Call for new health policies

Bangladesh’s health sector has come a long way but new issues are emerging that call for reforms with more targeted and innovative policies, analysts say.

New projections show Bangladesh’s population for the first time is hovering below 200 million now and will reach 194 million in 2050.

Despite the fact that many more young women are attending school, teenage fertility has been declining much more slowly than older-age fertility, suggesting major family planning efforts with steps to raise the minimum age for marriage.

Maternal deaths came down to 194 per 100,000 live births in 2011 from 576 in 1990 and 322 in 2001, but analysts say “to reach the final hundred meters, business as usual will not be effective”.

With ‘exceptional’ progress in child health and survival, causes of under-5 deaths are changing in Bangladesh, which needs changing public health system to address the issue.

But consistent economic growth could not improve the nutritional situation of the country that demands breaking the ‘vicious cycle’ of malnutrition with lifestyle approach.

On the other hand, with the increasing trend of overweight, more people are now suffering from diabetes and high blood pressure than before.

These facts were revealed on Wednesday when analysts discussed the final report of the Bangladesh Demographic and Health Survey (BDHS) 2011 and policy implications, giving thoughts to health policymakers who will soon review the ongoing sector development programme, HPNSDP.

Dr Tahmeed Ahmed, Director of ICDDR,B’s Nutrition Division, said most of marriages in Bangladesh took place during adolescence and the couples took first child immediately.

“As one-fourth adolescent girls are malnourished in the country, the growth restriction of the child begins at the womb and it is born with low birth weight and later becomes malnourished.”

He said: “It forms a vicious cycle. This cycle needs to be broken by strategies directed to the life cycle to improve nutrition of adolescent girls, infants and young children and women.”

During 2009-2010 fiscal year, when Bangladesh’s per capita GDP was $ 687, the stunting rate was more than 41 percent. But in Uganda it was 33 percent with $523 per capita GDP.

He suggested promoting dietary diversity through nutrition-friendly agriculture as food being available does not necessarily imply good diet.

“Although 65 percent women live in households with food security, one in five food-secure women is malnourished. Even among the wealthiest families, 26 percent children were found stunted,” he said.

But families do not get proper awareness messages as it was found in the survey that exposure to family planning messages declined since 2007.

“BCC (behaviour change communication) needs to be strengthened,” said Dr Peter Kim Streatfield, a Director of ICDDR,B Population Division.

The BDHS found only one in three women and about half of men were exposed to family planning messages from TV, Radio or newspapers.

As teenage fertility has remained as a cause of concern, Streatfield said young women were enrolling at secondary school in record numbers, “but many do not graduate and marry soon after dropping out of school as there are few alternatives in rural areas.”

“The urban formal sector, for example, the textile sector, is no longer absorbing the large numbers it did in the late 1980s and 1990s.

“So employment opportunities are needed in rural places,” he said, adding that security of girls is also a concern.

Dr Ishtiaque Mannan, Chief of Party of USAID’s MCHIP project, said human resources issues should be addressed on a priority basis in the health sector.

“HR policies should be reviewed with proper enforcement of transfer, posting, study leave and deputation.” He suggested a number of policies to reach the ‘final hundred meters’ of the 400-metre track of reducing maternal deaths.

“Business as usual will no more work. We have to focus on very specific needs. We have to calculate it,” he said.

“We can even introduce task-shifting strategies,” he said since due to lack of anaesthetics, emergency delivery services do not function at rural health facilities.

“But if we train nurses with limited anaesthesia only for Caesarean section, we can save many mothers who need it (emergency C-section). And it is happening in many countries like Uganda, Tanzania,” he said.

Dr Shams El Arifeen, an ICDDR,B Director on child health, said diarrhoea was no more a major cause of under-5 deaths in Bangladesh. “Drowning is now responsible for 43 percent of all deaths under-5. But tested and effective interventions are not yet available to prevent it,” he said, suggesting that the public health system must respond to the changing pattern of causes of deaths.

As the BDHS also showed 25 million people aged above 35 years are hypertensive or pre-hypertensive that leads to development of hypertension and 17 million are diabetic or pre-diabetic, Dr Shamim Haider Talukder, CEO of Eminence, an NGO, suggested effective prevention strategies to avoid huge treatment costs.

“The current burden suggests that $150 million is needed per year for basic treatment of diabetes and it will increase to $262 million when pre-diabetic people will become diabetic. This figure is one-fourth of the total health budget,” he said.

Health and Family Welfare Ministry’s Senior Secretary Md Humayun Kabir said the final BDHS report would help the government modify the ongoing health, population and nutrition sector programmes.

Regarded as a ‘quality’ source of information by policymakers and researchers to plan, monitor and improve programmes under the health ministry, the periodic survey is being conducted every three to four years since 1993-94 with the support of USAID.