Bangladesh Health Sector Profile 2010

Download 4.34 Mb.
Size4.34 Mb.
  1   2   3   4   5   6   7   8   9   ...   34


Bangladesh Health Sector Profile 2010

Final Version


This volume is a product of the staff of the International Bank for Reconstruction and Development/The World Bank and HLSP/Mott McDonald Ltd, in collaboration with the World Health Organization and with inputs from staff of the Ministry of Health and Family Welfare and members of the Health Nutrition and Population Consortium in Bangladesh. Their work was carried out from 2009 to 2010. The findings, interpretations, and conclusions expressed in this paper do not necessarily reflect the views of the Executive Directors of the World Bank or the governments they represent, HLSP/Mott McDonald, or any of the agencies that contributed to this volume.

The World Bank, HLSP/Matt McDonald and the collaborating agencies do not guarantee the accuracy of the data included in this work. The boundaries, colours, denominations, and other information shown on any map in this work do not imply any judgment on the part of the World Bank or collaborating concerning the legal status of any territory or the endorsement or acceptance of such boundaries.


Executive summary 6

1. Socio-economic and demographic overview 29

1.1 Geography and demographics 29

1.2 Socio-economic profile 31

1.3 National development and policy framework 33

2. Health status (and trends) 37

2.1 Progress against the health MDGs and key health outcomes 37

2.2 Status in key health areas 38


2.3 Summary of principle causes of mortality and morbidity in Bangladesh 54

3. Health sector organisation 56

3.1 Historical background—development of the health sector 56

3.2 Organisational arrangements of MOHFW 56

3.3 Other government ministries and agencies involved in the health sector 63

3.4 Roles of the private sector and NGOs 64

3.5 Public health, and research and development 64

3.6 MOHFW governance arrangements 69

3.7 Formal regulatory structures 70

3.8 Community empowerment in the HNP sector of Bangladesh—regulation through information 72

3.9 Gender mainstreaming in the health sector 74

4. Health services 79

4.1 Utilisation of health care services 79

4.2 Overview of the health services network 82

4.3 Public sector health services 83

4.4 Non-state health services delivery 90

4.5 Health services for special populations 96

5. Human resources for health 98

5.1 Human resource policy and strategic planning 98

5.2 Workforce estimates 99

5.3 Estimating the health workforce gap 102

5.4 Public sector health workforce 104

5.5 Production of the health workforce 110

5.6 Professional regulation and professional development 112

6. Health information, monitoring, and evaluation systems 113

6.1 Information flows in the heath sector 113

6.2 Monitoring and evaluation systems under the SWAp 120

6.3 Information systems development 125

6.4 Information communications and technology 127

7. Health financing and expenditures 128

7.1 Funding flows 128

7.2 Health financing trends in Bangladesh 129

7.3 Alternative financing mechanisms 134

7.4 Resource allocation: Planning and budgeting processes 140

7.5 Financing flows at the upazila level 145

8. Procurement and supply of medicines 149

8.1 Overview 149

8.2 Procurement in the public sector 149

8.3 Logistics and supply chain for medicines in the public sector 154

8.4 Pharmaceuticals regulation 155

8.5 Pharmaceuticals manufacturing 158

8.6 Pharmacies and drug retail outlets 160

9. Sector response 162

9.1 Background and rationale for reform 162

9.2 Donor coordination 166

9.3 Draft National Health Policy 2010 168

10. Conclusion 172

References 174

Annex: Persons consulted 184

List of figures

Figure 1.1 Map of Bangladesh 29

Figure 1.2 Estimated Bangladesh population by end of 21st century (in millions) 30

Figure 1.3 Sectoral composition of the national economy 31

Figure 2.1 Map of Bangladesh showing MDG composite index by upazila 38

Figure 2.2 Trends in under-five mortality rates, 1989–2007 (per 1,000 live births) 39

Figure 2.3 Trends in under-five mortality rates by residence, 1993–2007 (per 1,000 live births) 39

Figure 2.4 Trend in national vaccination coverage among children 12–23 months, 1991–2009 (%) 40

Figure 2.5 Trend in infant mortality rate, 1989–2007 (per 1,000 live births) 41

Figure 2.6 Infant mortality rates by wealth quintile, 2004 and 2007 (per 1,000 live births) 41

Figure 2.7 Trend in deliveries attended by a skilled attendant/health care professional, 1993–2007 (%) 42

Figure 2.8 Prevalence of underweight children under five in Bangladesh and selected countries 42

Figure 2.9 Trends in Bangladesh of underweight children under five, 1990–2007 43

Figure 2.10 Contraceptive prevalence rates, 1975–2007 (%) 45

Figure 2.11 Trends in fertility rate among women aged 15–49, 1975–2007 (average number of children) 45

Figure 2.12 Non-communicable disease mortality over time in rural Bangladesh 48

Figure 2.13 Leading causes of death and DALYs, 2004 55

Figure 3.1 MOHFW senior management structure 57

Figure 3.2 Administrative levels (numbers) and average population 60

Figure 3.3 Functional organisation of the directorate general health services, MOHFW 60

Figure 3.4 Functional organisation of the top level of DGFP, MOHFW 62

Figure 3.5 Management arrangements for delivery of essential services in urban areas 64

Figure 4.1 Institutional deliveries by income group 79

Figure 4.2 Antenatal care by income quintile 79

Figure 4.3 Rich-poor differences in access to family planning methods 79

Figure 4.4 Means of meeting medical expense 80

Figure 4.5 Private expenditure on health by income group 81

Figure 4.6 Expenditure by type of provider: Where is the money spent? 81

Figure 4.7 Breakdown by contacts by source of treatment 82

Figure 4.8 Schematic of the health service delivery networks in Bangladesh 83

Figure 4.9 Structure of the health service delivery system in the public sector 84

Figure 5.1 Density of providers per 10,000 population 100

Figure 5.2 Schematic comparing the proportion of qualified and unqualified health care providers 102

Figure 5.3 Proportion of health care providers by location by type 102

Figure 5.4 Distribution of physician, nurse and dentist per 10,000 population by division 102

Figure 5.5 Schematic outlining process and responsibilities for creation of a new post 106

Figure 5.6 Schematic illustrating process for filling a vacant post 107

Figure 7.1 Map of funding flows 128

Figure 7.2 Total health expenditure by funding source (constant Tk billion) 129

Figure 7.3 Health expenditure by type of provider (constant Tk billion) 130

Figure 7.4 Per capita expenditure on health in selected countries in Asia (PPP $) 131

Figure 7.5 Allocation of the revenue budget, 2009/10 132

Figure 7.6 External partner funding by channel, 2003–7 (taka million) 132

Figure 7.7 Private expenditure on health by income group 133

Figure 7.8 Distribution of household expenditures on health by type of provider 134

Figure 7.9 Place of care for those who sought services for selected interventions 134

Figure 7.10 Fund flows for Maternal Health Voucher scheme 136

Figure 7.11 Schematic illustrating principles of a health insurance function 137

Figure 7.12 Payment arrangements for drug purchases by type of provider 139

Figure 7.13 Funding sources for the Revised Programme Implementation Plan,
July 2003–June 2011 140

Figure 7.14 Government funds release process 144

Figure 7.15 Multi-Donor Trust Fund release process 144

Figure 7.16 Overview of funds allocation and reporting flows at upazila level 146

Figure 8.1 Source of medicines for patients seeking care 160

Figure 9.1 Key milestones of the health and population sector policy and plans 162

List of tables

Table 1 Health indicators at a glance 8

Table 2 The leading causes of mortality and morbidity 11

Table 2.1 Recent progress against key health MDGs 37

Table 2.2 Trend in inequality in prevalence of malnutrition, 1996–1997 and 2004 (%) 43

Table 2.3 Leading causes of mortality and morbidity, 2004 54

Table 3.1 Proposed roles and responsibilities in MOHFW, late 1990s 59

Table 3.2 Health managers, institution heads, and supervisory staff, DGHS 61

Table 3.3 Health managers, institution heads and supervisory staff, DGFP 62

Table 3.4 List of leading agencies for public health, and research and development 65

Table 3.5 Main regulatory authorities in the health sector in Bangladesh 70

Table 3.6 Issues identified in the Gender Equity Strategy of 2001 75

Table 4.1 Summary of range of facility-based health services by referral level 86

Table 4.2 Summary of staff mix for public sector health services at upazila level and below 87

Table 4.3 Listing of total bed complement of hospitals in the public sector by type of hospital 87

Table 4.4 Summary of key roles in construction and maintenance management 89

Table 5.1 Health workforce ratios per 10,000 population, 2001–2005 99

Table 5.2 MOHFW present staff position and future projection 100

Table 5.3 Scope of services and staffing in other government ministries and agencies 101

Table 5.4 Bangladesh estimated health workforce density per 10,000, 2006 103

Table 5.5 Estimation of gap for doctors and nurses, 2007 103

Table 5.6 Projected workforce ratios per 10,000 population based on 2007 data 103

Table 5.7 Vacancies in different posts of DGHS, DGFP, and DNS, June 2008 105

Table 5.8 Public service cadres in the health sector 105

Table 5.9 Yearly production capacity of different categories of HRH inclusive of the private sector as of 2008 111

Table 5.10 Overview of regulatory functions by professional category 112

Table 6.1 HNPSP results framework 122

Table 7.1 Overview of the MOHFW budget 131

Table 7.2 Maternal Health Voucher scheme reimbursement rates 135

Table 7.3 Key financing characteristics of selected NGO programmes on health financing 138

Table 7.4 Summary of budget cycle 141

Table 7.5 Summary of planning and monitoring cycle 142

Table 9.1 List of HNPSP operational plans 163

Table 9.2 HNPSP performance against six core performance indicators 164

List of boxes

Box 1.1 National Strategy for Accelerated Poverty Reduction strategies 34

Box 1.2 Summary of MDG Progress Report for Bangladesh, 2008 36

Box 3.1 Role of the Secretariat of MOHFW 59

Box 5.1 Planning for nurse development 103

Box 9.1 Summary observations on the HNPSP Independent Review Team, APR 2009 165

Box 9.2 Draft National Health Policy 2010 168

Box 9.3 Remaining challenges outlined in the draft National Health Policy 169

Box 9.4 Key features of the draft National Health Policy 169



Asian Development Bank


Annual Development Programme


Acquired Immune Deficiency Syndrome


Antenatal Care


Annual Programme Review


Annual Programme Implementation Report


Acute Respiratory Infection


Bangladesh Bureau of Statistics


Behaviour Change Communication


Bangladesh Demographic and Health Survey


Bangladesh Health Watch


Bangladesh Integrated Nutrition Project


Bangladesh Medical and Dental Council


Bangladesh Nursing Council


Bangladesh Pharmacy Council


Bangladesh Rural Advancement Committee


Chief Accounts Officer


Controller General of Accounts


Construction Management and Maintenance Unit


Central Medical Stores Depot


Disability-adjusted Life Year


Drawing and Disbursement Officer


Department for International Development (United Kingdom)


Directorate General of Family Planning


Directorate General of Health Services


Dhaka Medical College Hospital


Data Management Information System


Directorate of Nursing Services


Directly Observed Treatment Short Course (TB)


Demand-Side Financing


Expanded Programme for Immunisation


Family Planning


Family Welfare Centre


Global Alliance for Vaccines and Immunisation


Gesellschaft für Technische Zusammenarbeit (German Technical Cooperation)


Health and Family Welfare Centre


Household Income and Expenditure Survey


Human Immuno-deficiency Virus


Health Nutrition and Population


Health Nutrition and Population Sector Programme


Health and Population Sector Programme


Human Resources for Health


Human Resource Management


International Centre for Diarrhoeal Research, Bangladesh


Information Communication Technology


Information, Education and Communication


Institute of Epidemiology and Disease Control & Research


Information Technology


Japan International Cooperation Agency


Kreditanstalt für Wiederaufbau (German Development Bank)


Logistics Management Information System


Management Accounting Consolidation System


Maternal and Child Health


Maternal and Child Welfare Centre


Millennium Development Goal


Monitoring and Evaluation


Management Information System


Ministry of Health and Family Welfare


Ministry of Local Government, Rural Development and Cooperatives


Management Support Agency


Medium-Term Budget Framework


Mid-Term Review


National AIDS/STD Programme


Non-Communicable Disease


National Electro-Medical Equipment Workshop


Non-Governmental Organisation


National Institute of Population Research and Training


National Institute of Preventive and Social Medicine


National Nutrition Project/Programme


National Strategy for Accelerated Poverty Reduction


National Tuberculosis Control Programme


Pharmacy Council of Bangladesh


Programme Implementation Plan


Procurement and Logistic Monitoring Cell


Postnatal Care


Public Works Department


Social Marketing Company


Sexually Transmitted Disease


Sector-Wide Approach


Swedish International Development Cooperation Agency






Upazila Health Complex


Union Health and Family Welfare Centre


United Nations Development Programme


United Nations Population Fund


United Nations Children’s Fund


Urban Primary Health Care Project


United States Agency for International Development


World Health Organization

Share with your friends:
  1   2   3   4   5   6   7   8   9   ...   34

The database is protected by copyright © 2019
send message

    Main page