An Assignment on An insightful assessment of essential services in

Bangladesh, with special focus on health.

Submitted by

Mohammad Shafiqul Alam

Dept. of Economics

University of Dhaka.

INTRODUCTION:

One of the central insights of development economics is the importance of

human capabilities, both as end and as a means of development. At early

stages of development, capabilities related to nutrition and health is of

special importance. For instance, health makes wide-ranging contributions

not only to economic growth but also to demographic change, social equality,

political democracy, and many other aspects of development. Good health is a

fundamental basis of the quality of life as well as of social progress.

Further, both theory and evidence point to the importance of public services

in this field. Economic theory draws attention to pervasive “market failures”

in the private provision (especially unregulated provision) of essential service

such as health care. Empirical evidence suggests that rapid reductions in

under nutrition, ill health and related deprivation are typically based on

extensive public action.

After partition from India in 1947, Bangladesh achieved full independence in

1971 and became a parliamentary democracy in 1991 after 20 years of

military regime. With rigid central government structures and disagreement

between main parties largely inhibiting response to local health needs ,

Bangladesh began a wide programme of reforms to address issues of

responsiveness. The main reforms in Bangladesh aimed at integrating the two

separate divisions of health services and family planning thus unifying the

two programmes with the intention of improving their efficiency and

responsiveness to the user population.

This term paper presents an insightful assessment of essential services in

Bangladesh, with special focus on health. For instance, we are that many

development experts in Bangladesh surprised and interested to learn that

many people live far away from the nearest health center.

Three hundred and forty children die every single day in Bangladesh due to

untreated diarrhea, but in Sri Lanka can expect to live for 74 years. While

Bangladesh is witnessing unprecedented prosperity and growth, basic human

development for the vast majority is not happening. The region is expected

to miss many of the Millennium Development Goal (MDG) targets, and

government need to uphold the basic rights to essential services. Well-

planned actions need to be implemented on a mammoth scale to improve the

delivery of health, water and sanitation.

CURRENT SITUATION OF HEALTH SECTOR IN BANGLADESH:

“You can not talk in isolation about healthcare. It is linked with sanitation

and drinking water”

Aswini Kumar Nanda,

Researcher, India.

By following the speech of Aswini Kumar Nanda, we analyze health sector of

Bangladesh with regarding the current situation of healthcare indicators

accessing safe water, and sanitation.

HEALTHCARE INDICATORS:

By analyzing some healthcare indicators, we can make us well informed about

the current situation of health sector of Bangladesh.

Infant Mortality Rate (IMR) decreases to 46/1000(1973) from

140/1000(2005).

Maternal Mortality Rate (MMR) decreases to 30/1000(1973) from

3.1/1000(2005).

Crude Birth Rate (CBR) decreases to 47/1000(1973) from

18.2/1000(2005).

Crude Death Rate (CDR) decreases to 17/1000(1973) from

3.2/1000(2005).

Life Expectancy at Birth (LEB) increases from 45 years to 65 years.

Doctor/ Population Ratio increases from 1:6250 to 1:4105.

Now immunization coverage under one year is 85%.

42% population is covered by essential health care.

A trained person assists 14% delivery.

Source: BMC International Health and Human Rights.

ACCESS TO SAFE WATER:

Water is central to the way of life in Bangladesh and the single most

important resource for the well being of its people. It sustains an extremely

fragile natural environment and provides livelihood for millions of people.

Unfortunately, it is not infinite and cannot be treated as a perpetual free

gift of nature to be used in any manner chosen. The unitary nature of water

makes its use in one form affect the use in another. Its availability for

sustenance of life, in both quantitative and qualitative terms, is a basic

human right and mandates its appropriate use without jeopardizing the

interest of any member of the society.

Availability of water, including rainwater, surface water, and groundwater, in

usable forms calls for its sustainable development, a responsibility that has

to be shared collectively and individually by members of the society. Private

users of water are the principal agents for its development and management

and private investments need to be actively promoted in the water sector,

ensuring equal opportunity to all. However, development of water resources

often requires large and lumpy capital investment and generates economies

of scale, which justifies public sector involvement. Government's role also

becomes important because of the necessity of protecting the needs of the

society at large and addressing important environmental as well as social

issues such as poverty alleviation and human resources development.

Water resources management in Bangladesh faces immense challenge for

resolving many diverse problems and issues. The most critical of these are

alternating flood and water scarcity during the wet and the dry seasons,

ever-expanding water needs of a growing economy and population, and

massive river sedimentation and bank erosion. There is a growing need for

providing total water quality management (checking salinity, deterioration of

surface water and groundwater quality, and water pollution), and

maintenance of the eco-system. There is also an urgency to satisfy multi-

sector water needs with limited resources, promote efficient and socially

responsible water use, delineate public and private responsibilities, and

decentralize state activities where appropriate. All of these have to be

accomplished under severe constraints, such as the lack of control over

rivers originating outside the country's borders, the difficulty of managing

the deltaic plain, and the virtual absence of unsettled land for building water

structures.

Some Data:

Water: MDG STATUS of Bangladesh BANGLADESH Targets Current % Target %

Ensure that 100% of urban and 96.5% of rural population have access to safe water by 2015

Rural 72 96.5

Urban 82 100

Water: Bangladesh

Year 1990 2006

% of population with access to improved drinking water sources

Rural 68 74

Urban 83 83

Total 71 77

Source: UNSTAT, December 2006, Millennium Indicator Database http://unstats.un.org/unsd/mi/mi_goals.asp

Situation Analysis

In the case of Bangladesh the target is to increase coverage of safe water

from 99 percent to 100 percent in urban areas and from 76 percent

(arsenic-adjusted estimate) coverage to 96.5 percent in rural areas by 2015.

In the case of Bangladesh, MDG 7 - Target 10 was modified to highlight the

crucial role that access to water and to sanitation play in maintaining a

healthy and productive population. Besides the global indicator of the

proportion of population with sustainable access to an improved water

source.

Water: Bangladesh

% Of population using improved drinking

water sources 2000 Total 97

Urban 99

Rural 97

Situation Analysis:

This indicator is defined as the percentage of the population who use any of

the following types of water supply for drinking: piped water, public tap,

borehole or pump, protected well, protected spring or rainwater. By this

definition nearly 100 percent of the population in Bangladesh has access to

water. However, over the last few years thousands of tube-wells have been

found to be contaminated with naturally occurring arsenic at higher than

WHO-recommended levels. If quality is taken into account, access to safe

water drops to only 72 percent in rural areas. In spite of the fact that this

is good coverage by developing country standards, it implies that 30 million

people remain without access to safe water. Coverage in urban areas is 82

percent.

PROPORTION OF POPULATION WITH SUSTAINABLE ACCESS TO AN IMPROVED WATER SOURCE:

This indicator is defined as the percentage of the population who use any of

the following types of water supply for drinking: piped water, public tap,

borehole or pump, protected well, protected spring or rainwater. By this

definition nearly 100 percent of the population in Bangladesh has access to

water. However, over the last few years thousands of tube-wells have been

found to be contaminated with naturally occurring arsenic at higher than

WHO-recommended levels. If quality is taken into account, access to safe

water drops to only 72 percent in rural areas. In spite of the fact that this

is good coverage by developing country standards, it implies that 30 million

people remain without access to safe water. Coverage in urban areas is 82

percent.

SANITATION:

The Government of Bangladesh has laid down ambitious plans to achieve

nationwide coverage of sanitation by 2010, well ahead of the time scale of

the sanitation target of the Millennium Development Goals (namely to reduce

by half the number of people without access to adequate sanitation by the

year 2015). Recent estimates of sanitation coverage in Bangladesh are 39%

for the rural and 75% for urban populations. This implies accelerating the

rate of progress from the present 1% to 8% each year. Until recently there

has been relatively little work on the costs and benefits of sanitation; these

are often quantified in terms of benefits to health and in timesavings.

For example it is estimated that in Bangladesh over US$80 million (Taka 500

Cores) is spent on medicines, doctors fees and travel costs in relation to

illness that can be associated with poor sanitation. What is rarely, if ever,

mentioned are the potential wider benefits to the economy, particularly in

relation to the employment that can be generated for small-scale

entrepreneurs. These typically include builders and masons, and suppliers of

building materials. This paper focuses on the Total sanitation Campaign

(TSC) that has been in operation in rural Bangladesh since the late 1990s.

The approach was pioneered by the Bangladeshi NGO, the

Village Education and Resource Center (VERC), with the support of the

International NGO Water Aid. It takes a community based approach to

achieving 100% sanitation coverage, working on the principle that the

community itself has the resources and ability to address sanitation (and

associated water and hygiene) problems. Involvement of community members

from the beginning, in awareness-raising and planning, through to

implementation and monitoring, is a key Supporting factor in the success of

the approach. With appropriate external support from NGOs to identify the

current situation and need for improvement, the community plans and

implements solutions to meet that need.

Some Data:

Sanitation: MDG STATUS of Bangladesh

Ensure that 100% of urban and rural population have access to improved sanitation by 2010

Rural 29 55.5

Urban 56 85.5

Source: MDG: Bangladesh Progress Report, December2006, GOB-UN

Sanitation: Bangladesh

% of population using adequate sanitation facilities 2000 Source: UNICEF

Total 48

Urban 71

Rural 41

Situation Analysis:

Access to improved sanitation must be increased from 75 percent to 85.5

percent in urban areas, and from 39 percent to 55.5 percent in rural areas

by 2015

In the case of Bangladesh, MDG 7 - Target 10 was modified to highlight the

crucial role that access to water and to sanitation play in maintaining a

healthy and productive population. Besides the global indicator of the

proportion of population with sustainable access to an improved water

source, a second indicator was included - the proportion of urban and rural

population with access to improved sanitation.

PROPORTION OF THE URBAN AND RURAL POPULATION WITH ACCESS TO IMPROVED SANITATION:

In rural areas access to improved sanitation has increased from 11 percent in

1990 to 29 percent in 2002. In the case of urban areas however, the

situation has deteriorated, coverage dropping from 71 percent to 56

percent. This is mainly due to unbridled and unplanned urbanization that has

been taking place in recent years. Although technologies such as sewers,

septic tanks, pour-flush latrines, simple pit latrines, and ventilated improved

pit latrines contribute towards the achievement of target 10, additional

factors also need to be taken into consideration. For example, it is essential

in the case of simple pit latrines that excreta are adequately treated before

being discharged into the environment. Even in towns and cities with

sewerage systems, discharges are passed untreated directly into the

environment. Solid waste disposal remains an environmental sanitation

hazard, especially in the urban areas.

The Government recognizes the importance of increasing access to

sanitation. Following a major initiative that culminated in the SACOSAN

Conference in Dhaka in October 2003, the Government declared its own

target of achieving 100 percent sanitation coverage by 2010, and has

allocated two percent of its annual development budget for the task.

EXPENDITURE ON HEALTH SECTOR:

State commitment to health care has often been repeated. Article 12 of the

International Convention on Economic Social and Cultural Rights(1966) states

that „the state is obliged to attain the highest attainable standard of health

for its population. States are required to adopt administrative, budgetary,

judicial, promotional and other measures towards the full realization of this

right‟.

For ensuring the above article of ICESCR and also ensuring the requirements

of PRSP, Bangladesh has to spend and handsome total for the health sector.

The followings indicates the proportion of total budget expenditure on

health sector from 2001-02 to 2006-07:

Year % Of total Budget

2001-02 6.74

2002-03 6.51

2003-04 6.77

2004-05 5.70

2005-06 6.73

2006-07 6.85

Source: Shamunnay (NGO)

In current situation, the targeted expenditure on health sector is very poor

because per capita health service in only 341 taka thereby per day health

service for an individual only .93 taka, which is not supported by MDG and

PRSP.

After the year of 2000, the death of mother has been declined 1 per lucks.

In regard this rate, we need 156 years to ensure the aim of MDG!! On the

other hand. In declining child mortality, we need 22 years!!.

For this, the targeted expenditure on health sector should have 2% of GDP.

Expenditure on health sector is much better for other South Asian

countries than Bangladesh.

COMPARATIVE ANALYSIS OF SOUTH ASIAN COUNTRIES IN

REGARDING CURRENT SITUATION OF HEALTH SECTOR:

Population without access to Improved water and sanitation.

Country Drinking Water (%) Sanitation (%)

Bangladesh

Pakistan

Nepal

India

Sri Lanka

Afghanistan

25

10

16

14

22

87

52

46

73

70

9

92

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CONCLUDING REMARKS:

Bangladesh, with the large concentration of poor people in South Asia, needs

to make a huge step forward in this battle against backward health sector.

Concerted action to provide universal healthcare, water supply, and

sanitation of good quality has enabled dramatic strides in human

development within some pockets of Bangladesh. The time now comes for the

entire region to emerge as an influential global voice on the strength of its

overall development- both economic and human. The annals of history eagerly

await the erasure of poverty and inequality. The efficient delivery of free

and good quality essential services will be key.

REFERENCES:

1. „Serve the Essentials‟ (what governments and donors must do to

improve South Asia‟s Essential Services) by Oxfam-GB.

2. Human Development Report 2006(Bangladesh Rural sanitation Supply

Chain and Employment Impact).

3. “Shifting millions from open defecation to hygienic latrines” by Village

Education and Resource Center (VERC)

4. “Shifting Millions from Open defecation to Hygienic Practices” by

Water Aid, prepared for the ADB, dated 15 August 2005.

5. MLGRDC, (2005), National sanitation Strategy, Local Government

Division, Ministry of Local Government, Rural Development and

Cooperatives, People‟s Republic of Bangladesh.

6. MDG: Bangladesh Progress Report, February 2005, GOB-UN.

7. Assignment on “Health sector reforms and human resources for

health in Uganda and Bangladesh: mechanisms of effect” by Syed

Azizur Rahman.

8. UNDP. Human Development Report. New York: UNDP; 2004.

9. DFID. Bangladesh Health Briefing Paper. DFID Health Systems

Resource Center: London; 1999.

10. Shamunnay (NGO).

.