Addressing Bangladesh’s demographic challenges
Title: Addressing Bangladesh’s demographic challenges
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Lead executing agency: The Ministry of Local Government, Rural Development and Cooperatives (MLGRDC); the Ministry of Health and Family Welfare (MOHFW)
Overall term: 2012 to 2017
In 2016, approximately 34 per cent of Bangladesh’s 160 million people lived in one of the country’s rapidly expanding cities and towns. With millions of people migrating from rural areas in search of work, the urban population topped more than 56 million people in 2016, increasing the demand for urban public health services.
In Bangladesh, two ministries are responsible for delivering these services: The Ministry of Local Government, Rural Development and Cooperatives (MLGRDC) is predominantly responsible for primary healthcare in urban settings, while the Ministry of Health and Family Welfare (MOHFW) is responsible for rural areas and for overseeing hospital care and health education institutions.
In many of the country’s cities, the administrative and technical responsibilities of MLGRDC-appointed health agencies are not clearly delineated from those implemented by authorities operating under the MOHFW. The upshot in the cities of Sylhet, Rajshahi and Narayanganj include fragmentation, duplication and inefficiency. Consequently, mechanisms need to be put in place to coordinate the activities of all those involved.
While the health sector as a whole has developed significantly in recent years, the sexual and reproductive health rights sector (SRHR) still exhibits substantial shortcomings. The fertility rate has fallen over the last two decades, but the use of modern contraceptives remains low and abortion rates are high. With only a third of all births attended by skilled professionals, delivery complications are common. These problems are particularly acute in the urban centres of eastern Bangladesh, where access to SRHR services is limited.
To close the gaps identified in health service provision in urban areas and to improve service delivery, especially for the urban poor, health governance and health education capacities are strengthened at the Ministry of Health and Family Welfare and in Sylhet, Rajshahi and Narayanganj City Corporations as well as in medical college hospitals and nursing colleges in Sylhet and Rajshahi.
The German Federal Ministry for Economic Cooperation and Development (BMZ) is supporting the relevant health authorities and ministries in the cities of Sylhet, Rajshahi and Narayanganj. The GIZ implemented project ‘Addressing Bangladesh’s demographic challenges’ focuses on improving SRHR services in urban areas, and on promoting the healthcare system’s institutional and organisational development. Specifically, this concerns:
- Health governance, with a special focus on quality management and inter-ministerial coordination;
- Health information systems;
- Improving service delivery, from better emergency obstetrical care and midwifery education, to health promotion (with a special emphasis on adolescents and consumer rights);
- Human resources for health.
On behalf of GIZ, EPOS Consultancy has supported project rollout since 2012 and will be implementing all areas of activity in 2017.
Results achieved so far
Having cooperated with the Sylhet City Corporation since 2012, the project began working in the cities of Narayanganj and Rajshahi in 2014. So far, the three project sites have generated the following results:
- A number of situational analyses have been undertaken, including the mapping of public and private healthcare providers. The project has thus documented the distribution of available services, as well as their costs.
- Other studies have also been completed: a study of health-seeking patterns; a survey of knowledge, attitudes and practices (KAP) among adolescents with respect to sexual and reproductive health; and a comprehensive analysis of maternal mortality.
- All stakeholders are committed to using a standardised format for reporting routine data to the respective health departments in Sylhet, Rajshahi and Narayanganj City Corporations.
- Primary healthcare standards specific to urban areas in Bangladesh have been developed and assessed in line with relevant national standards, laws and policy, and in line with inputs from providers and users.
- The application of standards and tools has been scaled up in 20 primary healthcare facilities under Sylhet City Corporation – alongside 22 in Rajshahi and 23 in Narayanganj City Corporations – thus providing services to an estimated 2.5 million people. The three City Corporations have organised, trained and equipped working cells (UHMIS Cell, QM Cell and EPI) with the human resources required to improve and coordinate primary healthcare services in the cities and to monitor online data.
- Primary healthcare providers are currently submitting routine data online, enabling the City Corporations to regularly monitor their performance.
- Each City Corporation has installed a coordination mechanism secretariat that also holds zonal and central coordination meetings to review the status of primary healthcare services in their city.
- Two tertiary and one secondary level hospital at the project sites have successfully implemented the quality management approach ‘5S Kaizen TQM’ in line with Bangladesh’s national strategic plan for improving the quality of health service delivery.
- Bangladesh introduced its first midwifery diploma course in 2012. The first batch of midwives trained according to international standards graduated in 2015, with the second scheduled to follow in December 2016. The project supported the course by developing a competency-based method for assessing the clinical training sites and by drafting and implementing a mentor and preceptorship concept for clinical midwifery instructors and facilitating intensive capacity development measures for the nursing college faculties in Sylhet and Rajshahi.
- More than 25,000 adolescent boys and girls aged 10-19 years from urban slums in the three City Corporations have since attended health education sessions.