Focus areas

Health

Health is a fundamental element of human wellbeing and development. Bangladesh has made tremendous success in the health sector over the last few decades. The country has seen remarkable improvements in several health-related indicators of the Millennium Development Goals (MDGs), including infant, under-five child and maternal mortality rates, vaccination coverage, contraceptive use, skilled birth attendance, malaria prevalence and life expectancy and is working hard to achieve the Sustainable Development Goals (SDGs). Despite these, the health sector is still experiencing some problems such as disease burden, unavailability of health services in hard-to-reach areas and financial constraints.

Noncommunicable diseases (NCDs) are the major cause of morbidity and mortality, accounting for 67% of total deaths in Bangladesh. This means every year more than 0.5 million people die because of NCDs. Of these deaths, cardiovascular diseases contribute the highest (30%), followed by cancers (12%), chronic respiratory diseases (10%) and injuries (7%). NCDs cause a significant number of disabilities as well. Physical inactivity, unhealthy diets, tobacco use, and harmful use of alcohol are the prominent risk factors of NCDs. On the other hand, the country’s 26% deaths are caused by communicable diseases, maternal, perinatal and nutritional conditions.

The health system of Bangladesh is pluralistic, which consists of four key actors: government, private sector, NGOs and international development organizations. Only about 3% of the GDP is spent on healthcare services. The out-of-pocket health expenditure in Bangladesh is 66% of the total health expenditure, which is much higher than the world average 32%. This has made poor households unable to access healthcare services. There is a low access to healthcare services in rural and hard-to-reach areas.

Occupational health

Safe work is one of the fundamental rights of workers. Occupational health and safety is an important component of decent work agenda that mandates everyone at work will be free from all kinds of hazards and risks. As evidenced by studies, manufacturing sector workers are more vulnerable to occupational injuries and diseases. Bangladesh has a large manufacturing sector that contributes about 29% to its GDP. This sector alone employs more 12 million people, which is equivalent to 20% of total employment. However, the country is faced with occupational health and safety hazards in its manufacturing sector. The prevalence, pattern and magnitude of occupational injuries and diseases vary among workers due to the nature of work and hazards they are exposed to at factory level. Common injuries include bruises, lacerations, cuts, abrasions, dislocation, sprain, strain and amputation. Workers who work in ready-made garments, leather, glass and steel factories are more likely to suffer occupational injuries and diseases. According to Bangladesh Occupational Safety, Health and Environment (OSHE) Foundation report 2017, at least 11,767 workers were injured and 12,864 workers were killed in workplace accidents during the last 10 years. Of the dead workers, 1,971 were from the ready-made garments industry. Workplace injuries and deaths bring huge economic costs for victims, their families and the nation. An ILO study shows that work-related accidents and ill-health amount to approximately 4% of the world’s GDP. These injuries and deaths can be avoided if potential hazards at workplace are identified and safety measures are taken in advance. Taking the safety and protection issues of workers into consideration, the Government of Bangladesh adopted National Occupational Health and Safety Policy in 2013. To date, very little action has been taken to enforce such measures to strengthen the occupational safety conditions among manufacturing workers in Bangladesh.

Nutrition

Nutrition is a vital part of health and development. Better nutrition is associated with improved child & maternal health, stronger immune systems, lower risk of non- communicable diseases, productivity and longevity. Malnutrition is still a great problem in Bangladesh though there have been significant economic progress and poverty reduction over the last decades. About 36% of total under-five children are stunted and 14% are wasted and 33% are underweight, which is approximately 5.5 million. 50% of pregnant women and 40% of non-pregnant women suffer from anemia, 57% of non-pregnant women suffer from zinc deficiency, and 22% of non-pregnant women have deficiency in vitamin B 12 . In addition, 31% of ever-married women age 15-19 years are underweight. Undernutrition contributes to an intergenerational cycle of undernutrition and poverty. Obesity is also a growing public health concern in the country. The prevalence of obesity is 3.8% among urban under-five children and 23.8% ever-married women of reproductive age. It leads to development of chronic diseases like diabetes mellitus, high blood pressure, hypertension, heart disease and stroke.

Malnutrition carries a huge economic burden for individuals and the nation. It costs Bangladesh an estimated 2–3% loss of national income due to its long-term impact on productivity. On the other hand, every 1 US dollar spent for programs to reduce stunting generates an economic return of 17.9-18.4 US dollar. Therefore, there is a need of more nutrition focus from the Government and development partners.

Water, Sanitation and Hygiene (WASH)

Water, sanitation and hygiene (WASH) are fundamental to health. Access to WASH includes safe water, adequate sanitation and hygiene education. Poor WASH has become a big public health problem in Bangladesh. Of the country’s 165 million people, 5 million do not have access to safe water. People in urban slums, hilly terrains, river islands and coastal areas have limited access to safe water sources. According to Multiple Indicator Cluster Surveys (MICS) 2013, more than 41% of people drink water from sources with faecal contamination. In recent years, there has been tremendous progress in open defecation and Bangladesh has become a role model for other countries in the South Asia region. Now only 1% of the total population practice open defecation compared to 34% in 1990. But a large number of people (40%) are still out of improved sanitation facilities. However, around 20 million people are currently exposed to arsenic contaminated water across the country. Handwashing is the most effective hygiene practice. Only 30% people wash hands with soap or ash and water after defecating. Improved WASH has a strong positive impact on health, education and development. Children living in an environment with poor WASH facilities are more often attacked with diarrhea and cholera which are the major cause of child mortality. When children become sick, they miss school. Frequent illness leads to undernutrition and undergrowth among children, constraining educational potential and stifling economic development. The Government of Bangladesh has the Sector Development Plan for the Water and Sanitation Sector (2011-25) in order to improve the WASH situation. However, Bangladesh has still a long way to go to meet the Sustainable Development Goal (SDG) of providing universal access to clean water and sustainable sanitation by 2030.

Elderly Population

Ageing is seen as an emerging challenge in Bangladesh as the number of elderly population is increasing rapidly. At present, about 7.5% of the country’s total population (12.5 million) constitutes elderly population aged over 60 years, and this percentage is expected to reach 21.9% by 2050. This means that there will be a senior citizen in every five Bangladeshis. The elderly encounter many problems such as lack of social dignity, economic crisis, housing problem, limited access to healthcare, food insecurity, malnutrition, negligence, loneliness and lack of recreation in their daily lives. At the age of over 60 years, people in Bangladesh become jobless and depend on their children’s income. But many children do not feed their parents at an old age. When these poor parents do not get financial support from the children, they are involved in disgracious tasks, including even begging. Family is the basic source of love and care for elderly population. In the past, old parents used to live a secured and respectful life in close contact with families. Today the scenario has changed. New generations have a preference for nuclear families. They treat their old parents as a burden and send them to old homes. The health and nutrition status of elderly people in Bangladesh is not satisfactory. About 60% of the elderly suffer from five diseases at any point in time and 24% are underweight. The most common chronic diseases afflicting the elderly are diabetes, heart disease, stroke, asthma, lung disease, arthritis, dementia and depression. However, wives become widowed earlier than husbands in Bangladesh because they marry men several years older than themselves. In such cases, widows feel lonely and those who have no sons face economic hardships.

The Government of Bangladesh has taken several initiatives to protect the rights of elderly population. With an aim to enhance the wellbeing of elderly people, the government approved the National Policy on Older Persons in 1999. The government passed Parents’ Care Act 2013 for ensuring social security of senior citizens. Old age allowance was introduced in Bangladesh in the FY 1997-98 to ensure socioeconomic development and social security for elderly people and increase the dignity of elderly people within family and community. Bangladesh has pension policies to ensure social security on old age for retired government employees only. There are also several NGOs which work for elderly people. To date, the rights of elderly population in Bangladesh have not been protected because the concerned laws and policies are not being implemented properly and existing safety net programs are not adequate for the elderly.

EDUCATION

Education is the fundamental right to everyone. It enhances full development of human potentials, understanding, respect for others and productivity. Bangladesh has three levels of formal education - primary, secondary and tertiary. Primary education begins at the age of 6. There are five grades in primary schools. Primary education is free in government schools and compulsory for all children. Secondary education is divided into three stages: Junior Secondary, Secondary and Senior Secondary. Tertiary education includes graduate and postgraduate levels. Three categories of education - general, technical and madrasa are offered in Bangladesh. There is also non-formal education outside the formal education system, which is provided to disadvantaged groups. Of the non-formal education programs, adult literacy and non-formal primary education are very popular.

There has been remarkable progress in primary and secondary education. We have achieved gender parity at both primary and secondary levels. The initiatives of the Government including exemption of school frees for girls in rural areas and stipend scheme for girls at secondary level have helped to attain gender parity. At the same time, it is true that drop-out rates are higher among girls than boys at secondary level. Female students drop out at secondary level because of early marriage and lack of poverty among other reasons. Student-teacher ratio in primary education is 39.8 which is far better than other South-Asian countries. On the other hand, the share of trained teachers in total teachers in primary education is 53% which is lower than many South-Asian countries. To date, tertiary education has not achieved gender parity. Gender parity index (GPI) in tertiary education has reached its peak at 0.74 in 2014. A large number of children with disabilities are out of education. Bangladesh. Bangladesh spends around 2% to the GDP on education, which is smaller than any regional country. Despite these, the Government is making efforts to achieve SDG 4 which emphasizes inclusive and quality education for all and promoting lifelong learning.

GENDER

Nowadays gender has become a core component of comprehensive development. Gender equality claims equal access to resources and opportunities regardless of gender, including material assets as well as household, social, political and economic decision-making. Gender equality scenario in Bangladesh is not yet satisfactory though there has been much progress over the last decades. Lack of education, discrimination, early marriage and many more factors create barriers to gender equality. Education is significantly associated with women empowerment. In the past, parents did not want to send their daughters to school. In this regard, now parents’ perceptions have partly changed. If we look at school enrolment rates, this change is clearly visible. Gender parity has been achieved in primary and secondary education. But the picture is different in higher education. Parents invest more in boys than girls for higher education, thinking they will depend on their sons for old-age support. Labour force participation is an important determinant of women empowerment. Female labour force participation has increased to 36.1% in 2019 from 23.6% in 1990. This is good but not enough for women empowerment. A recent study conducted by CARE Bangladesh shows that 71% of garments workers give all or a large portion of their salaries to their husbands. It indicates that though women are earning money, many of them cannot control over material assets and participate in decision-making. Early marriage is also strongly related to women empowerment. About two-thirds of girls in Bangladesh are married under the age of 18 years, which blocks the opportunity of their education.

Gender equality has positive impacts at both household and national levels. Higher female earnings and bargaining power translate into greater investment in children’s education, health and nutrition. A study shows that an additional 1% investment in female education impacts 23.8% increase in the country’s GDP. However, achieving gender equality is not a quick fix. It will take sound public policies, a holistic approach and long-term commitment from the Government and all development partners.

ENVIRONMENT & CLIMATE ACTION

Environmental degradation and climate change have become a great threat to food production, livelihood, air quality, water safety and health in Bangladesh. The country is recognized as one of the most climate vulnerable countries in the world mainly because of its geographic location, low elevation from the sea level and dominance of floodplains. Floods, tropical cyclones, storm surges, river bank erosion, landsides, salinity intrusion and droughts are common forms of natural disasters. It is assumed that more than 14% of the country will be extremely vulnerable to floods by 2030 due to rise in the average sea level. According to Intergovernmental Panel on Climate Change (IPCC), due to sea-level rise, about 5.5 million people of coastal regions will be displaced and 40% of productive land in the southern region will be lost by 2080. Displaced people take shelter in urban slums, which ultimately results in rapid urbanization and creates many urban problems. However, climate change increases the spread of infectious diseases such as malaria, dengue and cholera.

The Government of Bangladesh has taken various initiatives to strengthen the ecosystem, combat and mitigate climate change. The Government has developed the National Plan for Disaster Management 2010-15. Bangladesh is committed to achieving SDG 13: ‘Take urgent action to combat climate change and its impacts’ and SDG 15: ‘Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss’.

AGRICULTURE

Agriculture sector is the largest sector in Bangladesh in terms of employment and the major source of livelihood in rural areas where around 70% of the total population live. Although about two-thirds of the total workforce are employed in agriculture, the country’s economy has undergone a sectoral shift – from agriculture to manufacturing and services over the last 4 decades. While in 1971, agriculture sector contributed more than 60% to the GDP, this share has now declined sharply to only 13.1%. The relative size of agriculture in terms of output has decreased but its importance in employment generation, food security and poverty alleviation has not reduced at all. The main cops of the country are rice, wheat, jute and potato. Major fruits include banana, mango, coconut, jackfruit and pineapple.

There has been much headway in food production due to technological advancement and government initiatives such as subsidization of fertilizer and seed and mechanization of irrigation. Despite these, farmers face some challenges. Climate change has a direct negative impact on the production of crops. Agriculture is mostly affected by flood, drought and salinity. About 1 million ha of the coastal region is saline. Drought is a big problem that affects total 3.7 million ha every year. Flood affects about 2.6 million ha annually. Most of the farmers are small and marginal. They do not have adequate money in hand to bear the cost of seed, fertilizer and irrigation. During the cultivation period, they take loans from local money lenders or microfinance organizations at high interest rates. Limited knowledge and lack of skills among farmers constrain crop production too. They do not know about new varieties and develop skills in new farming technology. After production, farmers face the greatest challenge in selling crops. There is no ideal market system in the country where farmers participate and bargain for fair prices of their products. In this situation, agents whom we call ‘middlemen’ buy products from them at a low price. So, farmers can hardly return the amount of money they invest in crop production. Many marginal farmers migrate to towns to change their luck, leaving their forefather’s occupation. Therefore, the Government and other stakeholders should take timely measures to improve and sustain the agriculture sector.