Strategic Objective 3 :

Better health for the poor (MDG 4, 5 and 6)

A. Introduction

Background

The strategic goals for the Netherlands support to the health sector in Bangladesh are better access to quality health services for the (most) disadvantaged and improved sexual and reproductive health and rights. The health sector in Bangladesh has demonstrated significant successes over the past three decades, in particular in reducing the total fertility rate and decreasing infant and child mortality rates. However, significant challenges remain, including persistent high rates of maternal mortality and malnutrition; addressing violence against women (which counts for at least 14% of maternal deaths) and limited access to services for women and girls. Health indicators generally reflect marked gender inequalities.
 

Rationale for EKN support to the sector

The strategic goal for the Netherlands support to Bangladesh (2005-2008) is the improvement in the health status of the Bangladeshi population, with particular emphasis on sexual and reproductive health and rights status of the Bangladeshi women and girls. The health sector in Bangladesh has demonstrated significant successes over the past three decades, in particular in reducing the total fertility rate and decreasing infant and child mortality rates. However, significant challenges remain, including persistent high rates of maternal mortality and malnutrition; addressing violence against women (which counts for at least 14% of maternal deaths) and limited access to services for women and girls. Health indicators generally reflect marked gender inequalities.

Objectives in the Health Sector

The overall objective is sustainable improvement of health, nutrition and family welfare status of the population of Bangladesh, especially the vulnerable, e.g. the poor, women, the children and the elderly. These groups are the ultimate beneficiaries of the programme, while the intermediate target group is placed in the supply side and should benefit from the foreseen improved service efficiencies, including human resource development.

B- Cooperation with GoB and donors

There are two voluntary agreements governing the relationships between the GOB and DPs. The first is the Memorandum of Understanding which sets out the framework for all DPs – pooled and non pooled donors - to provide financial support to NHPSP. The second is the Partnership Agreement (or code of conduct) which commits the GOB to continue to improve “the performance of its institutions in managing health sector resources” and the DPs to continue working towards strengthening and utilising government systems...”. It also commits the GOB to provide quarterly Programme Monitoring Reports. The Partnership agreement establishes the HNP Forum and the HNP Consortium.

The HNP Coordination Committee was established since the original agreements for HNPSP were signed. It is chaired by the Secretary with the membership comprising senior managers, the Chair of the HNP Consortium and the World Bank. Its Terms of Reference are to:

• Monitor progress of the APR recommendations;

• Identify implementation constraints and take corrective measures;

• Propose agenda items for the HNP forum;

• Take stock of progress of the task groups and provide feedback; and

• Evaluate periodically the functioning of the task groups

According to the Partnership Agreement the role of the HNP forum, also chaired by the Secretary, is to facilitate the exchange of information and policy dialogue between the DPs and GOB. It is understood that its membership comprises implementing partners, civil society as well as GOB officials and DPs. The HNP Consortium exists to enable DPs to share information and to coordinate their activities in pursuit of a sector wide approach (SWAp.)

Important other donors in sector

HNPSP is supported by development partners who pool their funds: DFID, EC, Sweden, the Netherlands, UNFPA (on a pilot basis) and the World Bank. USAID, ADB, GTZ, JICA, UNICEF and WHO are no pool funders, but rather provide specified support to the programme. Apart from the World Bank, all HNPSP pool funders provide support to the health sector through other channels and the health related UN agencies provide parallel support to the Ministry of Health and Family Welfare (MOHFW) and the Ministry of Local Government (MOLG) through their Country Programme. Non-DAC donors like China and India are not participating in the HNPSP.

Donor Cooperation

The HNP consortium agenda is currently focused on sharing information on the progress of the various task groups that have been established. The present Chair of the Consortium (UNFPA) has endeavoured to harmonise DP practices by preparing a paper which identifies four principles: (a) joint, where possible, e.g. for instance in respect of missions, analytical work; (b) a division of labour where lead partners are identified for particular themes; (c) coordinated technical assistance in terms of support to task groups; and (d) common harmonised procedures.

C- Activities under taken in support of the EKN objectives

1. Health Nutrition and Population Sector Programme (HNPSP)

Objective:

The Netherlands provides support to the Government of Bangladesh Health Nutrition and Population Sector Programme (HNPSP). The aim of HNPSP is to enhance the growth and poverty reduction prospects of Bangladesh and accelerate progress on the MDG targets set out in the Poverty Reduction Strategy Paper (PRSP). The programme builds on the implementation of the first Health and Population Sector Programme (HPSP), which marked a shift from a multiple project approach to a single sector-wide approach (SWAp). The HNP Strategic Investment Plan (SIP) of the Ministry of Health and Family Welfare is underpinned by a three year Programme Implementation plan (PIP).

Partner organisations:

HNPSP is supported by a large group of development partners. The Embassy of the Kingdom of the Netherlands, the European Commission, DFID, UNFPA, and the German and Swedish Embassies pool their funds, which are administered by the World Bank in a Multi Donor Trust Fund (MDTF). On 15 October 2006, the Government and the World Bank signed a MDTF Grant Agreement for the channelling of U$ 460 million grant funding. Other donors provide specified parallel support to the programme.

Budget:

DP contribution to HNPSP was originally the total of around USD 1.184 billion for the period 2005-2010 of which 57.3% through pooled funds, 19.6% through non-pooled and 23.1% through parallel project aid. The share of the total government budget allocated to the MOHFW budget was originally foreseen to increase to 10% annually, which is not the case. The Bangladesh Economic review of 2007 shows that the percentage of the GOB Health and Population budget did increase to 10.38 % in 2006/2007

Timeframe:

The time frame of HNPSP is 2006-2010, likely to be extended till June 2011.

Rationale:
The HNP SIP is consistent with the PRSP, in that it aims to improve the health system’s responsiveness to the HNP needs of the poor by:

• Improving HNP service efficiencies, including human resource development

• Accelerating progress towards MDG goals

• Improving equity through better targeting of public subsidies to the poor

• Strengthening the stewardship and governance role of the MOHFW

• Dialogue with civil society and developing mechanisms to encourage greater ownership of HNPSP by stakeholders.

• Improving sector governance and management

Relevant website: www.hnpinfobangladesh.com

2. Maternal, Neo-natal and Child Health (MNCH)
 

Objective:

The goal of the MNCH project is to strengthen community level health systems for maternal and neonatal child health care through: 

• Capacity development;

• Community empowerment;

• Improving HC and services at the facility level;

• Increased informed demand for facilities and services;

• Increased participation; resp. to MNHC services.

Partner organisations:

The main partners are BRAC and UNICEF.

Budget:

€ 6 million

Timeframe:

2008-2013

Rationale:

Relevant websites: www.un-bd.org; www.brac.net

3. ICDDR,B

Core funding is provided to the International Centre for Diarrhoeal Disease Research, Bangladesh, ICDDR,B. The mission of ICDDR,B is to develop and promote realistic solutions to the major health, population and nutrition problems facing the poor people of Bangladesh and other settings. The Centre is an international health research institution located in Dhaka. With the changing trend in the world scenario in health and population over the years, ICDDR,B has expanded its activities to address some of the most critical global health needs. In collaboration with partners from academic and research institutions throughout the world, the Centre conducts research, training and extension activities as well as programme-based activities.

Partner organisation:

ICDDR,B

Budget:

$ 9.600.000

Timeframe:

2007-2010

Relevant website: www.icddrb.org

4. WHO Menstrual regulation

The Menstrual Regulation programme is a challenge fund for NGOs which aims to reduce maternal mortality through improving equitable access to services of the government of Bangladesh for prevention of unsafe abortion in both rural and urban areas.

Partner organisation:

WHO

Budget:

$ 3.932.000

Timeframe:

2007-2011

Relevant website: www.who.int