Challenges of meeting MDG4 and MDG 5 in Bangladesh

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Challenges of meeting MDG4 and MDG 5 in Bangladesh

• Prof. Kishwar Azad
• Project Director
• DAB-Perinatal Care Project

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• Area ? 147,570 km
• Population ? 142 million TFR 3
• Per capita GDP ? 456
• Life Expectancy (2004) ? 65.1 years
• Overall Literacy Rate (2004) ? 50.0

BDHS 2007, BBS 2006
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MDG 4 Reduce U5MR by two thirds BANGLADESH
Target
(1990)
50
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78 (2006)
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Trends in Newborn Infant and Under-5 Mortality
Rates by Year, Bangladesh 1993 - 2007
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Causes of Under-5 mortality
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Interventions to achieve MDG-4
Syphilis Control Folate Supplementation
Birth spacing Maternal Nutrition Malaria
Control Kangaroo Care
Warming Resuscitation
Tetanus Toxoid Safe and Clean Delivery Prophylacti
c Eye Care Early and Exclusive Breastfeeding Manag
ement of infections Immunization
Case management in community and facility
(IMCI/Community IMCI) ORS Zinc
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Causes of Neonatal Deaths
Infection 50 Asphyxia 21 LBW/PT 11
BDHS2004
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MDG 5 Reduce by three-fourths the Maternal
Mortality Ratio BANGLADESH Targets
(2005)
(1990)
13.8
3.0
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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 Toxoid Clean delivery Treatment of
postpartum infection
Family Planning and Postabortion Care
Magnesium Sulfate Calcium supplementation
Partogram
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Active Management of the Third Stage of
Labor Management of postpartum Hemorrhage
Most life-saving interventions require
considerable skill
Iron supplements, Intermittent Treatment of
Malaria
Tetanus Toxoid Clean delivery Treatment of
postpartum infection
Family Planning Postabortion Care
Magnesium Sulfate Calcium supplementation
Partogram
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Maternal Health and FP Programmes (existing)

• Maternal Health Strategy (2001)
• Comprehensive and emergency obstetrics services
• Community-based Skilled Birth Attendant (C-SBA)
  Program
• 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

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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)

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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

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Opportunities to overcome challenges- 2

• 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

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