Photo: STAR

That health care delivery in Bangladesh is in need of a major overhaul. The poor continue to die of preventable diseases, and infant and maternal mortality rates in Bangladesh are very high. A recent study by the donor agencies once again emphasises the fact that the funds and schemes meant for the poor in Bangladesh do not always reach them. Evidence shows that health services are primarily accessed by the better off people rather than the poor.
The study which looked at eleven programmes worldwide, discovered initiatives that have ensured that 30 to 40 per cent of benefits reached the population's poorest 20 per cent as opposed to the typical 10 to 20 per cent. For instance, three projects run by the NGOs in Bangladesh, especially in remote rural areas, demonstrated greater success in reaching the poorest in the community. Some of the reasons for this were that the services were generally free or low cost, the timings were convenient for the poorest preoccupied with their own livelihood concerns, mobile vans delivered health care at the doorsteps, and the delivery was done through women.
The study also found that specific programmes in countries as diverse as Argentina, Cambodia, Ghana, Zambia, and Nepal were more effective in their reach because of innovative approaches in delivery. For example, some strategies that effectively reduced inequalities in health services delivery in these countries envisaged contracting with NGOs to provide primary care and using immunisation programmes to distribute insecticide-treated bed nets.
None of the government's well-intentioned plans will be effective unless budgetary allocations to the health sector are increased, and more importantly, mechanisms of monitoring and accountability are firmly put in place. Real change can only occur when there is strong political will and recognition, particularly among health policy makers, that current health interventions are not effectively addressing the needs of the most disadvantaged.