Dhaka: In March and April 2008, the Ministry of Health and Family Welfare (MOHFW) and the development partners (DPs) working in the health, nutrition and population (HNP) sector conducted a Mid Term Review (MTR) of the Bangladesh Health, Nutrition and Population Sector Program (HNPSP). The MTR was guided by a Steering Committee consisting of MOHFW and DP representatives and included a review of the Program by independent consultants and a stakeholder consultation. These reports were discussed by the Government of Bangladesh (GOB) and DPs in internal meetings. An action plan was developed jointly and agreed upon during a policy dialogue that included GOB, DPs and other stakeholders.
HNPSP – an overview
The Bangladesh HNPSP is a GOB led program supported by a range of multi-lateral and bi-lateral development agencies that are working together in a HNP Consortium. HNPSP has a total investment of about USD 4.2 billion, consisting of USD 1.3 billion in donor aid and USD 2.9 billion of GOB resources all aligned to support the Government’s Poverty Reduction Strategy and Strategic Investment Plan. The Program aims to modernize the health sector and accelerate progress towards the health–related millennium development goals (MDGs).
The total DP support of USD 1.3 million consists of pooled finance of USD 816 million and the rest in parallel financing. The pooled finance is made up of a multi-donor trust fund of USD 493 million and World Bank credit of USD 323 million. At present, six agencies are contributing to the trust fund – the United Kingdom Department for International Development (DFID), the Embassy of the Kingdom of the Netherlands, European Commission, Swedish International Development Cooperation Agency (Sida), German Development Cooperation, and the United Nations Population Fund (UNFPA).
Progress
Cooperation between MOHFW and DPs continue to remain strong. There have been improvements in the management and leadership, and accountability for implementation of the program. The MTR noted that progress has been made in strengthening delivery of health care services. MOHFW has established a Management Support Agency that will be contracting out services to non-public actors in remote and hard to reach areas to improve service delivery for the poor. GOB will continue to deliver a package of accelerated health care services to make these available for the most vulnerable especially women, children and the malnourished. Given the substantial progress made over the past year, the pool financiers of HNPSP have agreed to provide additional USD 38 million to GOB as recognition of its good performance. This is the first time, since the inception of HNPSP, that funds are being disbursed for good performance of the program.
According to the Bangladesh Demographic and Health Survey (BDHS) 2007, marked improvements have been made in the coverage of basic services such as immunization, vitamin A supplementation, and tuberculosis. The BDHS also shows good progress between 2004 and 2007 towards achievement of some of the health-related MDGs, including declines in infant mortality rates from 65 per thousand live births to 52 per 1000, and under 5 years of age mortality from 88 per thousand live births to 65 per 1000. Total fertility rate decreased from 3.0 in 2004 to 2.7 in 2007. While the BDHS shows improvements in the average value of most major service and health outcome indicators, there is a widening gap between the rich and the poor for some output indicators such as antenatal care, delivery care and assistance, and vitamin A supplementation.
There is a need to make the services easily available to the poor. There is also a need for the Government to improve some of its systems and processes especially relating to information systems, financial management, procurement and human resources.
The way forward
During the policy dialogue, GOB and DPs agreed on an action plan that would be implemented over the coming months. These would help MOHFW in the delivery of services that meet the needs of the poor, reduce fiduciary risks by making the systems more accountable and strengthen the health system through greater commitment and partnership with the non-public actors. MOHFW also aims to promote more decentralized approaches such as district level planning and providing greater authority to local level health and hospital committees. In this way, the Program will be able to improve the quality of health care services and help Bangladesh in achieving the MDG targets.