Abstract: Writing earlier this year, as part of a series of country case studies on good health at low cost, Dina Balabanova and her colleagues concluded that “Bangladesh has made enormous health advances and now has the longest life expectancy, the lowest total fertility rate, and the lowest infant and under-5 mortality rates in south Asia, despite spending less on health care than several neighbouring countries”. 1 Balabanova D Mills A Conteh L et al. Good health at low cost 25 years on: lessons for the future of health system strengthening. Lancet. 2013; 381: 2118-2133 Summary Full Text Full Text PDF PubMed Scopus (187) Google Scholar Why is this so? In Bangladesh, funds dry up for arsenic mitigation researchEfforts to tackle what WHO describes as “the largest case of mass poisoning of a population in history” are being hampered by a dearth of funding for research. Patrick Adams reports. Full-Text PDF The Bangladesh paradox: exceptional health achievement despite economic povertyBangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Full-Text PDF Harnessing pluralism for better health in BangladeshHow do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defined by the participation of a multiplicity of different stakeholders and agents and by ad hoc, diffused forms of management has contributed to these outcomes by creating conditions for rapid change. Full-Text PDF Community-based approaches and partnerships: innovations in health-service delivery in BangladeshIn Bangladesh, rapid advancements in coverage of many health interventions have coincided with impressive reductions in fertility and rates of maternal, infant, and childhood mortality. These advances, which have taken place despite such challenges as widespread poverty, political instability, and frequent natural disasters, warrant careful analysis of Bangladesh's approach to health-service delivery in the past four decades. With reference to success stories, we explore strategies in health-service delivery that have maximised reach and improved health outcomes. Full-Text PDF Explaining equity gains in child survival in Bangladesh: scale, speed, and selectivity in health and developmentBy disaggregating gains in child health in Bangladesh over the past several decades, significant improvements in gender and socioeconomic inequities have been revealed. With the use of a social determinants of health approach, key features of the country's development experience can be identified that help explain its unexpected health trajectory. The systematic equity orientation of health and socioeconomic development in Bangladesh, and the implementation attributes of scale, speed, and selectivity, have been important drivers of health improvement. Full-Text PDF Reducing the health effect of natural hazards in BangladeshBangladesh, with a population of 151 million people, is a country that is particularly prone to natural disasters: 26% of the population are affected by cyclones and 70% live in flood-prone regions. Mortality and morbidity from these events have fallen substantially in the past 50 years, partly because of improvements in disaster management. Thousands of cyclone shelters have been built and government and civil society have mobilised strategies to provide early warning and respond quickly. Increasingly, flood and cyclone interventions have leveraged community resilience, and general activities for poverty reduction have integrated disaster management. Full-Text PDF Innovation for universal health coverage in Bangladesh: a call to actionA post-Millennium Development Goals agenda for health in Bangladesh should be defined to encourage a second generation of health-system innovations under the clarion call of universal health coverage. This agenda should draw on the experience of the first generation of innovations that underlie the country's impressive health achievements and creatively address future health challenges. Central to the reform process will be the development of a multipronged strategic approach that: responds to existing demands in a way that assures affordable, equitable, high-quality health care from a pluralistic health system; anticipates health-care needs in a period of rapid health and social transition; and addresses underlying structural issues that otherwise might hamper progress. Full-Text PDF Bangladesh's health revolutionMy country, Bangladesh, has seen a health revolution in my lifetime. Maternal mortality has decreased by 75% since 1980,1 infant mortality has more than halved since 1990, and life expectancy has risen to 68·3 years, higher now than in neighbouring India and Pakistan.2 Such rapid changes in health have almost no historical precedent, save perhaps for Japan's breakneck modernisation following the 19th-century Meiji Restoration.3 Full-Text PDF Health care for poor people in the urban slums of BangladeshBangladesh has witnessed substantial success with respect to health, as described in the Lancet Bangladesh Series and elsewhere.1 The daunting challenge now is the health of poor people living in urban areas. Massive and rapid urbanisation is occurring, with rural populations moving to cities in huge numbers, driven by poverty, climate change, and the promise of better economic opportunities.2,3 In the past 40 years the proportion of the population living in urban settings in Bangladesh has increased from 5% to 28%, with roughly 45 million people now living in urban areas. Full-Text PDF What's happening in Bangladesh?Self-assured commentators who saw Bangladesh as a “basket case” not many years ago could not have expected that the country would jump out of the basket and start sprinting ahead even as expressions of sympathy and pity were pouring in. This informative Lancet Series on Bangladesh1–6 helps to explain what happened—and why. It is important to understand how a country that was extremely poor a few decades ago, and is still very poor, can make such remarkable accomplishments particularly in the field of health, but also in social transformation in general. Full-Text PDF
Publication Year: 2013
Publication Date: 2013-11-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 34
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