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
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 Five Year Plan (2016-20). The goal is to ensure that quality services are delivered in an effective and equitable way and move towards universal health coverage. Results achieved so far include significant increases in the level of spending for repair and maintenance of health facilities at Upazila (subdistrict) level and below, and increases in the number of health complexes with at least 2 posts for accredited midwives (meeting the target of 150 midwives). In addition, in the Sylhet and Chattogram divisions of the country 15 districts reached at least 85 percent coverage of measles-rubella vaccinations among children 0-12 months; 25 percent of registered children aged under 2 years received specified nutrition services; and 138,000 deliveries have taken place in public health facilities.
More information on how Bangladesh is achieving results is available in the latest GFF Annual Report.