Policy and Strategy of Maternal Health Programs
Achieving Millennium Development Goal 5 in Bangladesh calls for an appreciation of the evolution of maternal healthcare within the national health system to date plus a projection of future needs. This paper assesses the development of maternal health services and policies by reviewing policy and strategy documents since the independence in 1971, with primary focus on rural areas where three-fourths of the total population of Bangladesh reside. Projections of need for facilities and human resources are based on the recommended standards of the World Health Organization (WHO) in 1996 and 2005. Although maternal healthcare services are delivered from for-profit and not-for-profit (NGO) sub-sectors, this paper is focused on maternal healthcare delivery by public sub-sector. Maternal healthcare services in the public sector of Bangladesh have been guided by global policies (e.g. Health for All by the Year 2000), national policies (e.g. population and health policy), and plans (e.g. five- or three-yearly). Under the Family Planning wing of the MoHFW, the number of Maternal and Child Welfare Centers has not increased but new services, such as cesarean-section surgery, have been integrated. The Health Services wing of the MoHFW has ensured that all district-level public-health facilities. However, these plans have been too meager, and their implementation is too weak to fulfill expectations in terms of the MDG 5 indicator—increased use of skilled birth attendants, especially for poor rural women. The use of skilled birth attendants, institutional deliveries, and use of cesarean section remain low and are increasing only slowly. All these indicators are substantially lower for those in the lower three socioeconomic quintiles. The Government of Bangladesh needs to functionally integrate the Health Services and Family Planning wings, move towards a facility-based approach to delivery, ensure access to key maternal health services for women in the lower socioeconomic quintiles, consider infrastructure development based on the estimation of facilities using the WHO 1996 recommendation, and undertake a human resource-development plan based on the WHO 2005 recommendation.
Mridha, M. K., Anwar, I., & Koblinsky, M. (2009). Public-sector maternal health programmes and services for rural Bangladesh. Journal of Health, Population and Nutrition, 124-138.
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