Third and Fourth Periodic Report on CRC - Unicef

Convention on the Rights of the Child
Delivery of primary health care services in four major metropolitan cities, Dhaka, Chittagong, Rajshahi <strong>and</strong>
Khulna, began to improve after 1997, when the Urban Primary Health Care Project (UPHCP) was initiated by
the MOLGRD&C with support from ADB, UNFPA <strong>and</strong> the Nordic Development Fund. In addition to these four
major cities, primary health care services have also been provided in the other urban <strong>and</strong> municipality areas
through the NGO Services Delivery Programme (NSDP) funded by USAID <strong>and</strong> the Support for Basic Services
in Urban Areas Project (SBSUAP) funded by UNICEF. The UPHCP also provides reproductive health services
through upgraded municipal maternity centres for the provision of comprehensive EmOC services, family
planning, <strong>and</strong> RTI/STD detection <strong>and</strong> treatment. Under the SBSUAP, primary health care services are given by
the Local Government Division of MOLGRD&C as a component of comprehensive package for community
development through Urban Development Centres (UDCs).
The Government <strong>and</strong> NGOs undertake national campaigns to increase public awareness on health promotion,
disease prevention, polio eradication, vitamin A <strong>and</strong> iodine supplementation, prevention of injuries, <strong>and</strong> the care
of pregnant women.
6.4.3 Shortfalls <strong>and</strong> challenges
Despite the above programmes, less than 40% of the population has access to modern primary health care
services, beyond immunisation <strong>and</strong> family planning. Overall, Bangladesh spends only 1.2 percent of GDP on
health against a WHO target of 5 percent. Health expenditure per capita is barely inadequate to meet exp<strong>and</strong>ing
health dem<strong>and</strong>s in the country (only 12 US$ including US$7 private out of pocket against WHO suggested
optimum expenditure of $ 34 per capita per year for the least developed countries). Persons per physician in
2005 were 3,317 against 4,043 in 2001. Alongside the Government, about 400 NGOs run 170 hospitals in
different parts of the country <strong>and</strong> these hospitals have about 4,500 beds. Private healthcare facilities are also
available in the country <strong>and</strong> being increasing involved through initiatives like private-public partnership.
Table 6.1: Availability of Medical Facilities
Year
Hospitals
Hospital Beds
Public Private Total Public Private Total
Doctor Nurse Midwife
1991 610 280 890 27,111 7,242 34,353 21,004 9,655 7,713
1996 645 288 933 29,502 8.025 37,527 27,425 13,830 11,200
2001 670 712 1, 382 33,368 12,239 45,607 32,498 18,135 15,798
2005 1683 N.A - 51044 N.A - 41933 N.A N.A
Source: BBS
Health expenditure, according to a study conducted by BIDS in 2001, is disproportionately high among the
poorest household, who spend approximately 38 percent of household income on the treatment of illness
compared to the richest household who spend only 3.4 percent, suggesting that poor households face
significant economic pressure to fiancé treatment, <strong>and</strong> open to real risk of indebtedness.
While there has been progress in disease prevention <strong>and</strong> control, <strong>and</strong> a decline in childhood communicable
diseases, new <strong>and</strong> old infectious diseases, such as newer drug resistant tuberculosis, malaria, Dengue <strong>and</strong>
HIV& AIDS are threats to health. The trend of non- communicable disease such as cancer, diabetes,
cardiovascular diseases <strong>and</strong> injuries are likely to rise in the future.
The malaria threat in Bangladesh is deepening in some parts of the country although aggregate statistics
suggest a progressive lowering over the last four years to around one percent. While 13 of the 64 districts in the
57