Over the past decade, Bangladesh has made significant progress in child and maternal mortality, with fertility rates steadily decreasing. Among the factors thought to have contributed to these outcomes, despite low public spending on health services, are female education and labor force participation, which have empowered women and girls to delay marriage, reduce fertility, and take more control over their own and their children’s health and nutrition. However, there has been insufficient attention paid to adolescent health, while retention of girls in secondary education has been identified as a key challenge. Progress on child under-nutrition has been also slower. Finally, financing gaps and governance challenges still constrain the effective use of increased spending in health. The government is committed to continue to advance gains already made, improving quality of care and reducing persistent socio-economic and geographic inequalities.
The GFF Partnership Response
Through support to the government’s programs in both the health, nutrition, and population (HNP) and education sectors, the GFF is contributing with US$15 million for health and US$10 million for education to a coordinated impact of international financing of over US$1 billion and influencing domestic government spending of US$30 billion in the two sectors over five years.
The Health Sector Support Project (HSSP) in Bangladesh, co-financed by US$15 million from the GFF (of which US$ 5 million have already been disbursed), US$500 million from IDA, US$23 million from Sweden, US$13 million from the Netherlands, US$ 22 million from the Government of Canada, US$ 56 from DFID (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, particularly Sylhet and Chittagong Divisions.
A US$10 million GFF grant is co-financing the World Bank Transforming Secondary Education for Results Program and it is catalyzing a collaboration between the health and education sectors to help the government design and deliver school-based services to improve adolescent health. With the aim to use secondary schools as platforms to improve adolescent health services and outcomes, the GFF supported the Ministries of Education and Health and Family Welfare in the development of 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. 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 of Bangladesh has developed its fourth Health, Nutrition, and Population Strategic Investment Plan in collaboration with development partners, nongovernmental organizations, civil society, and other stakeholders, in line with the Sustainable Development Goals and the government’s 7th Five Year Plan (2016-20). The program costs US$14.7 billion to cover from January 2017 until 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. Some of the results achieved thus far include improvements in the level of expenditures for repair and maintenance at Upazila (subdistrict) level and below (more than 180 percent since 2016) and increases in the number of Upazila Health Complexes with at least 2 posts for accredited midwives (the target of 150 was met). In addition, in the Sylhet and Chattogram divisions: 15 districts reached at least 85 percent coverage of measles-rubella vaccination among children 0-12 months; 25 percent of registered children aged under 2 years received specified nutrition services; and 138,000 normal deliveries have taken place in public health facilities.
Future plans include technical assistance to further support the implementation of the Health Care Financing Strategy (2012-2032), continued support on private sector engagement, and ongoing support for adolescent health, including a joint education and health sectors monitoring and evaluation framework. Activities will continue to advocate for increasing domestic resources allocated to health and for more coordinated multi-sectoral support to adolescent health.
More information on how Bangladesh is achieving results is available in the latest GFF Annual Report.