Civil Society Participation in Health Sector Reforms in Bangladesh

Teachers in training at a BRAC site in Bogra, Bangladesh

Following the Cairo conference, which changed population policy and where the Bangladesh government played a significant role, IWHC worked on behalf of the Swedish government in a tripartite effort to redesign Bangladesh's population policy from a conventionally narrow emphasis on family planning services alone to inclusion of essential obstetric care, improved antenatal services, attention to adolescents and young married couples, and initiation of an HIV/AIDS program along with other STD services.

From 1996 to 1998, a Health and Population Sector Strategy was formulated by the Bangladesh government, major donors, and a broad range of civil society organizations.  The resulting Health, Nutrition, and Population Sector Program focused on improving the health of women, children, and the poor; recognized social and gender equity as central concerns; and took steps to develop a strong base of community support.

Thanks to this coordinated government and civil society initiative, the percentage of women receiving antenatal care rose from 26 percent to 56 percent, female life expectancy increased from 58 to 60 years, and the maternal mortality ratio fell from 440 maternal deaths per 100,000 live births to 322, between 1998 and 2003. The use of emergency obstetric care rose from 5% to 27%, and the mortality rate for children under five in Bangladesh also dropped significantly.

Despite their involvement in designing the reforms, however, women's and other civil society groups were excluded from the implementation phase. An IWHC-supported research project has focused attention on the importance of involving civil society throughout the reform process—design, implementation, and evaluation. Through documentation, public advocacy, and a series of workshops and dialogues on reproductive health with civil society, village health watch committee members, government officials, researchers, service providers, and the press, the project sought to build local advocacy capacity to hold government accountable.

More recently, researchers affiliated with IWHC's work in Bangladesh established a National Health Watch which is housed in the Bangladesh Rural Advancement Committee (BRAC) School of Public Health, to ensure implementation of the national health agenda. In 2006, Health Watch experts drafted the country's first annual State of Health report.

For more information, please email us at asia@iwhc.org.

Page last updated 10/4/07.