Serious Health Threat
Bangladesh suffers from a host of water-borne and communicable diseases that threaten its very survival.
The constitution of Bangladesh terms health as a basic right of the people. Current and previous health sector programs implemented in the country have often focused on low-income groups leading to what many term as a SectorWide Approach (SWA). Bangladesh has made considerable progress over the last few decades in improving the health of its population. This has manifested in a declining population growth rate, increased life expectancy at birth and decreased infant mortality rates. However, with a meager $57 recorded per capita health expenditure, Bangladesh has a long way to go before it can solve the innumerable health problems that paralyze it.
The health sector in Bangladesh can be analyzed in the light of various factors; the health of vulnerable groups, the prevalence of communicable and non-communicable diseases, the water and sanitation crisis, environmental health issues and the response to natural disasters.
Vulnerable groups include women, children, youth and the elderly.
According to WHO, while the child mortality rate has declined, maternal mortality rates remain high. Malnutrition is common among pregnant women as well children and adolescents. Nearly half of Bangladeshi children are moderately underweight, one-third suffer from stunted growth and a large number of adolescents, girls in particular, are severely malnourished. The threat of measles poses another challenge with approximately 20,000 children dying of the disease each year. Efforts are urgently needed to ensure safe access to immunization and control vaccine preventable diseases. The youth in particular, also suffers from the risks associated with sexual behavior.
Communicable diseases such as malaria, tuberculosis, HIV/AIDS and the Avian Influenza, are also a cause of serious concern. In the 1970s, malaria was eradicated from Bangladesh but re-emerged in the 1990s, as one of the major causes of death. Out of 64 districts, 13 districts bordering the east and northeast parts of Bangladesh, constitute the high risk malaria zone. P. Falciparum, one of the most dangerous types of malaria infection, puts nearly 11 million people at risk every year. In addition, Bangladesh also suffers from the HIV/AIDS epidemic. This is due to the high prevalence of the disease in neighboring countries and limited access to counseling and testing services plus the social stigma attached to it. Recently, concerns of HIV-tuberculosis co-infection have arisen in Bangladesh, which records the highest number of tuberculosis cases. Bangladesh is also prone to natural disasters such as floods and cyclones that lead to outbreaks of communicable diseases. During the floods of 2004, more than 400,000 people required treatment after suffering from different diseases, particularly diarrheal diseases, in the aftermath.
From an environmental point of view, the water and sanitation crisis contributes to diarrheal diseases that kill over 100,000 children each year. Thousands of cases of diarrhea occurring in children and adults are recorded every day. These diseases are linked to malnutrition, poor maternal health, high fertility and child survival. In Bangladesh, many wells containing arsenic were closed without considering the repercussions. Once a well is painted red, signifying that the water contains arsenic concentrations above the national standard, community members are discouraged from using it. However, when a well is closed, communities must look for other alternatives for drinking water. In their desperate quest, they usually return to the traditional unprotected water sources such as ponds or ditches, or walk to distant wells that do not contain arsenic.
While reducing the effects of chronic arsenic exposure, such practices dramatically increase the risk of bacteriological contamination, leading to greater outbreaks of water-related diseases. These issues are more pronounced in the squatter settlements of urban slum areas, which are the most densely populated areas of the country. This is because people from rural areas migrate in large numbers to urban centers, hoping to earn enough wages to support their families. A concentration of people in a small area leads to issues of acute poverty, overcrowding and poor housing which further aggravates the health and sanitation problem. Furthermore, outbreaks of dengue are common in unhygienic settlements and government efforts need to be taken to control mosquito breeding.
When it comes to non-communicable diseases (NCDs), unplanned urbanization again plays a major role in contributing to the burden. Other underlying factors that cause NCDs include changing dietary habits, unregulated tobacco consumption, air pollution, road traffic injury and lack of awareness regarding healthy behavior and lifestyle. Tobacco in particular is a major risk factor.
Despite significant improvements, the government has a long way to go in ensuring that the basic health needs of the population are met. The centralized state health management system has proven to be ineffective in providing equitable health care, especially in rural areas. Concerted efforts need to ensure that health workers are effectively trained and deployed. The government of Bangladesh, along with the World Health Organization, is making a conscious effort towards improving the health situation in the country. In 1999, the WHO developed Country Cooperation Strategies (CCS) to help initiate and strengthen lucrative health policies and develop projects with the help of government officials, development experts and other key stakeholders.
The CCS Strategic Agenda has been aligned with key national and international development priorities including the Millennium Development Goals, the Health, Nutrition and Population Sector Program (HNPSP) and the National Strategy for Accelerated Poverty Reduction (NSAPR). This agenda aims to increase the accessibility of vulnerable groups to health services, prevent and control major communicable diseases, promote healthy lifestyles for the prevention of major NCDs, improve access to safe water and sanitation, assist in the development of the health workforce and overall health systems across the country and improve disaster management.