangladesh, over the past decade there has been a significant decline in infant and child mortality. Control and prevention of diseases, such as measles, poliomyelitis, and diphtheria along with widespread use of ORS for diarrheal diseases have greatly reduced childhood mortality and morbidity. Bangladesh is on the verge of Polio eradication, and has already achieved the elimination goal for leprosy at the national level. People are living longer; the average life expectancy at birth in Bangladesh had increased to over 65.1 years in 2004. Population continues, however, to grow at about 1.5 percent and TFR has remained around 2.51 for the last several years. The maternal death ratio is still high at over 300 per 100,000 live births.

While there has been substantial progress in disease prevention and control and a decline in childhood communicable diseases, new and old infectious diseases, such as malaria, tuberculosis and acquired immunodeficiency syndrome (AIDS) are important threats to health for the years ahead. Projections are uncertain because of the potential of travel and trade, urbanisation, migration and microbial evolution to amplify these diseases. The emergence of drug resistant malaria and tuberculosis further increases the risk.

Non-communicable diseases are a heterogeneous group that includes major causes of death, such as heart diseases, diabetes and cancer, and disability, such as mental disorders. These are also on the rise in Bangladesh.

Malnutrition is a major cause of death and debility in children in Bangladesh. Micro-nutrient deficiency is quite common; nearly 75 per cent of children's life is spent in illness mostly due to malnutrition related debility and infections. Poor nutrition deters physical, cognitive and mental development. Low birth weight and malnourished children are susceptible to infections; roughly two-thirds of under-five deaths are attributed to malnutrition, 75 per cent of it being associated with mild and moderate malnutrition. About 25 per cent of maternal deaths are associated with anemia and haemorrhage. Women and adolescent girls mostly suffer from Anemia owing to iron deficiency. 

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 WHO is a specialized agency of the UNITED NATIONS system, and is the leading technical agency on matters relating to public health, worldwide.

The World Health Organization (WHO) has been providing technical assistance to the Government of the Peoples’ Republic of Bangladesh for the development and strengthening of the country’s public health systems since 1972. WHO defines health "as a state of complete, physical, mental and social well-being and not merely the absence of disease or infirmity". To realize the objective of attaining the highest possible level of health by all people, WHO has formulated a corporate strategy comprised of seven strategic directions and six core functions, which provide a broad framework for focusing WHO's collaboration with countries. In addition, a six-year Medium-term Strategic Plan based on thirteen strategic objectives (SOs) has been developed for Bangladesh and other SEAR countries.

The strategic directions are as follows:

Strategic direction 1: Promote access of vulnerable groups to health services ensuring a continuum of care throughout the life course.

Strategic direction 2: Enhance capacity for the prevention and control of major communicable diseases and diseases targeted for elimination/eradication, and strengthen integrated disease surveillance.

Strategic direction 3: Promote healthy lifestyles and cost-effective interventions for the prevention and control of major NCDs and injuries, and for mental health promotion.

Strategic direction 4: Enhance equitable and sustainable access to safe water and sanitation, reduce environmental and occupational health risks and promote food safety.

Strategic direction 5: Strengthen multisectoral approaches for emergency preparedness, response and recovery.

Strategic direction 6: Strengthen the health system with a focus on health workforce development and equitable access to quality health care.

Strategic direction 7: Foster partnership and coordination for national health development.

The core functions include the following:

    * Providing leadership on matters critical to health and engaging in partnerships where joint action is needed
    * Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge
    * Setting norms and standards, and promoting and monitoring their implementation
    * Articulating ethical and evidence-based policy options
    * Providing technical support, catalysing change, and building sustainable institutional capacity
    * Monitoring the health situation and assessing health trends  

    
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Within the broader framework of corporate strategy, WHO prepares a country-specific cooperation strategy. The WHO Country Cooperation Strategy (CCS) for Bangladesh was developed in consultation with GoB and DPs. The CCS for Bangladesh is based on a comprehensive review of the country’s health and development challenges. The CCS is a medium-term framework that establishes the strategic directions and provides guidance for planning, budgeting and resource allocation. Some of the salient features of the CCS are:  

• Reducing under-five and maternal deaths by further accelerating quality health services to children and mothers.

 

• Combating major communicable diseases including multi-drug resistant TB, malaria and the spread of HIV/AIDS.

 

• Containing the increasing trend of major non-communicable diseases (NCDs) and reversing the trend by addressing health risks.

 

• Ensuring equitable and sustainable access to safe water supply and sanitation, and promoting environmental and occupational health.

 

• Strengthening epidemic alert, and emergency preparedness and response to effectively tackle public health emergencies.

 

• Bolstering the health system’s responsiveness for equitable access to quality health care, fairness in health-care financing, and pro-poor and improved governance and stewardship.

 

• Strengthening human resources for health development by addressing health personnel shortage, and improving quality of their education, deployment and utilization.

Within the broader framework of corporate strategy, WHO prepares a country-specific cooperation strategy. The WHO Country Cooperation Strategy (CCS) for Bangladesh was developed in consultation with GoB and DPs. The CCS for Bangladesh is based on a comprehensive review of the country’s health and development challenges. The CCS is a medium-term framework that establishes the strategic directions and provides guidance for planning, budgeting and resource allocation. Some of the salient features of the CCS are:  

• Reducing under-five and maternal deaths by further accelerating quality health services to children and mothers.

 

• Combating major communicable diseases including multi-drug resistant TB, malaria and the spread of HIV/AIDS.

 

• Containing the increasing trend of major non-communicable diseases (NCDs) and reversing the trend by addressing health risks.

 

• Ensuring equitable and sustainable access to safe water supply and sanitation, and promoting environmental and occupational health.

 

• Strengthening epidemic alert, and emergency preparedness and response to effectively tackle public health emergencies.

 

• Bolstering the health system’s responsiveness for equitable access to quality health care, fairness in health-care financing, and pro-poor and improved governance and stewardship.

 

• Strengthening human resources for health development by addressing health personnel shortage, and improving quality of their education, deployment and utilization.

In addition to the LCG mechanism, WHO also enjoys bilateral collaboration and support from donors in Bangladesh.

COLLABORATION WITH NGOs, PROFESSIONAL SOCIETIES, UNIVERSITIES AND RESEARCH INSTITUTIONS

WHO collaborates with professional societies, universities, NGOs and civil societies in specific and selected areas under the frame work of Plan of Action jointly developed and agreed  with the Government (MOHFW). Accordingly, WHO cooperates with the BMA, the Private Practitioners' Association, the major tertiary medical colleges, several international and national NGOs, including GK, BRAC, ICDDR,B, Damien Foundation, Save the Children, DORP, and research institutions such as BIDS and CPD, among others.
     

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Dramatic Improvements in Health

Twenty years ago, many experts claimed the nation's conservative culture and low standard of living would be insurmountable obstacles to family planning and child survival programs in Bangladesh. However, over the past three decades health indicators have improved dramatically.

In Bangladesh contraceptive use among currently married couples increased from 8% in the mid 1970’s to 56% in 2007. This resulted in a significant decline in fertility from 6.3 to 2.7 children per woman over the same period. However, recent findings from the 2007 Bangladesh Demographic and Health Survey show that contraceptive use rate has not improved in the past 3 years. Bangladesh’s goal to reach a fertility level of 2 children per woman or below will require contraceptive use to increase substantially over the current use rate.

There has been a significant increase in use of antenatal care among pregnant women, from 49%in 2004 to 52% 2007.4. Despite the rise in antenatal care, only one in five women receive the recommended four or more antenatal visits during her pregnancy. Less than one in five deliveries are assisted by a trained birth attendant. has a consequence-35 women are dying each day in giving child birth.

Over the last three decades, mortality rates of children under the age of five have declined significantly. Their risk of dying has fallen from 250 to 65 deaths per 1000 live births. Similar sharp decline has occurred in infant deaths due to the success of a number of child health programs like increasing vaccination coverage and improving management and treatment of diarrhea and acute respiratory infections.  Most deaths among children under five years of age, occurs now in the first month of life.  Reducing neonatal mortality has become an emerging challenge for Bangladesh.
Recent Plateaus Require Vigilance

Bangladesh’s huge population size, extreme population density and high levels of poverty impose significant challenges to sustain the successes achieved in health. The recent plateau in contraceptive use, if it continues to persist, will be a major setback for limiting the country’s population growth and stabilizing its population size.
 
Still, 85 percent of child deliveries occur at home, most with no trained birth attendants present. Only one in five women seek health check ups for herself or the baby within 6 weeks of delivery. The HIV/AIDS infection rate remains low in the general population. However, in certain high risk groups, the infection rate is rapidly reaching 

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