An assignment on health sector in Bangladesh with a brief comparison with other South Asian countries.

1. 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.

2. 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

3. 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).

4.  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,

5. 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 %
Rural 72 96.5
Ensure that 100% of urban and 96.5% of rural population have
Urban 82 100
access to safe water by 2015
Water: Bangladesh
Year 1990 2006
Rural 68 74
% of population with access to improved drinking water sources Urban 83 83
Total 71 77
Source: UNSTAT, December 2006, Millennium Indicator Database http://unstats.un.org/unsd/mi/mi_goals.asp
Situation Analysis

6. 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 Total 97
water sources 2000
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

7. 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

8. current situation and need for improvement, the community plans and
implements solutions to meet that need.
Some Data:
Sanitation: MDG STATUS of Bangladesh
Rural 29 55.5
Ensure that 100% of urban and rural
population have access to improved Urban 56 85.5
sanitation by 2010
Source: MDG: Bangladesh Progress Report, December2006, GOB-UN
Sanitation: Bangladesh
% of population using adequate sanitation Total 48
facilities 2000
Urban 71
Rural 41
Source: UNICEF
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

9. 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

10. 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 25 52
Pakistan 10 46
Nepal 16 73
India 14 70
Sri Lanka 22 9
Afghanistan 87 92

 A balance sheet for Human Development and Access to Essential
.
Services.

11. Country
Country What has progressed
What has progressed What remaiins depriived
What rema ns depr ved
Banglladesh
Bang adesh In Banglladesh.. The iinfant
In Bang adesh The nfant There iis a 40% vacancy rate
There s a 40% vacancy rate
mortalliity rate dropped
morta ty rate dropped iin doctor postiings iin poor
n doctor post ngs n poor
dramatiicallly:: from 145-to 46
dramat ca y from 145-to 46 areas wiith a concentratiion
areas w th a concentrat on
per1000 lliive biirth between
per1000 ve b rth between of heallth workers iin urban
of hea th workers n urban
1970 to 2003..
1970 to 2003 centers..
centers
Popullatiion wiith sustaiinablle
Popu at on w th susta nab e Arseniic iin Shalllow tube-wellls
Arsen c n Sha ow tube-we s
access to iimproved
access to mproved found iin 59 out of the 64
found n 59 out of the 64
saniitatiion iincreased from
san tat on ncreased from diistriicts has exposed an
d str cts has exposed an
23% to 48% between 1990
23% to 48% between 1990 estiimated 25 miillliion peoplle
est mated 25 m on peop e
to 2002..
to 2002 to toxiins..
to tox ns
Indiia
Ind a Increased successfull
Increased successfu 80% of totall heallth fiinanciing
80% of tota hea th f nanc ng
treatment of tubercullosiis
treatment of tubercu os s iis from out-of-pocket
s from out-of-pocket
cases from 3 out of 10 cases
cases from 3 out of 10 cases expenses of end-users and
expenses of end-users and
to 8 out of 10 between
to 8 out of 10 between the poorest 20% have doublle
the poorest 20% have doub e
1993and 2001..
1993and 2001 the mortalliity rate of the
the morta ty rate of the
riichest quiintiille..
r chest qu nt e
Water coverage iin rurall
Water coverage n rura
habiitatiions iincreased from
hab tat ons ncreased from Even,, iif the MDG targets are
Even f the MDG targets are
56% to 95% between 1995
56% to 95% between 1995 achiieved iin 2015,, 500 miillliion
ach eved n 2015 500 m on
and 2004..
and 2004 peoplle wiilll llack access to
peop e w ack access to
saniitatiion and 334 miillliion
san tat on and 334 m on
accesses to safe water..
accesses to safe water
Srii Lanka
Sr Lanka 90% of chiilld delliiveriies take
90% of ch d de ver es take In jaffna.. The maternall
In jaffna The materna
pllace iin a publliic heallth
p ace n a pub c hea th mortalliity rates have
morta ty rates have
faciilliity by a skiillled biirth
fac ty by a sk ed b rth iincreased ten folld and are
ncreased ten fo d and are
attendant..
attendant ten tiimes than iin Collombo..
ten t mes than n Co ombo
Hiigh mortalliity rate iin urban
H gh morta ty rate n urban In 2002,, 22% of the
In 2002 22% of the
areas and estate pllantatiions
areas and estate p antat ons popullatiion was wiithout
popu at on was w thout
were partiiallly addressed
were part a y addressed access to iimproved driinkiing
access to mproved dr nk ng
through concerted efforts
through concerted efforts water..
water
to buiilld water and saniitatiion
to bu d water and san tat on
faciilliitiies..
fac t es
CONCLUDING REMARKS:

12. 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.

13. 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).
.