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Understanding the Bangladesh 'health miracle'


Future Health Systems is a research consortium working to improve access, affordability and quality of health services for the poor. We are a partnership of leading research institutes from across the globe working in a variety of contexts: in low-income countries (Bangladesh, Uganda), middle-income countries (China, India) and fragile states (Afghanistan) to build resilient health systems for the future. After a successful first five-year phase from 2006-2011 (see our success stories), we are entering a new six-year phase of research, funded mainly by UK aid.

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Understanding the Bangladesh 'health miracle'

Future Health Systems


Last Thursday, FHS partner icddr,b in collaboration with brac and The Lancetlaunched a six-part special investigation into the health landscape in Bangladesh. The series explores how a country with low spending on health care, a weak health system, and widespread poverty has managed to make some exceptional health gains over the last two decades -- for example in the survival of infants and children under five years of age, life expectancy, immunisation coverage, and tuberculosis control.

The series is available free of charge (though registration with The Lancet is required). An interview with Mushtaque Chowdhury of brac provides a useful overview of the series.

What sets Bangladesh apart, according to the series, is its pluralistic health system in which many stakeholders including the private sector and non-governmental organisations (NGOs) have been encouraged to thrive and experiment. This has led to rapid improvements in access to essential services such as diarrhoea treatment, family planning, vitamin A supplementation, and vaccination coverage.

FHS Research Co-Director, Professor Abbas Bhuiya notes:

“Promoting an open culture of research-based innovation has made Bangladesh a pioneer in scaling up community-based approaches that have brought key health interventions to every household, making huge inroads into improving maternal and child health and reducing population growth.”

One striking example is tuberculosis treatment. By mass deployment of community health workers, cure rates escalated from less than 50% to more than 90%—among the highest in the world. Another is contraceptive use. By recruiting female health workers to deliver door-to-door family planning services, Bangladesh has achieved high (62%) contraceptive prevalence and a rapid fall in fertility from 6.3 births per woman in 1971 to 2.3 in 2010—a rate unparalleled in other countries with similar levels of development.

Other factors that have had a big impact on the health of Bangladesh’s population include a strong focus on reducing gender inequality through pro-poor and pro-women development programmes (e.g. in education and microfinance), and improvements in natural disaster preparedness and response.

Less successful have been attempted improvements in poverty reduction, maternal and child malnutrition, and access to primary care.

“The stark reality is that prevalence of malnutrition in Bangladesh is among the highest in the world. Nearly half of children have chronic malnutrition. Moreover, over a third the population (more than 47 million) live below the poverty line, and income inequality is widening”, says Professor Bhuiya.

Additionally, more needs to be done to address the poorly-equipped public health sector which, although free to the poor, faces a reported shortage of 800 000 doctors and nurses. They point out that every year 4–5 million people are pushed into poverty because they have to pay for health services directly, partly due to the rapid growth of the unregulated, low-quality, high-cost private sector.

In the first phase of FHS research, icddr,b -- recognising the burgeoning role of the private sector in Bangladesh -- experimented with ways for improving the services of village doctors through a franchise system. In the current phase of work, FHS Bangladesh continues to explore ways of improving these services through the use of mHealth technologies to strengthen links with formal health providers.

Articles in the series that involved FHS researchers include:

Outside of the series, in the current issue of the Lancet also featured the following comment piece by Professor Abbas Bhuiya: