Bangladesh’s health sector has come a long way, reaching several millennium development goals and taking great strides in maternal and child health, immunisation coverage and TB control. But the double burden of existing communicable and emerging non-communicable diseases (NCDs) is threatening to undermine the benefits of development and growth that have been achieved over the past four decades.
NCDs are not passed from human to human like many traditionally observed illnesses in tropical countries such as Bangladesh. Instead, a person may be genetically predisposed to, or at risk of NCDs from behavioural or environmental factors. The four most common forms of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.
The emerging epidemic
In Bangladesh, there has been a slow decline in tobacco use – one of the main reasons for asthma, cancer and chronic obstructive pulmonary diseases. Cardiovascular diseases account for the greatest number (17 per cent) of all NCD-related deaths, and more than eight per cent of the adult population suffers from diabetes. Yet the country’s health system and policies still continue to prioritise the needs of children and reproductive-age women with little preparedness and skills to address the emerging epidemic of the NCDs.
Having not been addressed in the previous MDGs, NCDs have now been recognised as a major global health challenge and included in the Sustainable Development Goals. As a result, currently two significant policies are being developed in Bangladesh that includes NCDs – the seventh five-year plan (2016-2020), and the fourth health sector plan (HPNSIP 2016-2021).
“While these documents are being formulated, it is high time to discuss, debate, and strategise approaches and interventions to mainstream preventive NCD interventions in the existing primary healthcare infrastructure in a sustainable manner,” said Dr Syed Masud Ahmed, professor and director of the BRAC School of Public Health’s Centre of Excellence for Universal Health Coverage. The School currently hosts the secretariat of Bangladesh Health Watch (BHW), a civil society initiative comprised of multiple stakeholders.
Civil society for health policy
Since 2006, BHW has been monitoring the health sector agenda and programmes, while advocating for the improvement of the country’s health system. The group’s members have joined forces to carefully review health policies and recommend appropriate actions for change that will have a lasting impact on the lives of Bangladeshi people.
The collective is comprised of several key public and private sectors players, including high-ranking representatives from BRAC, EngenderHealth, and WaterAid. Others include individuals who were previously holding prominent positions at the National Institute of Population Research and Training, WHO, and government ministries including Health and Family Welfare. BHW also includes members from research hospitals such as the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), think tanks such as Centre for Policy Dialogue, academics from BRAC University and Dhaka University, as well as members of the media and activist groups. Including a wide range of perspectives and expertise provides BHW with the legitimacy that allows for access to those who directly inform and formulate policy change.
Civil society has already been active in monitoring the country’s progress in various sectors, such as education, with the Education Watch having been established in the late 1990s. Reports released annually by Education Watch have been widely considered a credible source of information used to inform national policy and programming. Similarly, BHW has also been playing a part in influencing the national health agenda through its series of reports. The first report published focused on the theme of health equity (2006), followed by health workforce (2007), health governance (2009), universal health coverage (2011), and urban health challenges (2014).
Bringing NCDs into the mainstream
As a result of its continuous efforts, BHW has become a credible source for instigating policy changes at the top level. For instance, findings from the health governance report, governance and stewardship were included as legislative priorities in the next Health, Nutrition and Population Strategic Investment Plan 2016-2021. Additionally, recommendations from the report on health workforce stated the need to restart recruitment and training of additional medical assistants and family welfare visitors as a matter of urgency. Subsequently this was reflected in the Health Workforce Strategy 2008, stating special attention would be placed on improving the production capacity of the institutes responsible for production of nurses, health technologists, medical assistants, family welfare visitors and skilled birth attendants.
This year, the collective has decided to focus on the theme of tackling emerging NCDs. With both the five-year plan and next health sector plan already on its way to being drafted, NCDs can have a catastrophic impact on spending and impoverishment caused by large out-of-pocket expenditures for treatment. Thus one of the recommendations made by BHW is that the government must urgently focus on mainstreaming NCD care in primary healthcare facilities, emphasise prevention over treatment, screening and appropriate referral for early diagnosis and treatment.
However, these recommendations are not a silver bullet. Much work is still left to be addressed in order to continue the sustainable development of the national health system. NCDs include a large spectrum of illnesses, including mental health and road accidents, which will not be included in the most recent BHW report. However the collective agree that the significance of these problems in Bangladesh are deserving of their own reports as policies continue to evolve to include these immediate and emerging health sector issues.
The author is Communications and Knowledge Manager, BRAC School of Public Health