Health in Bangladesh

"Bangladesh and its people are rapidly changing and in quite a few ways for the better. The very negative image that Bangladesh acquired in the 1970’s has become much more balanced. The country is gradually becoming known for innovations such as micro-credit and oral rehydration solution treatment of diarrhoea as well as for successful mass campaigns such as family planning."

In such a dynamic context the overview of the current situation, early 2003, is therefore bound to be incomplete, open for discussion and will soon be dated. Nevertheless, at a glance, the following can be said about Bangladesh as of the end of 2002.
In December 2002 the total population of Bangladesh stands at over 133 million (Bangladesh Bureau of Statistics 2001). This is considerably less than even the lowest predictions a few decades ago. However, in spite of all development efforts, half of these 133 million people still live under the international poverty line. They have to make ends meet on less than one US $ per day. Half of those poor even live in absolute poverty, earning not even enough to buy enough food-grain to maintain healthy bodies.
In addition to these few ‘facts’, below is a brief listing of some of the achievements over the last few decades as well as a highlight of the main concerns. Furthermore the position of women and of the Christian community and NGOs is dealt with briefly.

Achievements
The "Bangladesh National Strategy for Economic Growth and Poverty Reduction" (ERD 2002) (B-NSEGPR) mentions 7 achievements (following (Akash 2002)) :

#A reduction of the acute deprivation in terms of food and income
#Increased access of the poor, both boys and girls, to education and health services
#An increase in the real wages of rural labourers
#Increased access of the poor to micro credit
#Volume of remittances from abroad has increased
#Non-farm employment opportunities have increased
#The role of women entrepreneurs in rural areas has increased.
In addition various other sources indicate clear progress in the following areas: a reduction in the number of the poorest households, i.e., without even homestead land from 2% in 1983-84 to 0.91% in 1996 (Toufique and Turton 2002 17), an increase in the awareness and mobility of women, both in rural areas due to the work of NGOs and in urban areas due to the commercial sector, particularly the Ready Made Garments (RMG) industry, a considerable improvement in Human Development Indicators (ERD 2002 5) and a decrease in the real price of food grains (Islam 2002 12).

NGO programs on the other hand often fail to reach the poorest of the poor. The design of their programs require people to have at least a place to live, an address, and often more as well such as the initiative (and time) to join a group and attend meetings, a minimal level of savings, of skills to make use of credit etc.

Remaining Challenges
While there is general consensus about these positive developments, there is another side to the coin; failure and backsliding. The B-NSEGPR lists 16 ‘failures’:
#The law and order situation has deteriorated extremely
#The vulnerability of the poor and the weak has increased enormously
#The rule of local musclemen has increased very much
#The administration in general and law enforcing agencies in particular are not accountable
#Political parties recruit school dropouts and engage them in terrorism
#The poor are disorganized and not aware of their rights
#Local government institutions lack power and accountability
#Local level health services are of poor quality
#The public/private dual education system enhances inequality
#Many government services are in a deplorable condition
#The standard of agricultural extension services is low
#There is little coordination between the various GoB agencies, as well as NGOs and CBOs
#Rural inequalities, in particular the rural-urban gap is increasing
#Politics has become polarized and conflict oriented
#Rural savings and other groups have not been able to unite and form federations
#The poor have little or no voice in policy formulation at local, regional or national level.

Overall Bangladesh has done relatively well on the human development front, but poorly in the field of reducing income-poverty. For instance Bangladesh’s achievements in the area of reducing income poverty must be seen against the achievements in neighbouring countries:
"During the period between early eighties and early nineties, the incidence of income-poverty declined by 0.8 per cent per year in Bangladesh compared with 1.9 per cent for India, 1.4 per cent in Pakistan and 3.6 per cent in Sri Lanka" (ERD 2002 3).
Finally the economic growth of Bangladesh, currently at around 5%, is considerably lower than the potential of 7-8% (World Bank 1998 111). In addition, because of the rather unequal distribution of the economic growth that has been achieved, much remains to be done if the poor are to reap the minimal benefits of being citizens of the "Golden Bengal".

The Position of Women
Women in Bangladesh still suffer disproportionately more from poverty than men. The long term and lasting impact of this is nowhere as clear as in the number of men and women alive in the country. As of 2001 there were 103.8 men for every 100 women in Bangladesh (Bangladesh Bureau of Statistics 2001 5). This is better than the even higher ratio of 105.9 in the 1991 census (Bangladesh Bureau of Statistics 2001 24). Nevertheless these figures still indicate that in Bangladesh women die in much larger numbers than in industrialized countries and that much work remains to be done. Poverty affects both more women than men and affects women worse than men. As the B-NSEGPR states:

"Notwithstanding the general improvement in the child nutritional status over the nineties, the female disadvantage in malnutrition continues not only to persist, but has also increased over the period. The HDS for 1996/97 and 1999/00 show that girls are more likely to be stunted and underweight than boys. The female-male gap for the severely stunted (percentage below –3 SD) increased from 10 per cent in 1996/97 to 16 per cent in 1999/00. Similarly, the gap for the severely underweight (percentage below –3 SD) increased from 19 per cent to 26 per cent over the same period. The gender inequality is sharper in case of severe malnutrition compared with moderate malnutrition—a striking similarity to what has been observed with respect to greater feminization of extreme poverty." (ERD 2002 13)

Of particular concern are female-headed households, of which 95% live below the poverty line (DFID 1998 2).
The Human Development Survey 2000 shows considerable sex differential in the rate of incidence of a disease case, with women being ill 11% more often than men (ibid, 12). In the last few years the enrolment of girls in primary and junior secondary schooling equals that of boys, or even surpasses it (with older girls making up for what they missed at a younger age). However, at higher secondary (age 16-20) and tertiary (age 21+) level girls are still lagging behind considerably.

The programs of NGO to help women get organized in groups and the RMG industry are also contributing to women taking a higher profile in public life. Their involvement in these activities is often a stepping stone on the way to availing the reserved or even contested seats created in representative institutions.

The prevailing bias against women is also clearly visible in the lack of women in positions of authority. In all but a few institutions, both governmental and non-governmental and in the commercial sector there are far more men than women.This is the more surprising because women are the prime target group of these NGOs.