Bangladesh, with a population of 160 million and per capita income of US$1,480 (2017), has achieved a number of Millennium Development Goal (MDG) targets for health, nutrition, and population (HNP) outcomes. Child and maternal mortality, as well as fertility rates, have continued to decrease over the past decade, although progress on child undernutrition has been slower. As a result, Bangladesh prioritized addressing malnutrition and maternal, under-five and neonatal mortality, to reach the Sustainable Development Goals (SDGs) and accelerate progress toward universal health coverage.
However, financing gaps, governance challenges and system management weaknesses still constrain the effective use of increased spending to achieve these health objectives. In addition, while Bangladesh has made significant progress in increasing health service coverage and improving health results, the country prioritizes further enhancing gains made – in immunization coverage, for instance – improving quality of care and reducing persisting socio-economic and geographic inequalities. Urban health, climate change and adolescent health are also prioritized to lead the country toward universal health care.
The Global Financing Facility (GFF) supports aligning financing and technical support to meet these challenges with a focus on improving reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N) outcomes. The GFF is catalyzing coordinated impact of international financing of over US$1 billion and influencing domestic government spending of US$30 billion through government programs in HNP and education sectors over five years. It will develop and implement school-based services to improve adolescent health, provide technical support and policy development on health financing, strategies and interventions for adolescent health, civil registration and vital statistics, equity, the health of tribal and hill populations, climate change and health, to shape the efficiency and impact of the government programs in both sectors.
The share awarded to health in total government spending in Bangladesh remains very low, representing less than 1 percent of the gross domestic product, despite increases from US$6 to US$14 per capita between 2008 and 2017. This health expenditure performance is below international standards for an emerging middle-income country, and signals the need to increase investments for improved coverage and quality of health services.
The GFF supports improvements in budget planning and allocation, as well as increased efficiency in spending through development of core management systems, including financial management, procurement, and human resource management. The GFF focuses on strengthening the dialogue between the Ministry of Health and Family Welfare and the Ministry of Finance and Economy, as well as other stakeholders, by building the evidence base and fostering interaction on health financing policy. The GFF is improving the knowledge base for implementation of Bangladesh’s Health Care Financing Strategy for 2012–32, including analysis of health equity and financial protection, diagnosis of public financial management bottlenecks, engagement with the private sector, and dialogue on domestic resource mobilization.
The government and partners have pursued a sectorwide approach (SWAP) by adopting a series of multiyear strategies, programs and budgets for management, as well as development of the sector, with support from both domestic and international financing. The government developed its Fourth HNP Sector Program in collaboration with development partners, nongovernmental organizations, civil society, and other stakeholders. The program costs US$14.7 billion to cover from January 2017 and June 2022. It is currently in implementation to ensure citizens have access to quality and equitable health care to improve efficiency and equity while achieving universal health coverage.
The HNP Sector Program’s objectives and strategy are described in a Strategic Investment Plan and was operationalized by a Program Implementation Plan (PIP) approved in March 2017 by the Executive Committee of the National Economic Council chaired by the Prime Minister. The PIP is further detailed by 29 Operational Plans, each of which focuses on a specific technical area and describes the activities, budgets, and intermediate indicators necessary to achieve the objectives of the Sector Program.
To achieve this objective, the government needs to develop their health system governance; management and service delivery capacities; implementation of an Essential Services Package; and an emphasis on lagging regions such as Sylhet and Chittagong Divisions.
IDA AND TRUST FUND FINANCING
The Health Sector Support Project (HSSP)—financed by US$15 million from the GFF, US$500 million from IDA, US$13 million from the Netherlands, US$23 million from Sweden, US$60 million from the United Kingdom, and proposed co-financing from other partners—contributes to the government’s Fourth HNP Sector Program through a results-based strategy. The project supports development of health system governance, management and service delivery capacities, implementation of an Essential Services Package that includes key RMNCAH-N services, and a focus on lagging regions, in particular Sylhet and Chittagong Divisions.
Despite very low public spending on health services, several factors have contributed to improving HNP outcomes in Bangladesh. Female education and labor force participation contributed to empowering women and girls to delay marriage, reduce fertility, and take more control over their own and their children’s health and nutrition. However, attention to adolescent health has been insufficient and retention of girls in secondary education has been identified as a key challenge. The Transforming Secondary Education for Results Program is supported by US$10 million from the GFF and US$510 million from the International Development Association (IDA), as well as complementary financing of US$225 million from the Asian Development Bank.
On the basis of Bangladesh’s SWAP, the government aligned their domestic and international public financing in support of the Fourth HNP Sector Program which includes activities and budgets to achieve RMNCAH-N results supported by the GFF through HSSP. The program achieved its first planned results by implementing plans and budgets focused on improved RMNCAH-N services, implementation of online procurement and asset management systems to improve the efficiency of public funding, completion of needs assessments, planning, technical standards and service improvements for postpartum family planning services, emergency obstetric care, immunization, and maternal and child nutrition interventions and improved service coverage in Sylhet and Chittagong Divisions.
In addition, the GFF has catalyzed cooperation between the HNP and education sectors on development of technical strategies and interventions to maximize secondary schools as platforms to improve adolescent health services and outcomes. With support from the GFF, the Ministries of Education and Health and Family Welfare have formed a working group to jointly develop an Adolescent Students’ Program that includes incentives for vulnerable girls to stay in school, investment in separate functional toilets for girls, promotion of and facilities for menstrual hygiene, inclusion of adolescent health in the curriculum, teacher training, counseling of girls and boys, and awareness-raising on gender-based violence. With the support to both sectors, the GFF will contribute to the introduction and scale-up of these interventions.
GFF SECRETARIAT CONTACT
Maria Eugenia Bonilla-Chacin
PROJECT APPRAISAL DOCUMENT: HEALTH SECTOR SUPPORT PROJECT
PROJECT APPRAISAL DOCUMENT: Transforming Secondary Education for Results Operation Project
GFF COUNTRY SPOTLIGHT: BANGLADESH | PDF | 0.2MB
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