Challenges of meeting MDG4 and MDG 5 in Bangladesh

Prof. Kishwar AzadProject Director

DAB-Perinatal Care Project

•Area Area 147,570 km 147,570 km

• Population Population 142 million 142 million*

TFR 3 TFR 3

•Per capita GDP Per capita GDP $456 $456 **

• Life Expectancy Life Expectancy (2004)(2004) 65.1 years 65.1 years **

• Overall Literacy Rate Overall Literacy Rate (2004)(2004) 50.0% 50.0% ***BDHS 2007, **BBS 2006

MDG 4: Reduce U5MR by two thirds

BANGLADESH Target :

(2005)(1990)

50

78 (2006)

31

Trends in Newborn Infant and Under-5 Mortality Rates by Year, Bangladesh 1993 - 2007

133

116

9488

65

5052

6566

31

87 82

3741424852

0

20

40

60

80

100

120

140

160

180

1993 1997 2001 2004 2007 MDG Target

U-5

MR

per

100

0 L

B

U-5 mortality IMR Newborn mortality

Challenges of meeting MDG4

and MDG5 in Bangladesh

Causes of Under-5 mortality

Challenges of meeting MDG4

and MDG5 in Bangladesh

Tetanus ToxoidSafe and Clean DeliveryProphylactic Eye CareEarly and Exclusive BreastfeedingManagement of infectionsImmunization

Case management in community and facility (IMCI/Community IMCI)ORSZinc

Birth spacingMaternal NutritionMalaria ControlKangaroo Care Warming

Resuscitation

Syphilis Control Folate Supplementation

Interventions to achieve MDG-4

Causes of Neonatal Deaths

Unspecified4%

Possible Serious Infections

34%

Birth Asphyxia21%

LBW/PMB11%

Birth Injury4%

Others2%

Undetermined3%

ARI10%

Diarrhoea1%ARI+Diarr

1%N. Tetanus

4%

Cong. Abnorm5%

BDHS:2004

Infection: 50%

Asphyxia : 21%

LBW/PT : 11%

MDG 5: Reduce by three-fourthsthe Maternal Mortality Ratio

BANGLADESH Targets

(2005)

3.0

(1990)

13.8%

Interventions to achieve MDG-5

Iron supplements,

Intermittent

Treatment of Malaria

Antiretrovirals for HIV

Active Management of the Third Stage of Labor

Management of postpartum Hemorrhage

Tetanus ToxoidClean deliveryTreatment of postpartum infection

MagnesiumSulfateCalcium supplementation

Family Planning and Postabortion Care

Partogram

Active Management of the Third Stage of LaborManagement of postpartum Hemorrhage

Tetanus ToxoidClean deliveryTreatment of postpartum infection

Partogram

Iron supplements,Intermittent Treatment of Malaria

Most life-saving interventions require considerable skill

MagnesiumSulfateCalcium supplementation

Family Planning Postabortion Care

• Maternal Health Strategy (2001)Maternal Health Strategy (2001)

• Comprehensive and emergency obstetrics services Comprehensive and emergency obstetrics services

• Community-based Skilled Birth Attendant (C-SBA) Program

• Demand Side Financing: Maternal Health Voucher Scheme (MHVS)Demand Side Financing: Maternal Health Voucher Scheme (MHVS)

• Improved maternal nutrition in pregnancy and postpartum

• Birth preparedness and complication readiness

• Scaling up evidence-based practices for FP and maternal health

Maternal Health and FP Programmes (existing)

Challenges of meeting MDG4

and MDG5 in Bangladesh

Existing neonatal and child health programmes

• Essential newborn care• Special care for LBW babies• Exclusive and breastfeeding• Management of birth asphyxia and neonatal sepsis in the facility

and community• Immunization• IMNCI/Community-IMNCI • Routine Vitamin-A supplementation • Infant and young child feeding (National Nutrition Programme)• National Neonatal Health Strategy (under development)

Opportunities to overcome challenges-1• STRENGTHEN and EXPAND EXISTING PROGRAMMES

• Political commitment is critical - Strong government commitment present

– Governments, donors, partners, professionals and civil society need to work in concert

• Strategic focus for mother and child– Care during delivery is the priority – All women should ideally be able to deliver in health centres, with skilled

birth attendants/midwives working in teams– Target the women in greatest need: e.g., poor rural women– Breastfeeding, EPI, NNP, IMNCI at facility and community

• Greater financial resources– Protect poorest from catastrophic payments, ensure equitable coverage by demand side financing eg voucher scheme– More investment

• Continued– Investment in family planning and safe menstrual regulation – Strengthening of emergency obstetric care in hospitals

• Additional policies, such as those that bring about expansion of female education, reduction of maternal malnutrition, better financial access for the poor, and poverty reduction, are essential

Opportunities to overcome challenges- 2