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HEALTH
POLICY OF BANGLADESH
Health is defined as
A state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.
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
To ensure an effective health care system that responds to the need
of a healthy nation, a health policy provides the vision and mission for
development.
Pursuance of such policy will fulfill the demands of the people of
the country, while the 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.
Bangladesh expressed agreement on the declarations:
o Alma Ata, 1978
o The World Summit for Children 1990
o International Conference on Population and Development, 1994
o Beijing Womens Conference, 1995
INTRODUCTION
In the absence of a written and approved Health Policy, Annual Development
Programme and Five Year Plans substituted the policy principles until
recently.
The problems in the health services multiplied in the absence of a
clear policy.
Bangladesh is a developing country with highest population density. Key
demographic indicators:
Total Population over 130 million
Population density 881/sq km
People below poverty line 60%
77% live in rural areas
At current growth rate doubling (population) time is 25-30 years
Per capita GDP Tk.18, 896
Some Health infrastructure information:
UHFWC 3375
31-50 bed UHC 397
Various types o district level hospitals 80
Government medical college hospitals 13
Postgraduate hospitals 6
Specialized hospitals 25
Doctor to population ratio 1:4719
Nurse to population ratio 1:8226
Total hospital beds 40,773 (over 29000 in GOB)
Some health and FP indicators:
CDR 5.2 /1000 population
Annual Growth rate 1.48 percent
MMR 3.92 /1000 live births
IMR 62 /1000 live births
Under 5 MR 83 /1000 live births
TFR 2.9
CPR 53.8%
Life expectancy at birth 68 (m) and 69 (f)
Fully immunized children 52%
TB (smear positive new) detection rate 31.2%
PROCESS FOR FORMULATION
The Ministry of Health and Family Welfare constituted a Committee in
1996 for preparation of a Health Policy with members drawn from technocrats,
bureaucrats, civil society and professional bodies
o Further five Sub-Committees were formed to:
o Review and evaluate the existing health services and determining the
goals
o Formulate policies to ensure Essential Services
o Formulate policies to ensure Hospital-based Services
o Design Strategies for HRD
o Integrate NGOs and the Private Sector and plan for resources and utilization
of funds
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 organized 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 14-8-2000 approved the National Health Policy.
National Health Policy (NHP)
The Health Policy has:
15 goals and objectives,
10 policy principles and
32 strategies
NHP: OBJECTIVES
The Goal: 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.
Second To develop a system to ensure easy and sustained availability
of health services for the people, especially communities in both rural
and urban areas;
Third To ensure optimum quality, acceptance and availability of primary
health care and governmental medical services at the Upazila and Union
levels;
Fourth To reduce the intensity of malnutrition among people, especially
children and mothers; and implement effective and integrated programmes
for improving nutrition status of all segments of the population;
Fifth To undertake programmes for reducing the rates of child and maternal
mortality within the next 5 years and reduce these rates to be acceptable
level;
Sixth 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;
Seventh To improve overall reproductive health resources and services;
Eighth 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:
Ninth To devise necessary ways and means for the people to make optimum
usage of the available opportunities in government hospitals and health
service system, and to ensure satisfactory quality management, cleanliness
of service delivery at the hospitals;
Tenth 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;
Eleventh To strengthen and expedite the family planning programme with
the objective of attaining the target of Replacement Level of Fertility;
Twelfth To explore ways to make the family planning programme more acceptable,
easily available and effective among the extremely poor and low-income
communities;
Thirteenth To arrange special health services for mentally retarded, the
physically disabled and for elderly populations;
Fourteenth To determine ways to make family planning and health management
more accountable and cost-effective by equipping it with more skilled
manpower;
Fifteenth To introduce systems for treatment of all types of complicated
diseases in the country, and minimize the need for foreign travel for
medical treatment;
NHP: PRINCIPLES
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 everyones 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 various processes like planning, management,
local fund raising, spending, monitoring and review of the procedure of
health services delivery etc. with the aim of decentralizing the health
management and establishing peoples rights and responsibilities in the
system;
5. To facilitate and assist in the 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 the family planning activities;
7. To carry out appropriate administrative restructuring, decentralization
of the 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 in order 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,
in order to fulfill the aspirations of the people for their overall sound
health and access to reproductive health care.
NHP: STRATEGIES
In keeping with the purported goals, objectives and principles following
strategies will be adopted:
1. An appropriate implementation of the Health Policy needs mass-scale
consensus and commitment that will facilitate socio-economic, social and
political development.
2. Prevention of diseases and health promotion will be emphasized 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. As PHC is the universally recognized methodology to provide health
services, this will be adopted as the major component of the National
Health Policy in order to ensure delivery of cost-effective health services.
4. The Drug Policy will be liberalized and improved 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.
** Necessary steps will be taken to maintain quality standards of the
marketed medicines and raw materials used therein, and to rationalize
the usage of medicines. In this line, the required number of skilled manpower
will be acquired in the drug administration of the country.
** The Health Policy will ensure distribution of birth control supplies
and make improvements in the management of the domestic sources of the
same, including encouragement of the domestic entrepreneurs for production
of such commodities.
5. Epidemiological surveillance system will be integrated with the disease
control programmes. A specific institution will be entrusted with the
responsibility of such surveillance.
6. The basic principles for ensuring quality standards in health care
at various health centres will be adhered to. Standard quality assurance
guidelines including monitoring and evaluation mechanism will be provided
to every health centre.
7. Health Services Reforms Body will be formed 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.
8. An appropriate and need-based approach to develop HRD will be designed
in order to maximise the utilization of the knowledge and skills of health-related
personnel. A number of positions will be created with an appropriate career
planning system, which will be formulated and implemented. Appropriate
training will be provided.
9. The community and the local government will be integrated with the
health service system at all levels.
10. An integrated Management Information System (MIS) and a computerised
communication system will installed 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.
11. The BMDC and the BNC will be restructured and strengthened in order
to ensure strict supervision of professionals registration and their
quality of skills and related ethical issues. With a view to maintain
the required quality standards of performance, education and training
of the pharmacists, medical technologists and other paramedics, the Pharmacy
Council and the State Medical Faculty will be restructured and organized.
12. Various professional organizations such as BMA, BPMPA, BNA, unani
etc. will be integrated with the countrys health service system.
13. Need based medical education and training will be made that are people-oriented
and updated.
14. Arrangements will be made to institutionalise the management and
administrative training for improving the management capabilities of the
doctors.
15. Regular training such as reorientation, continuing medical education,
and administrative and management courses etc. will be imparted to all
staffs both in the public and private sector. In order to create the required
facilities for offering such training, a National Training Institute will
be established.
16. To ensure efficient hospital services the management of medical colleges/
institutions and related hospitals will be improved with increased levels
of financial and administrative delegation.
17. Nutrition and health education will be emphasised, as they are the
major driving forces of health and FP activities. There will be one nutrition
and one health education unit in each upazila, so that they can reach
every village. Information on health education will be disseminated to
the people through incorporating the community leaders and other departments/
organizations of the government in the health system. One of the goals
of the health care system will be to improve the nutrition status of the
people.
18. The public hospitals and clinics will charge a minimum user fee keeping
safety net for the poor and disabled for free care.
19. NGOs and Private Sectors will be encouraged to perform a complementary
role to the public sector in the light of the governmental rules and policies.
20. Infrastructure and transportation system will be developed to minimize
the disparity in access to health services between rural and urban areas.
21. Arrangements will be made to pay non-practicing allowances to those
doctors/trainee doctors who act as full-time and resident doctors thus
refrain themselves from private medical practices.
Those want to practice within the public facilities will be allowed to
do so only under a clear policy.
22. Accountability of all concerned in the health system will be ensured.
An adequate procedure will soon be designed to strengthen accountability
and ensure quick and strict legal disposal of cases relating to negligence
of duties.
23. A National Health and Population Council formed under the leadership
of the Head of the Government will provide support and advice on the implementation
of the Health Policy and will ensure effectiveness and accountability
of health system. The local and regional councils will monitor health
activities in their respective areas.
24. Intersect oral coordination and utilising resources of the concerned
sectors will strengthen linkages.
25. Research on various management styles and their effectiveness, clinical
services, approach to diagnoses, social and behavioral aspects, epidemiology
etc. will encouraged Information dissemination system will be strengthened,
especially involving the private organizations with an aim to reach grass-root
level. An effective referral system will be designed and installed and
its usage will be strictly supervised so to improve efficiency.
26. Duplication of activities from different projects, programmes and
activities will be avoided. To this end a policy-planning cell will be
established in the MOHFW through which effective and sustainable coordination
will be ensured.
27. 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.
28. Government allocation of expenditure budget may be distributed from
district to community level within reasonable flexibility. This redistribution
of expenditure budget will provide increased benefits to the poor and
destitute communities. This will optimise the expenses and accessibility
to services will be easy.
29. Alternative health care services, such as ayurvedic, unani and homeopathic
practices will be incorporated into the National Policy. Encouragement
will be given to the principle of making these three disciplines to be
more scientific.
30. The arrangement for delivery of ESP among the people from a one-stop
centre will be considered the appropriate strategy for provision of PHC.
This will be introduced throughout the country. For this, well-planned
and useful training will be imparted to the UHCs.
31. All development of the sector will be conducted through a sector-wide
management system.
32. An MBBS-doctor will be deployed in each UHFWC aid these facilities
will be equipped with residence facilities for doctors.
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