| First:
To make necessary basic medical utilities reach people of
all upazilla as per Section 15 (A) of the Bangladesh constitution and
develop the health and nutrition status of the peoples as per Section 18
(1) of the Bangladesh Constitution
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Second:
To develop system to ensure easy and sustained
availability of health services for the people, especially the poor
communities in both rural and urban areas
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Third:
To ensure optimum quality, acceptance and availability of
primary health care and governmental medial services at the upazilla
and union levels
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Fourth:
To reduce the intensity of malnutrition among people,
especially children and mothers; and implement effective and integrated
programs for improving nutrition status of all segments of the
population
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Fifth:
To undertake programs for reducing the rates of child
and maternal mortality within the next 5 years and reduce these rates to
an acceptable level
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Sixth:
To adopt satisfactory measures for ensuring improved
maternal and child health at the union level, and install facilities for
safe and hygienic child delivery in each village
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Seventh:
To improve overall reproductive health resources and services
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Eighth:
To ensure the presence of full-time doctors, nurses and
other officers/staff, provide and maintain necessary equipment and
supplies at each of the upazilla health complexes and Union Health and
Family Welfare Centers (UHFWCs)
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Ninth:
To devise necessary ways and means for the people to make
optimum usage of available opportunities in government hospitals and the
health service system, and ensure satisfactory quality management,
cleanliness of service delivery at the hospitals
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Tenth:
To formulate specific policies for medical colleges and
private clinics, and to introduce laws and regulation for the control
and management of such institutions including maintenance of service
quality
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Eleventh:
To strengthen and expedite the family planning program
with the objective of attaining the target of Replacement Level of
Fertility
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Twelfth:
To explore ways to make the family planning program more
acceptable, easily available and effective among the extremely poor and
low-income communities
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Thirteenth:
To arrange special health services for the mentally retarded, the physically disabled and elderly populations
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Fourteenth:
To determine ways to make family planning and health
management more accountable and cost-effective by equipping it with more
skilled manpower
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Fifteenth:
To introduce systems for treatment of all types of
complicated diseases in the country, and minimize the need for foreign
travel for medical treatment ab Road.
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| The Ministry of Health and Family
Welfare (MOHFW) constituted a National Health Policy Formulation
Committee on 28-08-1403 BS/December 12, 1996 AD. Later on, following a
decision of this committee, five separate sub-committees operated for
more than one year and then submitted their respective recommendations
in the form of five different reports. A Working Group was then formed
and entrusted with responsibility of compiling the recommendations made
in those five reports, arranging workshops in each of the six
administrative divisions to collect opinions of people from
cross-sections of the society on these reports. As per prior decision,
the Working Group compiled the five sub-committee reports, collected
opinions of people from various social strata on these reports in six
workshops held in six divisions for this purpose, and, finally,
presented the proposals and recommendations of the people regarding the
health policy obtained in the workshops to the National Health Policy
Formulation Committee. A report on the health policy was thus formulated
on the basis of a consensus.
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| Policy principles |
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The following policy principles have been adopted in order to attain the foregoing goals and objectives:
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i. To create awareness among the enable
every citizen of Bangladesh irrespective of caste, creed, religion,
income and gender, and especially children and women, in any
geographical region of the country, through media publicity, to obtain
health, nutrition and reproductive health services on the basis of
social justice and equality through ensuring everyone’s constitutional
rights;
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ii. To make the essential primary health care services reach every citizen in all geographical regions within Bangladesh;
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iii.To ensure equal distribution and optimum
usage of the available resources to solve urgent health-related
problems with focus on the disadvantaged, poor and unemployed persons.
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iv.To involve the people in various
processes like planning, management, local fund raising, spending,
monitoring and review of the procedure of health service delivery etc.
with the aim of decentralizing the health management system and
establishing people’s right and responsibilities in this system
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v.To tacilitate and assist in the
collaborative efforts between the government and the non-government
agencies to ensure effective provision of health services to all
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vi.To ensure availability of birth control
supplies through integration, expansion and strengthening of the family
planning activities
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vii.To carry out appropriate administrative
restructuring, decentralization of the service delivery procedure and
the supply system, and to adopt strategies for priority-based human
resource development aimed at overall improvement and
quality-enhancement of health service, and to create access of all
citizens to such services
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viii.To encourage adoption and application
of effective and efficient technology, operational development and
research activities in order to ensure further strengthening and usage
of health, nutrition and reproductive health services
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ix.To provide legal support with regard to
the rights, opportunities, responsibilities, obligations and
restrictions of the service providers, service receivers and other
citizens, in connection with matters related to health service; and
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x.To establish self-reliance and
self-sufficiency in the health sector by implementing the primary health
care and essential services programs, in order to fulfill the
aspirations of the people for their overall sound health and access to
reproductive health care.
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Policy strategies: |
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In keeping with the purported goals, objectives and principles, the following policy strategies will be adopted
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i.An appropriate implementation of the
Health Policy needs mass-scale consensus and commitment that will
facilitate socio-economic, social and
political development
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ii.Prevention of disease and health
promotion will be emphasized to achieve the basic objective of Health
for All”. The Health Policy focuses on provision of the best possible
health facilities to as many people as possible using cost-effective
methods, and will thus ensure effective application of the available
curative and rehabilitative services.
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iii.A primary health care is the universally
recognized methodology to provide health services; this will be adopted
as the major component of the National Health Policy in order to ensure
delivery of cost-effective health services
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iv. The Drug Policy will be liberalized and
improved in keeping with the Health Policy to fulfill the overall needs
for health services. There is need to ensure smooth availability of
essential medicines focusing on the current needs for such medicines and
their efficacy, including their affordability by all people. Necessary
steps will be taken to maintain quality standards of the marketed
medicines and raw materials used therein, and to rationalize the usage
of medicines. In this line, the required number of skilled manpower will
be acquired in the drug administration of the country.
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| The health policy will ensure
distribution of birth control supplies and make improvements in the
management of the domestic sources of the same, including encouragement
of the domestic sources of the same, including encouragement of the
domestic entrepreneurs for production of such commodities. |
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v.Epidemiological surveillance method will
be integrated with the disease control programs. A specific institution
will be entrusted with the responsibility of such surveillance.
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vi.The basic principles for ensuring quality
standards in health care at various health centers will be adhered to.
Standard quality assurance guideline including monitoring and evaluation
will be provided to every health center
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vii.A Health Services Reforms Body will be formed based on the Health and
Population Sector Strategy aiming at meeting the current demand. The role
of the Health Services Reforms Body will be the render the following
services
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Infrastructure reforms
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Acquisition of human resources,
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Planning and implementation of programs for development of
human resources related to the health sector,
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Career planning of the staff,
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Inspection of supplies and logistics,
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Consultations on how to effect overall
development of health services including its management styles etc
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Recommendations will be implemented in phases based on the
availability of necessary resources
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viii.An appropriate and need-based approach
to develop human resources will be designed in order to maximize the
utilization of the knowledge and skills of health-related personnel. A
number of posts will be created with a view to promoting the eligible
staff at the grassroots level on the basis of their seniority and skills
acquired. Special care will be taken to ensure that no staffs promotion
is held up.
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While a staff is sent for training outside his/her
own organization, necessary replacement will be put in place for the
term of the training, that is, no training leave may be allowed without
replacement
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ix.The people and the local government will be integrated with the health service system at all levels
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x.An Integrated Management Information
System (IMIS) and a computerized communication system will be installed
countrywide, to
facilitate implementation, action planning and monitoring.
The existing information system will be further strengthened by
recruiting more efficient and eligible incumbents. To this purpose,
extensive and appropriate training will be arranged, and the available
manpower will be expanded and their skills enhanced.
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xi.The Bangladesh Medical and Dental Council
(BMDC) and the Bangladesh Nursing Council (BNC) will be restructured
and strengthened in order to ensure strict supervision of medical
practitioners registration, their quality of skills, and related ethical
issues.
With a view to maintaining the required quality standards of the
performance, education and training of the pharmacists, medical
technologists and other paramedics, the Pharmacy Council and the State
Medical Faculty will be restructured and organized.
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xii.Various professional organizations, such
as, Bangladesh Medical Association (BMA), Bangladesh Private Medical
Practitioners Association (BPMPA), and the unani, ayurvedic and
homeopathic societies etc. will be integrated with the country’s health
service system.
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xiii.Need-based medical education and training will be made more people- oriented and updated.
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xiv.Arrangements will be mode for
institutional training, on such issues as management and administration,
for improving the doctors’ management
capabilities.
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xv.Regular training will be provided to the medical practitioners, teachers,
nurses, paramedics and other staff at all levels in both public and private
sectors through a specific institution. The following types of courses will be
offered from here:
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Reoriented Course,
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Continuing Medical Education Program,
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Administrative and Management Courses etc.
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In order to create the required facilities for offering such
training, a National Training Institute will be established.
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xvi.To ensure efficient health services, the
management of the medical colleges/institutions and related hospitals
will be improved, and higher levels of financial and administrative
power will be delegated to them.
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xvii.Nutrition and health education will be
emphasized, as these are the major driving forces of health and family
planning activities. There will be one nutrition education unit and one
health education unit in each upazilla, so that they can reach every
village of Bangladesh.
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Information on health education will be disseminated the
people through incorporating the community leaders and other
departments or organizations of the government in the health service
system. One of the goals of the health service system will be to improve
the nutrition status of the people.
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xviii. The government hospitals and clinics
will charge a minimum fee from the patients, but there will also be
provision for cost-free medical treatment to the poor and the disabled.
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xix.NGOs and other private organizations
will be encouraged to perform a role complementary to those of the
government in the light of the governmental rules and policy.
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xx.Infrastructure and transportation will be
developed to minimize the disparity in access to health services
between rural and urban populations. In order to ensure presence of
every officer and staff of the health service system at their respective
workplaces and their efficient services, development of education
facilities and improvement of the social environment in those
neighborhoods will be made.
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xxi.Arrangements will be made to pay
non-practicing allowances to the government doctors/trainee doctors who
act as full-time and resident doctor thus making them refrain from
private medical practice.
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Doctors working at a government medical college,
hospital or health center opting for private medical practice using the
facilities at the medical college, hospital or health center, will be
allowed to do so only under a clear policy.
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xxii.Accountability of all concerned in the
health service system will be ensured. An adequate procedure will soon
be designed to strengthen accountability and ensure quick and strict
legal disposal of cases relating to negligence of duties.
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xxiii.A national level health-and-population
council will be formed under the leadership of the Head of the
Government. This council will provide support and advice on the
implementation of the National Health Policy and will ensure
effectiveness and accountability of the health service system. The local
and regional councils will monitor the health-related activities in
their respective areas, including review of composition, application and
supervision of the primary health care provided to the people
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xxiv. Inter-sectoral coordination and
linkages will be strengthened way of utilizing the resources at the
disposal of concerned sectors for quick solution of the health-related
problems.
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xxv.Research on various management styles
and their effectiveness, clinical services, approach to diagnoses,
social and behavioral aspects of human beings, epidemics etc. will be
encouraged by the government.
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Information dissemination system will be strengthened,
especially by involving the private organizations, in order to make IEC
(information, education and communication) reach the grassroots level.
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A sound referral system will be designed and installed,
and its usage will be strictly supervised, so that a linkage can be
established among primary health care activities at various tiers
ultimately increasing the efficacy of this system.
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xxv1.Duplication of activities from
different projects, programs and activities will be avoided. In this
connection, a policy-planning cell will be established in the Ministry
of Health and Family Welfare, through which effective and sustainable
coordination may be ensured.
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xxvii.To goal of the Health Policy will be
to provide personal or client-centered health and reproductive health
service, so that an individual can have the opportunity to select
services according to his/her personal needs. This pattern of
services-delivery will be considered an important approach of the
National Health Policy and will contribute to a reduction in the rate of
unwanted pregnancies.
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xxviii..Governmental allocation of
expenditure budget for health centers from the districts to the
community level may be redistributed within reasonable flexibility. This
redistribution of expenditure budget will provide increased benefits to
the poor and destitute communities. As a result, expenses will be
optimized and health service will be easily available.
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xxix.Alternative health service systems,
such as ayurvedic, unani and homeopathic practices will be incorporated
into the National Policy. Encouragement will be given to the principle
of making these three
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disciplines of medical science more scientific and
time-worthy towards enabling the practitioners in these disciplines to
contribute to the country’s health service. Government will provide
appropriate support to these systems through enhancing grants and
arranging proper training in these areas, and ensure monitoring of the
quality of services rendered through these systems.
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xxx.The arrangement for delivery of
Essential Services Package (ESP) among the people from a single one-stop
health service center will be considered the appropriate strategy for
provision of primary health care. This will be introduced throughout the
country. For this purpose, well-planned and useful training will also
be arranged at the upazilla health complexes.
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xxxi. All development activities in the health sector will be conducted through a sector-wide management system.
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xxxii.. In order to bring every citizen of
the country under coverage of his health service system, one community
clinic will be established to serve every 6,000 persons. An MBBS-doctor
will be deployed in each Union Health and Family Welfare Center, and
each of these centers will also equip with residence facilities for the
doctor.
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Multi-dimensional problems at various tiers of the
physical and technical infrastructures of the health service system and
among the manpower employed have been creating bottlenecks towards
effective provision of health services. These colossal problems
accumulated over a long period of time and cannot be solved in a day.
Therefore, a comprehensive plan for efficient solution of the existing
problems must be formulated urgently after elaborate consideration of
the issues involved. Only way to an effective health service system lies
in timely modification, reform and correction of the country’s
traditional health service through adoption and implementation of a
transparent health policy.
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