Minoti, a Family Welfare Visitor in Badalpur Union, Bangladesh. Credit: Colin Crowley/Save the Children.

Minoti Rani Das is a family welfare visitor (community health worker). She says that hardly any of the mothers in her community go to a health worker for consultations when they are pregnant, for the delivery of their babies, or take their children when they are sick.

There are many reasons for this – most people just can’t afford to go to a doctor and access is a big problem because of poor transport.Minoti sees patients in her office three days a week. On other days she visits the patients in her area on foot to administer very basic healthcare directly where it is needed. She says “We go to the children and mothers and offer a service but it’s not always possible. In the summer when it floods it’s not always possible to reach many places.”

Neonatal mortality rate  (per 1,000 live births) (2011) 26
Under-five mortality rate (per 1,000 live births) (2011) 46
Maternal mortality ratio (per 100,000 live births) (2010) 240
Number of doctors, nurses and midwives per 10,000 people (2010) 5.7
Births attended by skilled personnel (2011) 31.1
Total expenditure on health as a percentage of gross domestic product (2011) 3.7%
General government expenditure on health as a percentage of total expenditure on health (2011) 36.6%

The health system in Bangladesh is a mix of public, private and NGO providers, with private expenditure on health comprising 63% of total health expenditure. The burden of communicable diseases is high yet declining, and the country has made good progress in reducing maternal and child mortality. Despite this, there are challenges across the domains of availability, accessibility, acceptability and quality of the health workforce.

There are wide disparities in distribution of the health workforce, with a great variation in density of physicians between regions. Only 21% of physicians are female and ratios of nurses to physicians are below the 2.5 OECD average. Furthermore there is evidence that mechanisms for regulation and licensing of the health workforce require strengthening. This may indicate that, while the existing HRH Strategy (2008) and accompanying policies appear to adopt good practice, they are not yet being fully implemented.

Density of skilled health professionals is below indicative thresholds which may present difficulties for successfully scaling-up to meet these by 2035. However, concerted efforts are being made, especially in the area of midwifery, with the introduction of innovative training models and the scaling up of community health workers (CHWs).

In 2011, Save the Children produced a report on The Status of Community Based Health Workers in Rural Bangladesh. This report argues that CHWs, especially those trained in essential newborn care, can save the lives of many children. An attempt was made to count the number of CHWs in each district including those employed by the government and NGOs. It found an unequal distribution of CHWs across the country and recommends that the Government of Bangladesh take a leadership role in increasing coverage of CHWs in underserved upazilas, developing clear policies and guidance for CHW programmes and conducting more routine mappings of CHWs.

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