Se­ri­ous Health Threat

Bangladesh suf­fers from a host of water-borne and com­mu­ni­ca­ble dis­eases that threaten its very sur­vival.

Southasia - - Bangladesh Health - By Fa­tima Si­raj Fa­tima Si­raj is cur­rently pur­su­ing a BBA de­gree at the In­sti­tute of Busi­ness Ad­min­is­tra­tion. She fre­quently writes on mar­ket­ing and so­cial is­sues.

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.

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