Bend the health curve with efficiency and quality, says Save the Children director

An expert says Bangladesh must target to make “a big achievement” in the next five years to reach the 2030 goals as the government is devising the upcoming health sector programme.

Both ‘quality and efficiency’ would be the key to bend the curve, Dr Ishtiaq Mannan, Director for Health, Nutrition and HIV/AIDS of the Save the Children International in Bangladesh told bdnews24.com.

Mannan is one of the experts who are working with the government to prepare the next five-year programme that would replace the ongoing Health, Population and Nutrition Sector Development Programme (HPNSDP) at the beginning of 2017.

This new programme is particularly important as the sustainable development goals have begun this year, and the government has set achieving universal health coverage target within the SDGs by 2030.

Within 2030, Bangladesh has also committed to reduce maternal deaths to 59 from the current level of 176 per 100,000 live births, newborn deaths below 12 per 1,000, under-5 mortality to less than 30.

Bangladesh’s MDGs achievements in particularly cutting maternal and child deaths have been highly acclaimed, but the country is stepping into the most difficult part of the race, the last 100 metre, by the day.

Mannan, speaking to bdnews24.com on the sidelines of a policy briefing on Wednesday, said business as usual would not work to translate those 2030 commitments into reality.

The policy briefs have been organised based on the findings of the latest Bangladesh Demographic and Health Survey (BDHS).

“We have to leapfrog. We have to jump at some point to reach the ultimate target,” he said.

For example, Bangladesh could ensure 38 percent facility delivery, a major indicator to reduce maternal mortality, in 2014.

“The target was to reach 50 percent in 2015. That means we have missed the target. Now we set the target to reach 60 percent by 2021 and in 2030 to almost 100 percent,” he said.

“But things will be harder by the day. It was easy to reach 38 percent from the 14 percent in 2004, but now the progress will be slow and it would be much harder when it goes up and up”.

“To bend the curve, we will need a major breakthrough strategy, much more financing, and big actions,” he said.

He said quality would be a “very big” issue. For example, he said, the special safe motherhood scheme in India, Janani Suraksha Yojana (JSY), had increased the rate of facility delivery to 80 percent.

But the maternal mortality rate remained 170 deaths per 100,000 births which is similar to Bangladesh.

“This is a paradox, but it happens due to lack of quality in facility deliveries in India”.

“They increased facility delivery which is a good story that we can learn, but the weakness is the facility is not prepared in that way.

“There are many articles (in the newspapers) that mothers come with their traditional birth attendants to deliver at hospitals in lure of incentives the government has offered.

“They (women) shifted to the facilities but facilities did not expand. That’s why mortality did not reduce”.

“So proper planning would be needed for bending the curve,” he said, as quality was always an issue in Bangladesh.

The last Bangladesh Health Facility Survey also pointed out the “very bad” quality of health facilities at the primary level, as far as preparedness was concerned.

“We have to set our programmes in a very regulated, planned and controlled way. The planning must be target oriented,” he said. “The government has the capacity, but in some cases the guidance is missing”.

Some people always point to resource constraints. “It’s scapegoat.  We have to ensure the optimal utilisation,” Mannan said.

For example, the government has over 4,500 family welfare visitors (FWVs) posted in rural areas.

“They are getting salaries from tax payers’ money. They are trained, but they are assisting less than one percent of the deliveries.

“That means implementation is not working. We need effective coverage which means quality plus coverage”.

“We have to increase efficiency. The government has to take steps to make its system more functional to ensure the maximum utilisation of the resources.

“In every sector programme, there is an indication that steps have to be taken to make the system more effective for proper operational procedure.

“But things remain as usual when it comes to implementation. We have to focus in this aspect in the new sector programme. Otherwise we’ll do what we did before, there will be no difference”.

Above all is governance and stewardship, he said.

“The efficiency issue is also important. People are paying 64 percent of their medical costs from their own pockets, but the product is very low quality”.

He said the government had taken the responsibility of healthcare by constitution, unlike many other governments including the US.

“Now it needs to regulate the private sector, and increase its own capacity so that at least poor can get the right care in government facilities.

“If we can increase the efficiency at district and below that level, then it is very much possible to reach the UHC,” he said.

“We have that infrastructure, we have the manpower. Drugs and logistics are not the problem. We have overall socio-economic development. We are food self-sufficient and the education sector is also doing well”.

But there are challenges ahead, he said, as the non-communicable diseases such as diabetes, heart diseases, and cancer are increasing sharply.

“There is an elephant in the room after 10 years or 20 years, but we are not prepared to handle it.”