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Focus on Health and Family Welfare vital to achieving development goals

Interview - May 12, 2015

Honorable Minister of Health and Family Welfare Mr. Mohammed Nasim has focused on achieving MDGs and lifting the population to world-class standards with regards to health, as well as social welfare.


In the  past  decade,  the  Bangladesh  economy  has  grown  at  nearly  6  percent  per  year,  and  human development has gone hand-in-hand with economic growth. Poverty has dropped by nearly a third, life expectancy has increased, as  has  literacy,  and  per  capita  food  intake,  with  more  than  15  million Bangladeshis pulled out of poverty since 1992. Recognizing that development is a long-term process, the current Five-Year Plan is part of a wider development vision defined by the government’s Vision 2021.  These targets, if achieved, will transform the socioeconomic environment. Do you believe that the government’s Vision 2021 presents a development scenario that will provide citizens with a higher standard of living and a more equitable socioeconomic environment?

Bangladesh is being regarded as the Emerging Tiger of Asia in terms of its economic growth. Bangladesh has been recognized among the next eleven economies of the 21st century due to having great opportunities for investment in foods and beverages, technology, textiles, leather tanning and real estate.

The government’s pro-people and pro-poor policies have also helped to make substantial changes in the socio-economic development, through building more and more road and tele-communication networks, and empowering women with bringing them to education and giving them more opportunity to participate in political domains and job market. About a hundred social safety net programs ensure protection of the poor and vulnerable sections of the society. Health, both as preventive and curative services, remains in the government's top social development agenda.

These proactive national policies and interventions responded through exciting progress in all the MDGs and development indicators including the health related MDGs.

The  Bangladesh  Ministry  of  Health  &  Family  Welfare  has definitely made progress in its MDGs towards  creating  the  conditions  necessary  to achieve the  fundamental  human  right  of  health.    The  efforts  made  to  promote  health  and  reduce suffering  in  the  spirit  of  social  justice have  been  central  to  all  policies  regarding  Health  and  Family Planning. In what ways do you see the  Ministry,  under   your guidance, has  made  progress  on goals such  as  lifting  public  health  standards  in  Bangladesh?

Before the last decade, despite having large population size and experiencing a high population growth rate, Bangladesh did not concentrate on giving adequate and effective health service to its citizens. Production and deployment of health workforce also did not match standard skill-mix and rural-urban distribution. The government has taken control over these facts and has started interventions in various ways to bridge the gap. Many new government medical colleges, nursing institutions, medical assistants’ training schools, health technologists’ institutes, midwifery training institutions, as well as grassroots level workers’ training facilities have been established.

Most recently the Honorable Prime Minister Sheikh Hasina inaugurated 11 new medical colleges in the public sector. Likewise, the private sector is encouraged to establish new academic and training institutions of all kinds to boost production of human resource for health. Currently we have 100 medical and dental colleges in the country, 38 in public sector and 62 in the private sector. Production of human resource is not the only health workforce issue, rather deployment and making sure that they work properly are the most critical issue.

The MOHFW filled up almost all the vacant posts in public health sector, created new posts, provided promotion to the eligible workforce, and ensured monitoring and supervision so that they work in their assigned place. Bangladesh has achieved remarkable successes in all the health related MDGs. Now we looking forward to the post-2015 global development goals and also to universal health coverage as one of the important components of the post-2015 development goals. The country has already developed its health care financing strategy to realize the UHC by 2032. The national health workforce strategy aims at meeting the requirement for implementation of the UHC.

Community clinics have made a breakthrough for improving the community health in Bangladesh. In the 80s, posts of a set of community health workers in the rural communities were created to directly interface with the households and family members during their home visits. But, a static clinic very close to the homes of the people was absent. Such a clinic in every small community catchments, to function as a nucleus of health improvement, was necessary.

Community clinics also mobilize proactive community participation. The community donates the land for constructing the structure, the government builds the small building, places permanent paid human resources, and provides a regular supply of medicines and logistics. On the other hand, the management and oversight are done by the local community-driven committee inclusive of elected members of local government body and community support group.

The full range of basic health and family planning services are provided from the community clinics, including also registration and tracking of pregnant mothers and under-5 children. Thirty essential medicines, which include 3 simple antibiotics. Other over-the-counter-drugs plus temporary contraceptives are supplied uninterruptedly for distributing among clients free of cost. Community clinic project encourages GO-NGO collaboration. Currently several NGOs are supporting the government in piloting different types of service improvement mechanism including capacity building, skill development, adding new service, enhancing accountability, etc. Several studies and formal assessment of community clinic functions done between 2011 and 2013 showed client satisfaction between 80% and 98%. Almost all respondents have opted for continuation of CCs as they are easily accessible, eliminate need for transportation, services provided free of charge, easier for taking counseling, and they cater their specific needs due to the fact that service is designed by local management committee.

Community clinics are symbol of gender, equity, voice and accountability in the grassroots level of rural Bangladesh. Most patients coming to community clinics are women and children, and are also from poor and underprivileged social groups. Through interface with households by community health workers and members of community support group, CCs serve purpose of universal health coverage.

The MOHFW of Bangladesh does not separate curative clinical service from preventive public health service. Community healthcare, day-care, hospitals, academic-training-research institutions, and health administration offices are all considered as composite elements of public health. The public health vision also looks at health as a multi sector responsibility and addresses issues like social determinants of health. Given the country’s socio-economic context, the national health services provide more emphasis on prevention, promotion of healthy lifestyles, early diagnosis and treatment through following key strategies.

Bangladesh over the past 6 years built a wonderful national eHealth network connecting the entire health sector beginning from the frontline health workers to hospitals and health managers. Well-recognized globally, the system allows us to gather real time health data to understand the country health situation easily for evidence based decision-making. The current public health goals of Bangladesh are to sustain and further consolidate the achievements, and to remain committed to the international health obligations, both for MDGs and post-MDGs. The public health vision, in a word, is to achieve the universal health coverage by 2032 in its literal meaning so that nobody fears to seek the highest level of healthcare because of financial reason and nobody is driven to financial catastrophe for availing healthcare.

You traveled recently  to Boston,  USA  as  well  as being  an  important  panel  speaker  in  the  WHO  Headquarters,  at  the Inter-Ministerial  Meeting  on eHealth Standardization; Interoperability. Do you believe international recognition and contributions are vital for Bangladesh's progress?

Yes, but to us knowledge and technology are more important than the receipt of financial assistance. For years, Bangladesh built its health systems and programs using the globally available knowledge and appropriate technology, and transforming them in the country context. At certain points of time, our successes became well known and the world started to recognize them. As our routine health programs have gained successes in attaining the basic health status of our people, we are increasingly paying attention to create advanced and state of the art health technology environment in the country.

With the availability of cheaper hardware, software and solutions, countries of the world are running after building different kinds of eHealth and ICT projects. However, without a systematic approach, standardization and interoperability framework, these projects may end up in silos, havocs and headaches. Bangladesh, in a short period of time, developed a national scale and affordable eHealth network but without forgetting the standardization and interoperability issues.

Bangladesh values international partnerships because these help Bangladesh to foster its success worldwide, to bring new partners with new knowledge and opportunity for technology transfer and collaboration.