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5. DEVELOPMENT OF
THE HEALTH SYSTEM
5.1 Health policies
and strategies
The cornerstone of national health policy is the Health
and Population Sector Strategy introduced in 1998. Priority is given to
ensuring universal accessibility to and equity in healthcare, with particular
attention to the rural population. MCH
receives priority in the public sector, and reproductive health has recently
become a priority concern. There has been improvement in the government
financial allocation for health. Efforts are being made to develop a package
of essential services based on the priority needs of clients, to be delivered
from a static service point, rather than providing door to door visits by
community health workers. This is a major shift in strategy and will require
complete reorganization of the existing service structure. This is expected
to reduce costs and increase efficiency as well as meet "peoples'
demand". Privatization of medical care at the tertiary level, on a
selective basis, is also being considered.
Related Links Ministry of Health Millennium
Development Goals (MDGs) Health Policy – WHO/HQ
Progress made towards achievement of health related MDGs is given at Annex-2
5.2 Inter-sectoral
cooperation
Inter-sectoral committees at the
different levels from the national level to the periphery are formed,
whenever the need for cooperation exists. At national level, for example,
nutrition and population councils are chaired by the prime minister. At the
district and thana
levels, inter-sectoral coordination committees also
exist, while at the lowest administrative level (union), similar committees
are formed, e.g., for water and sanitation projects.
5.3 Organization of
the health system
Committees have been formed, including an
inter-ministerial committee, to integrate/merge the health and the family
planning departments. Functionally, health and family planning personnel work
closely at Thana,
union and outreach levels, but a dichotomy exists at the district and
national levels. More decentralization of management is also being
considered.
Related Links Director General of Health Service Ministry
of Health – Organgram WHO-Bangladesh
Health System – WHO/SEARO
5.4 Managerial
process
The government decided to formulate a national health
policy during 1997, for which a health policy committee and five
subcommittees were formed. There was a change from a top-down planning
process for health to a participatory approach involving the stakeholders in
the health sector. The first product that was formulated utilizing this
approach was the health sector perspective plan. The health and population
sector strategy document was also prepared following the same process.
A new approach to program implementation, which is product
oriented and emphasizes on outputs rather than inputs is being tried out with
WHO assistance. Decentralization of the management process is also being
considered.
Related Links Ministry
of Health – Organgram
5.5 Health
information system
A weekly epidemiological surveillance and outbreak control
reporting system for selected communicable diseases have been initiated
throughout the country. The routine HMIS is functioning with some limitation,
though activities have been undertaken to strengthen it. Information support
is not yet adequate. Use of data remains limited. Strengthening of the HMIS
through training, use of data collection tools already designed, and the
establishment of information networks with computer support have been
planned.
Related Links Director
General of Health Services WHO-Bangladesh
5.6 Community
action
The roles of the individual, family and community are
emphasized in the intensified action programme for PHC implementation, which involves decentralized
planning at thana
and union level. A total of 12 districts (86 thanas)
are now in the intensified PHC programme. Through intersectoral
collaboration and community participation, a joint action plan has been
implemented involving 60,000 village health volunteers (one each for 50
households). The participation of teachers and religious leaders is
encouraged. The information department and mass media inputs are also
utilized to support IEC activities.
Related Links Director General of Health Service
5.7 Emergency
preparedness
Currently, there is no legislation in the country that
underpins the management of natural disasters at national and sub-national
levels. In the absence of any legislation, the Ministry of Disaster
Management and Relief in 1997 issued revised "standing orders for
disasters." These provide guidelines and instructions to various line
departments and ministries. There are separate standing orders for different
hierarchical levels of the health sector, which include coordination
committees; contingency plans for manpower deployment, essential medical
relief supplies and maintaining a database; training in emergency
preparedness and response; a communication network; and budgetary allocation
for emergency management. A draft "Disaster Management Act" is
currently under review.
Related Links EHA
- WHO/SEARO EHA –
WHO/HQ
5.8 Health research
and technology.
Three organizations [the Bangladesh Medical Research
Council (BMRC), the Institute
for Cholera and Diarrhoeal Disease Research,
Bangladesh (ICDDRB), and Essential National Health Research (ENHR)] spearhead
biomedical and operational research. They undertake training and provide
research grants. Many of the research findings are helpful in making policy
decisions. Research units have also been opened by BMRC
in medical colleges. Field study stations have been established by BMRC and ICDDRB. BMRC
has reorganized itself internally to cope with the growing demands of young
researchers. Literature search systems in BMRC
and ICDDRB have been modernized.
Health systems research (HSR)
is not handled as a separate, independent entity. Individual faculty members
and other relevant people have been trained in HSR,
but there is no coordination among researchers. Health training institutions
have yet to include HSR in their
curricula. The research culture is developing in Bangladesh, and there is no
effective critical mass of researchers to form a strong advocacy group.
Coordination and networking among researchers and funding agencies are yet to
be developed.
Related Links Director General of Health Service Research – WHO/SEARO Research
– WHO/HQ
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