Bangladesh er fattigere end f.eks. Pakistan og Indien og bruger færre penge på sundhed i forhold til indbyggertallet. Alligevel har det formået at opbygge et sundhedssystem, der på mange områder opnår bedre resultater end naboerne.
LONDON, 26 November 2013 (IRIN): In health terms, Bangladesh is a “positive deviant”, performing far better, given its widespread poverty, than anyone could have expected. The London-based medical journal, The Lancet, recently published a series exploring Bangladesh’s surprising success, calling it “one of the great mysteries of global health”.
Here’s the paradox: Bangladesh is a very poor country,- much poorer than India or Pakistan. It has the lowest spending on healthcare in south Asia, (just US$27 per capita annually), and is extremely short of qualified doctors and nurses (only three doctors and three nurses for every 10,000 residents).
And yet, compared with neighbouring India, Pakistan and Nepal, it has achieved some impressive statistics. It has lowest infant and child mortality (51 per 1,000 live births), the highest vaccination rates (86.2 percent of children between one and two years old are vaccinated to internationally recommended standards), and the most extensive reach of family planning services (52 percent of married women under 50 now use modern methods of contraception). It also has the lowest maternal mortality rate (194 per 100,000 live births), despite relatively few women (32 percent) giving birth with a skilled birth attendant present.
Carine Ronsmans, an epidemiology professor at the London School of Hygiene and Tropical Medicine, who has worked extensively in Bangladesh over the past four decades, said its success, supported by robust data, has been “amazing”.
The Lancet Series traced how these results came about in a country that broke away from Pakistan in a bloody civil war in 1971, which wiped out almost all national administration. With the government short of qualified officials, local NGOs filled the gap, motivated by patriotism and a desire to make their new country better and fairer than the one they had left behind. The new government welcomed their help, and outside donors supported them.
NGO-led reforms
The result is one of the world’s most vibrant, successful NGO sectors. One of those organizations, BRAC (founded as the Bangladesh Rural Advancement Committee), now has more than 100,000 full-time workers and is widely ranked as the biggest NGO globally.
BRAC and other NGOs organized village schools and community healthcare, promoted vaccinations, family planning, tuberculosis treatment, and mother and child health. They concentrated on the country’s most disadvantaged groups – women and children, the poor, and underdeveloped rural areas – while the private sector took over much of the specialised care. More than 80 percent of Bangladesh’s hospitals today are still private.
Rather than starting from a policy framework, as is the case in most countries, The Lancet’s editors noted, the Bangladeshi government instead “created an environment for pluralistic reform, in which many participants in the health sector, including non-governmental organisations and the private sector, were allowed to flourish”.
Drivers of success
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The Lancents serie om Bangladesh.
