Bangladesh Resource Mobilization and Sustainability in the HNP Sector Presented by Dr. Khandakar Mosharraf Hossain Minister for Health and Family Welfare Government of the People's Republic of Bangladesh High Level Forum on Health MDGs in Asia and the Pacific Tokyo, Japan JUNE 21-22, 2005
Presentation contents Commendable progress in HNP Key challenges in the HNP sector Health related MDGs, Bangladesh targets and current status Health related indicators and targets reflected in PRSP HNP Sector Support HNPSP - Sector Wide Program HNPSP Financial Support Share of GOB and DPs in HNPSP Areas of DP support HNPSP Pool Fund Support Internal Resource Mobilization Key innovations for Increasing Effectiveness to Achieve Health MDGs 2
Commendable progress in HNP Life expectancy has continued to improve: from 55 years to 62 years in the last ten years Maternal Mortality rate has declined from nearly 60 per 10,000 live births in the 1990s to between 32 and 40 in 2004. Infant mortality rate (IMR) has declined from 94 per 1000 live births in 1990 to 65 per thousand live births in 2004. Significant drop in Under-5 Mortality: from 144 deaths per 1,000 live births in the early nineties to about 88 per 1,000 live births in 2004 Decline in the level of malnutrition of children under-5 years is promising: a fall of over 35% between the mid eighties and 2004 In 2004, 73 % of Bangladeshi children 12-23 months can be considered to be fully immunized. Since 2001 not a single case of wild polio virus transmission has been confirmed in the country. 3
Commendable progress in HNP (cont.) Case detection rates for tuberculosis is 34 % from 29% in 1993 Total fertility rate has halved: from 6.3 in the early seventies to around only 3.0 in 2004. Recent evidence shows an encouraging fall of TFR below the 'above 3' plateau Contraceptive Prevalence Rate has increased from 44.6 in 1993-94 to 58 percent in 2004. HIV rates have remained below 1% in all groups except in IDUs in central Bangladesh where HIV positive rates reached 1.4% and 1.7% in 2000 and 2001 respectively and increased sharply to 4% in 2002 and 2003/2004. 4
Commendable progress in HNP (cont.) Legislations Promotion of breastfeeding. Safe blood transfusion Tobacco-control law Other achievements Increase of enrollment in primary education Polio eradication attained in the country Hepatitis-B included in EPI Contraceptives usage gradually rising 5
Key challenges in the HNP sector Achievements of MDGs target Mitigate Health inequalities (by income, gender, age, geographical areas, etc.) Emerging health needs (e.g. cardiovascular, diabetes) Improving the quality and scope of HNP services Diversification of HNP service provision-contracting out services to NGOs/private sector Stimulating informed demand for HNP services Improving sector governance & management Mobilizing more resources for HNP services 6
Health Related Millennium Development Goals, Bangladesh Targets and Current Status GOAL 4: REDUCE CHILD MORTALITY GLOBAL TARGETS BANGLADESH TARGETS INDICATORS CURRENT STATUS TARGET 2015 Target 5 Reduce by two thirds, between 1990 and 2015, the under-five mortality rate Reduce under-five mortality rate from 144 deaths per thousand live births in 1990 to 50 by 2015. Under-five mortality rate (deaths per 1000 live births) Infant mortality rate (deaths per 1000 live births) 88 65 50 22 Proportion of 1-year-old children immunized against measles 69% 100% 7
Health Related Millennium Development Goals, Bangladesh Targets and Current Status (Contd.) GOAL 5: IMPROVE MATERNAL HEALTH GLOBAL TARGETS BANGLADESH TARGETS INDICATORS CURRENT STATUS TARGET 2015 Target 6 Reduce by three quarters between 1990 and 2015, the maternal mortality ratio Reduce maternal mortality from 480 deaths per 100,000 live births in 1990 to 120 by 2015 Increase the proportion of births attended by skilled birth personnel to 50% by 2010 Maternal mortality ratio Proportion of births attended by skilled health personnel 320 13.4% 120 50% by 2010 Reduce TFR to 2.2 by 2010 Total Fertility 3.00 2.2 by 2010 Reduce maternal malnutrition to less than 20% by 2015 Proportion of mothers who are malnourished 45% <20% 8
Health Related Millennium Development Goals, Bangladesh Targets and Current Status (Contd.) GOAL 5: IMPROVE MATERNAL HEALTH GLOBAL TARGETS BANGLADESH TARGETS INDICATORS CURRENT STATUS TARGET 2015 Target 6 (Contd.) Increase by two years the median age of girls at first marriage Legally stipulated age at girl s first marriage 18 years 20 years Eliminate violence against women Proportion maternal deaths caused by violence 14% 0% 9
Health Related Millennium Development Goals, Bangladesh Targets and Current Status (Contd.) GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES GLOBAL TARGETS BANGLADESH TARGETS INDICATORS CURRENT STATUS TARGET 2015 Target 7 Have halted by 2015 and begun to reverse the spread of HIV/AIDS Have halted by 2015 and begun to reverse the spread of HIV/AIDS Condom use rate : Needle sharing among IUDs Health facilities with adequate equipment for screening HIV-infected blood 4.2% 25-75% 98 Safe Blood Center has been established 10
Health Related Millennium Development Goals, Bangladesh Targets and Current Status (Contd.) GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES GLOBAL TARGETS BANGLADESH TARGETS INDICATORS CURRENT STATUS TARGET 2015 Target 8 Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases Reduce 50% the incidence of cases and the number of deaths from malaria by 2015 Prevalence of malaria (million cases annually) Death rates associated with malaria 1 1% 0.5 0.05% 11
Health Related Millennium Development Goals, Bangladesh Targets and Current Status (Contd.) GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES GLOBAL TARGETS BANGLADESH TARGETS INDICATORS CURRENT STATUS TARGET 2015 Target 8 (Contd.) Detect 70% and cure 85% of detected cases by 2005 Prevalence of tuberculosis (per 100,000) 221 110 Death rates associated with tuberculosis (annually) 70,000 35,000 Proportion of tuberculosis cases under directly observed treatment short course (DOTS): detected cured 34% 84% 70% by 2005 85% by 2005 12
Health related indicators and targets reflected in PRSP INDICATOR 1990 Benchmark Data Current Status 2004 MDG Target 2015 Population Growth 2.1 1.5 1.3 Prevalence of underweight children (% of children under 5) 65.8 47.5% 32.9 Under-five Mortality Rate (per 1,000 live births) 144 88 50 Infant mortality rate (per 1,000 live births) 94 65 22 Maternal mortality ratio (per 1,000 live births) 4.8 3.2 1.2 Source: UNDP, BDHS 13
HNP SECTOR SUPPORT Ministry of Health & Family Welfare Health, Nutrition & Population Sector Programme (HNPSP) Government of Bangladesh Contribution [$2.365 Billion] Japanese Debt Cancellation ($100m) Ministry of Local Govt., Rural Development & Cooperatives MOF/ERD/MOHF W/MLGRDC POOL FINANCIERS Development Partners [$760.2m] CIDA (Canada) ($12.7m) DfID ($188.7m) EC ($130.1m) IDA ($300 m) Netherlands ($53.1 m) Sida ($74.6 m) UNFPA ($1.0 m) NON-POOL FINANCIERS Development Partners [$260 m] German Government ($15.9m) Japanese Government ($60 m) UNICEF ($48.5m) UNFPA ($35 m) WHO ($46 m) CIDA ($64 m) Sida ($3.8 m) DP [$96.5m] ADB [50 m] DfID [$28.3m] EU [$13.2m] Sida [$5m] Urban Health Project ESD NGO service delivery funded MOLGRD&C USAID [$210m] Rural/urban ESP activity funded through NGOs HNP DEVELOPMENT PARTNER CONSORTIUM: ALL MULTILATERAL AND BILATERAL DP INTRA-COORDINATION Programme Support Office (PSO) located in the Ministry of Health & Family Welfare: Coordination of DP financing contribution 14
HNPSP- Sector Wide Program The World Bank will work in cooperation with other Development Partners (DP) through a Sector Wide Approach (SWAp) to support the GOB's HNPSP, where: The Government will lead the process and DP will provide financial & technical assistance accordingly DP through HNPSP, will support the GOB's social development goals as outlined in the draft Poverty Reduction Strategy Paper (PRSP) and assist in attaining the Millennium Development Goals (MDGs) on HNP Purpose of the project: To increase availability and utilization of user-centered, effective, efficient, equitable, affordable and accessible quality services 15
HNPSP Financial Support Financing sources (2005-2010) Government US$ 2.3 billion IDA credit and grants from co-financiers US$ 760 million for the period 2005-2010 Non-pool financiers and other project aid US$ 580.6 million for the period 2005-2010 Total Development partner contribution to HNPSP is US$ 1.34 billion (approx.) for the period 2005-2010 of which 57.2% through pooled funds 19.6% through non-pooled funds 23.2% through parallel project aid 16
Share of GOB and DPs in HNPSP Government of Bangladesh (GOB): 2.3 billion US$ Development Partners (DPs): 1.34 billion US$ 4 3 1.34 DPs 37% 2 1 2.3 DPs GOB GOB 63% 0 GOB DPs 17
HNPSP Components: Areas of DP Support Component 1: Accelerating achievement of HNP-related MDG and PRSP goals (Essential service delivery, incl. reduction of maternal and childhood mortality and morbidity, control of population growth, and reduction of burden of TB, Malaria and HIV/AIDS) Component 2: Meeting emerging HNP sector challenges (incl. reduction of injuries, improvement of emergency services & disaster mgmt, control of major noncommunicable diseases, urban health services development) Component 3: Advancing HNP sector modernization (greater stewardship role of the Ministry of Health & Family Welfare in the sector, improved financial mgmt, decentralization, demand-side financing initiatives) 18
HNPSP Pool Fund Support Expenditure Category in DCA (2005-2010) Category 1 (25%) PERFORMANCE CATEGORY Performance- Based Financing (A) Performance Criteria (First year of implementation) -Share of total govt. expenditure allocated to MOHFW expenditure (%) Category 2 (15%) B. DIVERSIFICATION OF SERVICE PROVISION -Proportion of total MOHFW expenditure allocated to the 25% poorest districts (%) -Utilization rate of ESD by the two lowest income quintile (%) Category 3, 4 and 5 (60%) C. SUPPORT CATEGORIES (CORE HNP SERVICES IN SIP) Baseline Support (B+C) -Proportion of contracts awarded within initial bid validity period (%) -Proportion of births attended by skilled by skilled personnel (%) -TB case detection rate (%) 19
Internal Resource Mobilization Securing Resources: GOB plans to increase the allocation to HNP by 10% annually from 2005 to 2010. Strengthening MOHFW Management: Increasing capacity of MOHFW to absorb the financial resources Improving Sector Governance: Reducing system losses Public and Private Partnership: Promoting Private investment in areas where Private Sector has comparative advantage in the delivery of health services 20
Key Innovations for Increasing Effectiveness to Achieve Health MDGs Expansion of demand-side financing, including a number of local and community financing schemes. (e.g. implementation of a voucher scheme to enable poor pregnant women to purchase maternal health services ). SWAP governance / GOB ownership: GOB leading the SWAP Program Support Office (PSO) and a HNP Forum to facilitate TA management, GOB-DP policy dialogue and the monitoring of the program respectively 21
Key Innovations for Increasing Effectiveness to Achieve Health MDGs (contd.) Diversification of service provision and stewardship role of MOHFW: Public sector will aim to better utilize national capacity in service provision by setting up the legal and institutional arrangements for greater active involvement of non-public service providers: Management Support Agency (MSA) for diversification of service provision. Performance Monitoring Agency (PMA) for monitoring 22
Thank you 23