Academic journal article Journal of Health Population and Nutrition

Reaching the Unreachable: Barriers of the Poorest to Accessing NGO Healthcare Services in Bangladesh

Academic journal article Journal of Health Population and Nutrition

Reaching the Unreachable: Barriers of the Poorest to Accessing NGO Healthcare Services in Bangladesh

Article excerpt


Although the overall maternal and child-health indicators of Bangladesh have improved dramatically over the past 25 years, neonatal, infant and maternal mortality still remains high. The problem is most often associated with poor people which includes 45% of the population of Bangladesh. (1) For example, the infant mortality rate has remained stagnant since 1999 at 65 per 1,000 livebirths (2). Among the poorest Bangladeshis, the rate is even higher at 90 per 1,000 livebirths (2). Maternal mortality in Bangladesh also remains high, with an unacceptable level of 300 deaths per every 100,000 livebirths (3). Contributing factor for the high levels of maternal and infant mortality is the lack of access to formal healthcare by poor women and their children for antenatal, childbirth, and postpartum services (2). Beyond the issue of poor access is the fact that people in this low-income group face added risk factors due to poor health in their daily living environment. In fact, the cause of 21.1% of deaths among Bangladeshi children aged less than five years in 2004 was acute respiratory infection (ARI) due to exposure to biomass fuel in an inadequately-ventilated home--a common feature of low-income households across South Asia (4). Efforts to prevent these deaths must, therefore, confront the poverty that contributes to their poor health.

In response to the alarming statistics above, the Government of Bangladesh has developed a detailed maternal and child-health policy framework that includes--as one major element--the essential services package (ESP), designed in 1997, for delivery of services at local clinics throughout the country. The services under the ESP include contraception, antenatal and postpartum care, diagnosis and treatment of sexually transmitted infections, treatment of tuberculosis, and therapy for ARIs and diarrhoea (3). The most recent Health, Nutrition and Population Sector Programme Implementation Plan of the Government stresses increasing accessibility of services for the poor; it recommends participatory meetings, lowering the barriers the poor face, and improving the targeting of services and health programmes for the poor (3).

Although the Government affirms the rights of all citizens to healthcare and officially endorses increased services for the poor, its own health system struggles with constant and evolving changes, problems with effectiveness of the healthcare-delivery system, and inadequate coverage of the population (5). Approximately, 30% of the population (National Health Audit Report, 2002-2003) is covered by government services. Those who can afford it typically use the services of private providers (5).

Perhaps in recognition of its own limitations, the Government now looks into the NGO sector to supplement public-health services. In fact, the Government has allowed and encouraged NGOs to provide key health services in specific geographical areas underserved by government facilities (6). The vibrant, indigenous NGO sector of Bangladesh has, thus, stepped up to the challenge and is playing a major role in health advances, particularly in managing tuberculosis, malnutrition, and neonatal mortality (6). A recent World Bank study notes that the grassroots approach carried out by NGOs makes them more effective in reaching the poor than public and private providers because they are locally based and are also more accountable to their communities (6).

The creation of the USAID-sponsored National Integrated Population and Health Programme (NIPHP) in 1997 can be seen as part of the trend towards supporting healthcare provision by NGOs. This strategy, endorsed by the Government, strengthens the Bangladeshi NGOs in their provision of the ESP. In 2002, USAID began funding the NGO Service Delivery Program (NSDP) through a consortium of eight international organizations. Technical support and guidance was offered through the NSDP to 37 Bangladeshi NGOs that administer a network of 318 static clinics and 7,814 satellite clinics, covering 20 million Bangladeshis in areas where government services are largely inaccessible. …

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