Population Challenges for Bangladesh in the Coming Decades

Bangladesh currently has a population approaching 150 million and will add another 100 million before stabilizing, unless fertility can soon drop below replacement level. This level of fertility decline will require a change in marriage patterns, which have been minimal so far, even with increasing female schooling. It would also benefit from a long-awaited shift to long-term contraception. In addition to the consequence of huge population size, the density of population is already five times that of any other ‘mega’ country (>100 million), a very challenging situation for an agricultural society. Most of the future growth will be urban, increasingly in slums. Numbers of young people will not increase, but numbers of older people will increase 10-fold this century, creating a large burden on the health system, especially for chronic illnesses. High density of population means that agricultural land is virtually saturated, with very limited capacity to expand food production. Climate change may have dramatic impacts on agriculture, through flooding and drought resulting from weather changes and geopolitical influences on transborder rivers. Rising sea-levels and consequent salinity will affect crops and require shifts to alternative land use. Serious long-term planning is needed for meeting the growing needs of the population, both for distribution and consumption

Fifteen years of sector-wide approach (SWAp) in Bangladesh health sector: an assessment of progress

The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh embarked on a sector-wide approach (SWAp) modality for the health, nutrition and population (HNP) sector in 1998. This programmatic shift initiated a different set of planning disciplines and practices along with institutional changes in the MOHFW. Over the years, the SWAp modality has evolved in Bangladesh as the MOHFW has learnt from its implementation and refined the program design. This article explores the progress made, both in terms of achievement of health outcomes and systems strengthening results, since the implementation of the SWAp for Bangladesh’s health sector. Secondary analyses of survey data from 1993 to 2011 as well as a literature review of published and grey literature on health SWAp in Bangladesh was conducted for this assessment. Results of the assessment indicate that the MOHFW made substantial progress in health outcomes and health systems strengthening. SWAps facilitated the alignment of funding and technical support around national priorities, and improved the government’s role in program design as well as in implementation and development partner coordination. Notable systemic improvements have taken place in the country systems with regards to monitoring and evaluation, procurement and service provision, which have improved functionality of health facilities to provide essential care. Implementation of the SWAp has, therefore, contributed to an accelerated improvement in key health outcomes in Bangladesh over the last 15 years. The health SWAp in Bangladesh offers an example of a successful adaptation of such an approach in a complex administrative structure. Based on the lessons learned from SWAp implementation in Bangladesh, the MOHFW needs to play a stronger stewardship and regulatory role to reap the full benefits of a SWAp in its subsequent programming

Production and use of estimates for monitoring progress in the health sector: the case of Bangladesh

Background: In order to support the progress towards the post-2015 development agenda for the health sector, the importance of high-quality and timely estimates has become evident both globally and at the country level

Estimating the effects of COVID-19 on essential health services utilization in Uganda and Bangladesh using data from routine health information systems

Background Since March 2020, the coronavirus disease 2019 (COVID-19) pandemic has been a major shock to health systems across the world. We examined national usage patterns for selected basic, essential health services, before and during the COVID-19 pandemic in Uganda and Bangladesh, to determine whether COVID-19 affected reporting of service utilization and the use of health services in each country. Methods We used routine health information system data since January 2017 to analyze reporting and service utilization patterns for a variety of health services. Using time series models to replicate pre-COVID-19 trajectories over time we estimated what levels would have been observed if COVID-19 had not occurred during the pandemic months, starting in March 2020. The difference between the observed and predicted levels is the COVID-19 effect on health services. Results The time trend models for Uganda and Bangladesh closely replicated the levels and trajectories of service utilization during the 38 months prior to the COVID-19 pandemic. Our results indicate that COVID-19 had severe effects across all services, particularly during the first months of the pandemic, but COVID-19 impacts on health services and subsequent recovery varied by service type. In general, recovery to expected levels was slow and incomplete across the most affected services. Conclusion Our analytical approach based on national information system data could be very useful as a form of surveillance for health services disruptions from any cause leading to rapid responses from health service managers and policymakers

Estimating the effects of COVID-19 on essential health services utilization in Uganda and Bangladesh using data from routine health information systems

BackgroundSince March 2020, the coronavirus disease 2019 (COVID-19) pandemic has been a major shock to health systems across the world. We examined national usage patterns for selected basic, essential health services, before and during the COVID-19 pandemic in Uganda and Bangladesh, to determine whether COVID-19 affected reporting of service utilization and the use of health services in each country.MethodsWe used routine health information system data since January 2017 to analyze reporting and service utilization patterns for a variety of health services. Using time series models to replicate pre-COVID-19 trajectories over time we estimated what levels would have been observed if COVID-19 had not occurred during the pandemic months, starting in March 2020. The difference between the observed and predicted levels is the COVID-19 effect on health services.ResultsThe time trend models for Uganda and Bangladesh closely replicated the levels and trajectories of service utilization during the 38 months prior to the COVID-19 pandemic. Our results indicate that COVID-19 had severe effects across all services, particularly during the first months of the pandemic, but COVID-19 impacts on health services and subsequent recovery varied by service type. In general, recovery to expected levels was slow and incomplete across the most affected services.ConclusionOur analytical approach based on national information system data could be very useful as a form of surveillance for health services disruptions from any cause leading to rapid responses from health service managers and policymakers

Population, Family Planning and Reproductive Health Policy Harmonization in Bangladesh

Over the past 30 years, Bangladesh has achieved significant economic and human development progress, and demonstrated impressive policy as well as programmatic commitment to lowering the fertility level. However, its future socioeconomic prospects may be hampered by its population growth rate, depending on how quickly the fertility rates decline and at which point they stabilize. Projections estimate that the total population of Bangladesh in 2051 could increase to 218.1 million under a laissez faire projection scenario and 201.3 million under an accelerated fertility transition (AFT) scenario. This difference would have significant impacts on public spending, public services, and job creation. An AFT scenario would enable the country to improve the dependency ratios possibly resulting in economic benefits from harnessing the demographic dividend for several decades. To accelerate the demographic transition, the government will need to revitalize high-level coordination to ensure multisectoral engagement in population policies, including increasing the age at marriage, and improving education, skills development, job creation, and social safety nets for the vulnerable population groups. In addition, a sustained decline in fertility through increased access and coverage of family planning (FP) services is crucial, mainly by focusing on lagging regions and hard-to-reach areas, and by expanding the supply and provision of FP long acting and permanent methods. Strengthening the synergy and coordination of service delivery between the Health and FP directorates by building capacity for systems strengthening; promoting cross-referral between programs; and efficient provisioning of FP and reproductive health services through community clinics need to remain at the forefront of the government s health improvement efforts in Bangladesh

Tackling Noncommunicable Diseases in Bangladesh: Now is the Time

This report is organized in such a way that the key policy options and strategic priorities are based on the country context, including the burden of non-communicable diseases (NCDs) and associated risk factors and the existing capacity of the health system. Chapter one describes the country and regional contexts and the evidence of the demographic and epidemiological transitions in Bangladesh; chapter two outlines the disease burden of major NCDs, including the equity and economic impact and the common risk factors; chapter three provides an assessment of the health system and its capacity to prevent and control major NCDs; chapter four summarizes ongoing NCD interventions and activities in Bangladesh and highlights the remaining gaps and challenges; and chapter five presents key policy options and strategic priorities to prevent and control NCDs