Under-five mortality reduction in Bangladesh
From 2000 to 2015, Bangladesh's under-five mortality rate decreased by 56 percent.
Through a combination of evidence-based interventions and effective implementation strategies, Bangladesh has achieved significant reduction in under-five mortality, providing helpful lessons for other countries looking to replicate their success.
A key underpinning of Bangladesh’s success is the effective collaboration between the national government and local and international non-governmental organizations (NGOs). In addition, Bangladesh knew the importance of using data and research, community-level interventions, and a focus on equity to improve access for all populations. Finally, a strong commitment to women’s empowerment initiatives enabled greater impact of interventions and drove further improvements in women’s and children’s health.
High levels of collaboration between the national government and non-governmental organizations (NGOs)
Bangladesh’s campaigns against U5M were aided by a well-developed national NGO sector, which played a critical role in research and implementation
For example, the government partnered with NGOs in implementing the Bangladesh Integrated Nutrition Program and the National Nutrition Program, and NGOs played a vital role in the distribution of bednets to prevent malaria.
Emphasis on community-level interventions
A large, diverse, and highly empowered cadre of community health workers (CHWs) helped carry out these interventions
Consistent usage of data, research, and testing
These helped with the development of evidence-based interventions (EBIs), and provided a basis for adapting those interventions in response to new findings.
An emphasis on the collection and usage of empirical evidence was a consistent feature of Bangladesh’s U5M efforts. In addition to using data to monitor and evaluate interventions, the government and its NGO partners employed data for decision-making at several junctures. Data on disease burden and coverage gaps played a significant role in Bangladesh’s vaccine-introduction policies. For example, the country’s decision to set the upper age limit for measles vaccination at ten years was based on data showing that 89 percent of all serologically confirmed cases of measles were among children younger than ten.
Bangladesh benefited from strong local research institutions such as the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), whose demographic surveillance sites produced such data. Bangladesh was successful in leveraging local research institutions to heavily inform and influence government and NGO policies and programs.
Focus on equity in the implementation of U5M interventions
This was seen in the provision of low-cost treatments, as well as in the decision to begin phased rollouts of certain major programs in the highest-need areas of the country.
While Bangladesh remains a nation beset by some profound imbalances in health-care services and outcomes, it nonetheless demonstrated a notable commitment to greater equity in U5M interventions at several points during the study period. One major example was in the phased rollout of the Integrated Management of Childhood Illness (IMCI) program, in which Bangladesh achieved greater impacts by targeting areas where the need was most acute.
A national steering committee developed a plan for a phased national scale-up of the program, beginning in districts with the highest U5M rates followed by those with lower rates.
Where possible, the government sought to offer free or low-cost distribution of treatments to ensure access across income levels. This could be seen in the free distribution of ORS packets as part of the National Oral Rehydration Project, the free distribution of insecticide-treated nets, free test-to-treat malaria programs, and the subsidization of zinc supplements.
Strong commitment to women’s empowerment initiatives
These helped generate meaningful advances in women’s and children’s health across a society where females still face significant limitations and disadvantages.
According to interviewees – and international studies such as Success Factors for Women's and Children's Health – women’s empowerment was a crucial facilitator of U5M reduction in Bangladesh. Efforts that contributed to gender-equity improvements and are especially relevant to child health included interventions in family planning, education, and microcredit finance.
The rise in access to family planning and decline in fertility rates were important elements of a broader theme in Bangladesh’s efforts to reduce U5M – a greater empowerment of women in a traditionally conservative society. This theme of empowerment manifested itself across several areas, including increased availability of microcredit financing and heightened school enrollment levels.
Under-five mortality reduction in Bangladesh
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Countdown to 2015 tracks coverage levels for health interventions proven to reduce maternal, newborn and child mortality, together with data on equity of coverage, health financing, policy and health systems, and other determinants of coverage. It calls on governments and development partners to be accountable, identifies knowledge gaps, and proposes new actions to improve health and reduce mortality. Countdown’s data and analysis cover 75 countries that account for over 95% of all maternal and child deaths. The annual Countdown to 2015 country profile enables countries to track their progress and identify key areas where more progress is needed.
A team of researchers in Bangladesh, led by the International Centre for Diarrhoeal Disease Research in Dhaka, conducted an in-depth Countdown Country Case Study to explain Bangladesh’s success in reducing maternal mortality. Bangladesh, though it is one of the world’s poorest countries and has had relatively low national health spending, was at the time of the study one of only 9 Countdown countries on track to achieve the MDG 5 target of reducing its maternal mortality ratio by ¾ between 1990 and 2015. The study’s findings, published in The Lancet in June 2014, are summarised in this brief.