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The Meaning of Health Security for Disaster Resilience in Bangaldesh

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The Meaning of Health Security for Disaster Resilience in Bangaldesh Powered By Docstoc
					1
Versions of Security
 State based notions of security
 vs.
 Human security approach
  Food security
  Livelihood security
  Localised environmental security
  Social security
  Health security



                                      2
What is Health Security?
 Health Security is a state of preparedness that ensures the public is
 prepared for, protected from, and resilient in the face of health
 threats having potential economic or homeland security implications.

 Health security is achieved when health threats are identified; risks
 and consequences to human, animal, agriculture, food, water, and
 environmental health are minimized; and response and recovery
 actions are robust and effective.

 “It also means creating systems that give people building blocks of
 survival, dignity and livelihood. Human security connects different
 types of freedom, freedom from want, freedom from fear and
 freedom to take actions on one’s own behalf.” (Commission on
 Human Security, 2003)


                                                                         3
Sustainable Development

 Sustainable development refers to the
 development that meets the needs of the present
 without compromising the ability of future
 generations to meet their own needs.




                                                   4
Drivers of Health insecurity
  Marginalization
  Resource competition
  Population and migration issues
  International health architecture
  Threats to the food supply from a variety of sources (including
  crop failure, over fishing, trade issues, armed conflict, man
  made disasters)
  Environmental degradation and pollutants
  Globalization
  Urbanisation/industrialisation
....many of the drivers of health insecurity are closely linked.

                                                                    5
Why Health Security is important?
  Health security reduces vulnerability impact
  Health security indicators facilitate preparedness for
  changing risk thresholds
  Health security enables people to be resilient to
  vulnerability
  Health security contributes toward sustainable
  development impacts




                                                           6
  Bangladesh Fact Sheet
Area                       147,570 sq km
Population                 160 million
Urban population            45 million
Annual births               3.4 million
Life expectancy at birth    66 yrs
GNI Per Capita              US$ 750
GDP growth rate             6.1%
Adult literacy rate         54%
Primary school enrolment 81%
Population in poverty       32%
         Source. WB, UNICEF, BMMS, BDHS

                                           7
Statistics of some key Indicators in Bangladesh
                                                         1990           2011
Infant Mortality Rate (IMR)                               94             43
Maternal Mortality Ratio                                  574            194
(MMR)                                                                  (2010*)
Child Mortality                                            50            11
                                                    (BDHS 1993-1994)
Contraceptive Prevalence                                  39.9          61.2
Rate (CPR)                                               (1991)        (2011)
Water Use % using                                         78%           80%
improved drinking water                                                (2008)
sources
Life Expectancy                                           59.5         68.9 **
 * Maternal Mortality and Health Care Survey 2010
** UNDP Human Development Report 2011




                                                                                 8
9
              TFR continues to decline – 68% of population
                is at replacement fertility (Trends in Total
                        Fertility Rates, 1975 – 2011)
6.0

        5.1
5.0
                  4.3

4.0
                          3.4       3.3      3.3
                                                      3.0
3.0                                                          2.7
                                                                    2.3
                                                                            2.0
2.0


1.0


0.0
      1989 BSF 1991 CPS 1993-94   1996-97 1999-2000   2004   2007   2011   MDG
                         BDHS      BDHS     BDHS      BDHS   BDHS   BDHS   target
                                                                            2015
                                                                                    10
         CPR continues to increase - Trends in FP methods use
70       among currently married women age 10-49, 1975-2011
                                                             61
60                                                 58
                                                        56
                                              54
     Modern Method                       49
50
     Any method                     45
                               40
40

                          31
30
                     25

           19
20


10   8


-




                                                                  11
      Maternal mortality declines by 40% between
700                 2001 and 2010
600
         574

500

400

                             322
300
                                                                  MDG 5
                            BMMS
200                          2001                      194        Target

                                                                       143
100                                                  BMMS
                                                      2010

 0
  1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015




                                                                           12
                      Utilization of Maternal Health Services
                               Increased, 2004 – 2011
             35
                                                                 32

             30
                                                                                              27
                                  26
             25
                           22
                                                          21
Percentage




                                                                                       20
             20
                   17
                                                   16                           16
             15

             10

             5

             0
                  ANC at least 4 visits         Delivery attended by a      PNC for mothers within 2
                                               medically trained provider    days of delivery from a
                                                                            medically trained provider
                                   2004 BDHS       2007 BDHS       2011 BDHS
                                                                                                         13
       Poor-Rich inequity gap narrowed in Use of Health
                    Facilities for Delivery
  60
                                                              52.8
  50
                                                    7X
  40      12.2 X                                    higher
          higher
                           30.4
% 30


  20


  10                                                  7.5
                   2.5
   0
                    BMMS 2001                          BMMS 2010
                                Poorest   Richest
                                                                     14
                                 Decline in Trends of Newborn, Infant and
                                   Under-5 Mortality Rates, 1993 - 2011
                           150
                                   133

                                            116
                           120
Deaths/1,000 live births




                                                           94
                                                                         88
                            90
                                   87
                                             82                                      65
                            60                             66                                    53
                                                                         65
                                   52                                                52
                                             48
                                                           42            41                       43
                            30                                                       37
                                                                                                 31


                            0
                                 1993-94   1996-97     1999-2000      2004 BDHS   2007 BDHS   2011 BDHS
                                  BDHS      BDHS         BDHS
                                                     NMR        IMR    U-5 MR


                                                                                                          15
              Significantly increased in immunization coverage:
           Percentage of children receiving EPI vaccine, 1993 – 2011


                                                                                82.5
                                                                   76
                                                     68.4
                                                                                 84
                                   52.8                           77.2
                   46.9                              70.3
    46.2                           62.1
                                                                  89.7          93.2
                   61.2
     55                                              81.6
                                   69.1
                   60.1
    59.7                                                                        93.2
                                                                   90
                                                     80.3
                   66.5            70.2
     59

                                   90                93.3         96.8          97.8
    79.4           84.2



1993-94 BDHS 1996-97 BDHS    1999-2000             2004 BDHS    2007 BDHS     2011 BDHS
                               BDHS
                   BCG      DPT3          Polio3      Measles   All vaccine

                                                                                       16
                   Percentage of children under 6 month exclusively
                         breastfed (based on 24 hours recall)
             70
                                                                      63.5
             60

             50    45.9      45.1       46.1
                                                  42.2     42.9
Percentage




             40

             30

             20

             10

              0
                  1993-94   1996-97   1999-2000   2004    2007        2011
                   BDHS      BDHS       BDHS      BDHS    BDHS        BDHS

                                                                             17
             Tuberculosis case detection and treatment success rate,
                                  2000 – 2011

100
                                                     92      92     92       92      91    92
                                               89
90                           84      85
      80      80    81
80                                                                  73       74
                                                     71      72                      70
70                                                                                         65
                                               61
60

50                                   46
                             41
40                  34
      28      29
30

20

10

 0
      2000   2001   2002    2003    2004   2005     2006    2007   2008      2009   2010   2011

                         Case detection rate        Treatment success rate

                                                                                                18
                         Progress in Malaria Control in Bangladesh
                90,000                                                                    600
                                                         84,690
                80,000    501
                                                                                          500
                70,000
                                                                   63,873
                60,000                       59,857                                       400

                         48,121    307                                 55,873
Malaria Cases




                                                                                                Deaths
                50,000
                                                                                 51,795   300
                40,000
                                           228
                                     32,857
                30,000                                                                    200
                                                  154
                20,000
                                                                                          100
                10,000                                        47            37    36

                    -                                                                     -
                         2005     2006   2007    2008       2009   2010          2011
                                         Malaria cases      Deaths
                                                                                                         19
                          Key Achievements

   TFR continues to decline – 68% of population is at
replacement fertility
  Over last 35 years the decline in fertility
has averted:
 30 million population
 10.5 million births and
 30,000 maternal deaths
  CPR continues to increase
  A very high proportion of couples with 2 children do not
want more children
  Life expectancy has increased

                                                             20
                       Key Achievements

    Overall care seeking during pregnancy is on the
rise
   Institutional delivery has increased by almost 50%
in the last four years
   High treatment success rate for open pulmonary
tuberculosis cases
   Significant decline in deaths from malaria
   Equity gap in terms of care seeking and service
utilization is narrowing


                                                        21
                                     Success Factors
Political commitment for primary health care since independence
Good public health infrastructure
Availability of qualified health professional
Public-private partnership
ESP service delivery available at door steps – recently included
community clinic
Essential drug supply at grassroots level
Targeted approach in selecting public health priorities
Continued donor support, especially infectious diseases & FP
Introduction of appropriate technology
Remarkable progress in associate sectors; e.g., agriculture,
communication

                                                                   22
23
                 Prominent Gaps
  Addressing non-communicable disease
(NCD) remains a key public health concern

  Maternal and child malnutrition is a crucial
problem in Bangladesh

   No significant improvement was observed
in under 5 children nutrition status

  Educate & Address Healthcare issues in
Urban areas

                                                 24
                    Nutritional status of under 5 children, 2004 – 2011
             60.0


                     50.6
             50.0

                             43.2                                                42.5
                                       41.3                                             41.0
             40.0
                                                                                               36.4
Percentage




             30.0



             20.0                                          17.4
                                                   14.5             15.6


             10.0



              0.0
                            Stunting                      Wasting                  Underweight
                                       2004 BDHS   2007 BDHS         2011 BDHS
                                                                                                      25
                   Prominent Gaps
  Early marriage vs. teenage pregnancy

   Huge gap in complete MNCH services
utilization exists

  Despite significant achievements in maternal
and newborn care, only a few percentage of
mother and children received all cares



                                                 26
Only 19% of Pregnant Mothers and
   Newborns Receive all Care




   Source: Bangladesh Maternal Mortality Survey, 2010   27
                   Private expenditure on Health by Income Group
                          Private Expenditure on Health by Income Group

                    600                                                   12.0




                                                                                 % of monthly household expenditure
                    500                                                   10.0
                                                  Tk per household
Tk per household




                    400                                                   8.0
                                                  % of expenditure


                    300                                                   6.0



                    200                                                   4.0



                    100                                                   2.0



                      0                                                   -




                                                                                                                      28
                            Challenges
Sustaining the rate of decline of under-5
deaths will be difficult as neonatal deaths
contribute 60% of these deaths - innovative
initiatives needed to address this
Addressing Malnutrition
Targeting adolescent – to reduce early
marriage and teenage pregnancy
Unhygienic environment including poor water
and sanitation facilities
Establishing functional facilities for health
services
                                                29
       Challenges (continued)
   Tuberculosis and malaria control
   Strengthening referral linkage
   Partnership and coordination
   Inequity in accessing health care is likely to
influence health status
  Addressing poverty, education & empowerment
of women




                                                30
               Challenges (continued).
Overall 65% of married women do not want any more
children, but only 8% are using long acting or permanent
methods – scope for future FP program
Health Initiatives should link to wider poverty reduction
concerns
Should consider an integrated approach of implementing
infectious disease risk (e.g. TB, malaria, HIV/AIDS)
reduction agenda
Securing health through provision of insurance




                                                            31
                                   Way Forward
Political commitment to leverage support for addressing
underlying factors of adverse health outcomes
Health interventions should be linked with other domains of
human development – e.g. poverty, education, nutrition and
water, sanitation and hygiene and micro-credit
National long term strategies for specific health care in both
rural and urban areas
Global commitment and actions for allocating resources
and implementing health care




                                                            32
                                     Way Forward
Task-shifting/task sharing including frontline health workers
involvement
Strengthening and expanding public-private partnership
Community mobilization and empowerment
Referral system connecting community and facility
Health financing innovations for addressing equity,
governance and accountability
Common platform for sharing lessons and taking actions




                                                            33
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