Our situation in achieving MDG

Bangladesh has already met several targets of the MDGs like reducing poverty gap ratio, attaining gender parity at primary and secondary education, under-five mortality rate reduction, containing HIV infection with access to antiretroviral drugs, children under five sleeping under insecticide treated bed nets, detection and cure rate of tuberculosis under directly observed treatment short course and others. In addition, Bangladesh has made remarkable progress in the areas of poverty reduction, reducing the prevalence of underweight children, increasing enrolment at primary schools, lowering the infant mortality rate and maternal mortality ratio, improving immunization coverage and reducing the incidence of communicable diseases.

Background of HPNSDP 2011-16

With a view to accelerating progress of the health, population and nutrition (HPN) sector and addressing the challenges, the Ministry of Health and Family Welfare (MOHFW), Government of Bangladesh (GOB) has been implementing the Health Population and Nutrition Sector Development Program (HPNSDP) for a period of five years from July 2011 to June 2016. After HPSP (1998-2003) and HNPSP (2003-2011), the HPNSDP is the third sector-wide program for overall improvement of health, population and nutrition sub-sectors. The priority of the program is to stimulate demand and improve access to and utilization of HPN services in order to reduce morbidity and mortality; reduce population growth rate and improve nutritional status, especially of women and children.

HPN Sector Performance

Maternal mortality ratio, infant mortality rate and under-five mortality rate declined.
EPI coverage increased.
Population growth rate and the total fertility rate (TFR) declined.
Percentage of children receiving vitamin-A supplements increased.
Life expectancy at birth rising.
TB case detection and cure rates achieved MDG targets.
Polio and leprosy virtually eliminated.
Malnutrition and micro-nutrient deficiencies reduced.
HIV prevalence very low.
Remarkable countrywide network of health care infrastructure.

Main Challenges

Low rate of deliveries by skilled birth attendant.
High rates of neonatal deaths, malnutrition and micronutrient deficiencies.
Emerging and re-emerging diseases and impact of climate change.
Rise in non communicable diseases (NCD) including cardio-vascular diseases, diabetes, cancer and injury
Diversification of family planning (FP) service and high rate of discontinuation and unmet needs.
Ineffective urban primary health care service delivery.
Gender sensitive and equity based service delivery.
Inadequacies in human resources.
MIS functions along with sustained M&E system.
Quality assurance system, medical auditing, accreditation and weak legal framework.
Low utilization of public health facilities by the poor.

The HPNSDP 2011-16 strategies

Expanding the access and quality of MNCH services.
Strengthening of various family planning interventions to attain replacement level fertility.
Mainstreaming nutrition within the regular services of DGHS and DGFP.
Strengthening preventive approaches as well as control programs to communicable diseases and non communicable diseases.
Strengthening support systems and increasing health workforce at all levels.
Improving MIS with ICT and establishing M&E system.
Strengthening drug management and improving quality drug provision.
Increasing service coverage through public, NGO and private sector coordination.
Pursuing priority institutional and policy reforms.

New about HPNSDP 2011-16

Focusing the issue of maternal, neonatal, child and adolescent health, a new Operational Plan (OP) is being implemented under DGHS.
Emphasizing MNCAH interventions/services in urban slums, hard to reach and low performing areas.
Introduction of midwifery services and training.
Increasing facility based 24/7 services for management of maternal complications.
Prioritizing areas of high maternal mortalities, geographically and socially disadvantaged population.
Sharing of expertise and facilities between DGHS and DGFP for MNH services.
Strengthening sick newborn services with effective referral systems including home-visit.
Emphasizing long acting permanent method (LAPM) and unmet needs of FP services with area based targeted intervention.
Mainstreaming nutrition services through DGHS and DGFP for countrywide coverage.
Establishing e-health at all public facilities including the Community Clinics (CC).

Key HPN 2011-16 Services (Community to National Level)

Antenatal care, assisted delivery, postnatal care, neonatal healthcare.
Children’s treatment for diarrhea, respiratory illness, measles, malaria, etc.
Vaccination through EPI program.
Reproductive health and family planning counseling for adolescent and eligible couples.
Limited curative services
Distribution of family planning commodities.
Providing permanent method of contraception (Sterilization).
Distribution of oral rehydration salt for diarrheal diseases, folic acid/ iron supplementation.
Free distribution of essential medicines and ensure drug safety.
BCC and education program for raising awareness.
Identification of illnesses, like tuberculosis, emergency obstetric situation, life-threatening influenza, anthrax, etc.
24 hour emergency services with ICU/CCU facilities through secondary and tertiary hospitals.
All sorts of diagnostic tests.
24 hour emergency obstetric care (EmOC) service.
Sputum examination and free medicine for tuberculosis/ leprosy patients.
Diagnosis and management of patients through alternative medical services.
Nutritional education and micro-nutrient supplements.
Screening for malnutrition, treatment of complicated cases for severe and acute malnutrition.
Blood screening and safe blood transfusion.
Specialized treatment related to medicine, surgery, gynecology, pediatrics, orthopedics, eye, ENT, and other disciplines
Super specialized care at medical college hospitals and teaching institutes.
Referral from CC level to higher level centers for management of complicated cases.
Produce enough number of Nurses, CSBA, Midwifes, Paramedics, Health Technologist etc.
Continuous skill and capacity development training to the service providers.

HPNSDP 2011-16 partners

Development activities of HPNSDP are being implemented by MOHFW, DGHS, DGFP and other agencies through 32 operational plans. World Bank and JICA are providing credit and grants; whereas other DPs (DFID, SIDA, USAID, CIDA, EC, AusAID, Kfw, WHO, UNICEF, UNFPA, GIZ, UNAIDS, GFATM, GAVI, etc.) are providing grants. Total DP contribution to the development budget is about 61.29%.

HPNSDP 2011-16 Budget Estimates

Total Estimated Cost = Tk 56,993.54 Crore (US$ 7.7 billion)

Revenue Budget = Tk 34,816.88 Crore (US$ 4.7 billion)

Development Budget = Tk 22,176.66 Crore (US$ 3.0 billion)

GOB Contribution = Tk 43,420.38 Crore (US$ 5.9 billion)

DP Contribution = Tk 13,573.16 Crore (US$ 1.83 billion)

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