Patients line up for a telehealth consultation session near Rampur, Bangladesh. The country has emerged as a model for medical progress in the Global South. Alison Joyce/NPR Alison Joyce/2019 Alison Joyce Hide caption
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When people think of Bangladesh, they often think of poverty. When the country was founded in 1971, it was one of the poorest countries in the world. And perhaps they will think of political change. Massive protests this year led to the resignation of the prime minister. An interim government has been established, led by Nobel Prize winner Muhammad Yunus.
But Bangladesh defies stereotypes. It has rapidly risen to lower-middle income country status (average income is around $2,500) and is on track to be removed from the United Nations list of least developed countries by 2030.
Along with this escape from poverty, Bangladesh has made remarkable progress in improving healthcare. Two statistics illustrate the extent of progress.
In 1990, the average life expectancy was around 58 years, but in 2019 it rose to 74 years. These numbers come from a series of studies published in The Lancet. And the number of deaths from all causes has fallen sharply, from 1,500 deaths per 100,000 people in 1990 to 715 in 2019.
Moreover, these public health outcomes were achieved in a country with a per capita GDP of US$2,688.31 and a health expenditure as a share of gross domestic product of 2.36%. By way of background, other low- and middle-income countries spend 4% to 6% of their GDP on health and are often unable to achieve such dramatic improvements.
I was born in Kashmir, so I know the region very well. I spent several years in the Dhaka area of Bangladesh during my medical training. I was impressed by the combination of forces that led to improved health services. With international cooperation and funding, Bangladesh has established a network of community-based initiatives and small health centers led by grassroots health workers. These facilities provide women with reproductive services, promote immunizations, and teach them about nutrition.
Dr. Tina Mustahid examines patients via video from her office in Dhaka, Bangladesh. She mainly treats gynecological and digestive problems, joint pain, skin diseases, and fever. Alison Joyce on NPR/2019 Alison Joyce Hide caption
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Breakthrough in Bangladesh
Bangladesh is also where oral rehydration solutions were developed.
It may seem logical to give patients with severe diarrhea drinks made with salt (especially sodium and potassium), sugar, and water to restore lost fluids and nutrients. But in reality, oral rehydration solutions were a remarkable innovation. It was pioneered by Bangladeshi researchers Rafiqul Islam and Majid Molla from the Cholera Research Institute in Dhaka (now known as the International Center for Diarrheal Disease Research in Bangladesh). Collaborated with American doctors David Narin and Richard Cash.
Their findings showed that when adults with cholera were given oral rehydration solutions to parents, the need for intravenous treatment was reduced by 80%.
“Oral rehydration solutions are credited with saving more than 50 million lives in the 20th century,” said global health expert Thomas J. Bollyky, chairman of global health at the Bloomberg Council on Foreign Relations. . The Lancet hailed it as potentially the most important medical advance of the 20th century.
Big questions stand in the way
However, political turmoil in Bangladesh could lead to social turmoil. The question, then, is whether Bangladesh can maintain its role as a model for health progress in the Global South and address new health challenges.
The continuing priority is to fight infectious diseases. The World Bank has partnered with Bangladesh for 50 years to ensure improved treatment, prevention and referral services for infectious diseases, including mosquito-borne diseases such as dengue, which are on the rise in this time of climate change. It has promised $1 billion in subsidies and preferential loans. The situation is changing, even though deaths from many infectious diseases, such as tuberculosis, are decreasing.
And new challenges are emerging. Mortality rates from non-communicable diseases such as diabetes and Alzheimer’s disease are increasing rapidly in Bangladesh, leading to what epidemiologists call a “double burden.”
The country is also working to improve primary health care, including high blood pressure screening, with a $200 million investment from the World Bank. Approved in August 2023, the program requires continued support from the government to build primary health care centers and get monitoring programs off the ground.
Further challenges to the health care system include understaffing in health facilities and exorbitant out-of-pocket costs that prevent fair access to care.
WHO is already working with Bangladesh’s Ministry of Health and Family Welfare to develop the first national medical education strategy aimed at addressing the critical shortage of trained health workers. They invest in curriculum, certification, and faculty development.
International health organizations have a history of supporting countries during times of crisis like this. During a similar political crisis in Sri Lanka in 2022, the Global Fund to Fight AIDS, Tuberculosis and Malaria approved $989,687 in emergency funding to ensure distribution and access to essential medicines.
It is vital that these groups play a key role during this period of transition in Bangladesh. The World Health Organization, UNICEF, and non-governmental organizations focused on health and development must come together to protect the country’s progress and maintain the momentum of important efforts.
And they will receive great support from the people of Bangladesh. I have witnessed their resilience and adaptability. During the infamous Rana Plaza building collapse in Savar in 2013, which killed more than 1,000 garment factory workers, I volunteered with the International Committee of the Red Cross in Dhaka, providing basic clinical care and supporting the Bangladesh Red Cross. Taught preliminary disaster management techniques to Tsukisha staff. member. Despite one of the worst industrial disasters the country has ever faced, and despite scarcity of resources, people from all social and economic backgrounds came together to volunteer and emerge from the rubble of collapsed factories. We rescued as many people as physically possible.
This spirit of local and global cooperation will mean that Bangladesh remains an example of how to improve health care in the Global South.
Dr. Junaid Nabi is a public health researcher specializing in healthcare reform and innovation. Previously, he was a SAARC scholar in Bangladesh, conducting research on global health and providing disaster management training in Dhaka. He is a senior fellow at the Aspen Institute and a Millennium Fellow at the Atlantic Council.
