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Bangladesh
>> Regional Overview >> Bangladesh Overview Activity Data Sheet
PROGRAM: Bangladesh
TITLE AND NUMBER: Fertility Reduced and Family Health Improved, 388-001
STATUS: Continuing
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $26,000,000 DA; $14,000,000 CSD
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $23,000,000 DA; $14,000,000 CSD; $1,000,000 ESF
INITIAL OBLIGATION: FY 1997 ESTIMATED COMPLETION DATE: FY 2006Summary: Bangladesh's population continues to grow, and poverty and illness deny many families the opportunity for long, healthy, productive lives. Continued emphasis on family planning is required to reach replacement fertility, and basic health services must be improved. Activities under this Strategic Objective are intended to lower fertility and reduce infant, child and maternal mortality. Major planned results include a reduction in fertility from about 3.4 live births per woman in 1993/1994 to 2.9 by 2004 and a decline in infant mortality from 87 per 1,000 live births in 1993/1994 to 55 by 2004. Bangladesh has achieved impressive reductions in fertility and in infant and child mortality over the past thirty years.
USAID supports service delivery by 46 local non-governmental organizations (NGOs) that provide integrated maternal and child health services, including family planning, to a population of approximately 22 million. National level assistance that benefits all Bangladeshis is provided for social marketing; improved distribution of family planning and health commodities; immunization, including polio eradication; disease surveillance; and mass-media health-communications programs. In addition, HIV-prevention activities are targeted at high-risk groups. The Child Survival and Diseases (CSD) fund account supports portions of service delivery; technical assistance for immunization, nutrition surveillance and other child-health activity; social marketing; and operations-research programs. Population and AIDS funds support the balance of activities.
Key Results: The principal result to be achieved under this strategic objective is the increased use of high-impact health services. This requires increasing the availability of integrated health and family-planning services through a system that has traditionally emphasized vertical service provision through separate health and family-planning infrastructure and staff; improving service quality; and changing attitudes and behaviors with respect to service utilization among potential clients. It also requires the active involvement of the private sector, including NGOs and commercial product-distribution networks, to substantially complement and extend the reach of government health services.
Performance and Prospects: Performance over the past year, the third full year of the program, exceeded expectations. The program expanded access to high impact services, including immunization; treatment of diarrheal diseases, lower-respiratory infections and sexually transmitted diseases; family planning; vitamin A; and antenatal care. This has been done primarily through the following: (1) 322 community clinics and more than 150,000 associated clinic satellite sessions, all managed by NGOs; (2) technical assistance to government health sector; and (3) support for the Social Marketing Company (SMC).
Clinic usage increased by 65% in FY 2000 for a total of more than 14.1 million contacts. Total couple years of contraceptive protection grew to 3.12 million, up 32% from FY 1999. Distribution of oral contraceptives, injectables and condoms increased by 53%, 77% and 50%, respectively. The treatment of childhood diarrhea and acute respiratory infection and measles vaccination increased by 124%, 213%, and 70%, respectively. Antenatal and postnatal care increased by 84% and 90%, respectively, while tetanus immunizations for mothers grew by nearly 89%. Additional polio-surveillance facilitators helped document an acute flaccid paralysis rate of 1.6, up from 0.81 in FY 1999, and indicating an increasingly effective surveillance system. USAID also supported the National Immunization Day campaign, which achieved a full polio protection coverage rate of 89.5%, up from 76% last year.
A new communication and marketing strategy was developed and recently implemented. It will further increase clinic utilization and encourage behaviors such as exclusive breast feeding and vitamin-A consumption. An urban safe-motherhood pilot program was initiated. Operations research is being substantially revised to produce more program-relevant and cost-effective research. USAID and the United Nations Children's Fund (UNICEF) continued collaboration to reduce maternal mortality, and a survey to document the national maternal mortality rate and its causes was launched. Quality assurance data analysis demonstrated that 71% of NGO clinics were in compliance with an index of quality indicators this year, up from 25% in 1998-1999. SMC initiated the marketing of injectable contraceptives and over-the-counter sales of oral contraceptives. SMC sales of injectables increased by 274% and orals by 40%. Sales of both condoms and ORS rose by 5%.
USAID revamped its HIV/AIDS strategy to concentrate on high-risk groups. USAID-funded group meetings, peer counseling, condom sales, and treatment for sexually transmitted diseases increased dramatically. An HIV/AIDS advisor is now in place, USAID has constituted a donors group to enhance collaboration. USAID is assisting in the unification of the health ministry's separate health and family-planning logistics systems. Procurement issues have been reviewed, with attention focused on preparing policymakers and officials to more effectively procure contraceptive and health commodities using World Bank funds and guidelines.
In FY 2001, USAID will provide $23 million in DA funding for family planning activities, of which $10 million will be provided for purchasing contraceptive commodities for the social marketing program; $9 million for direct provision of family planning services; $2 million for information, education and communication activities; and $2 million for logistics support systems and management capacity building. An additional $3 million in DA will fund program monitoring and policy analysis. USAID will provide $14 million in CSD funding, of which $11 million will finance child survival activities, and $3 million will be used for HIV/AIDS prevention.
In FY 2001, clinical services and NGO institutional capacity will be strengthened. However, USAID is reaching the fiscal limits of network expansion, so future efforts will concentrate on improving service quality and coverage at current sites. A policy initiative with the Government of Bangladesh (GOB) will encourage the increased provision of health services by NGOs, and an effort will be made to promote these NGOs as models for expanding the private provision of basic services with government and other-donor financing. Technical assistance to revitalize Bangladesh's surgical contraception program will be funded in FY 2001. Quality assurance data will be used to improve training and supervision. USAID will continue to assist the GOB to improve its procurement practices, especially for contraceptives and will continue GOB assistance in logistics and training. A focused evaluation of key activities will be conducted in FY 2001.
Possible Adjustments to Plans: None.
Other Donor Programs: The World Bank and four bilateral donors directly fund the GOB's Health and Population Sector Program and represent the largest source of donor funds for the sector. USAID, United Nations Children's Fund, United Nations Population Fund, World Health Organization, Germany, and the United Kingdom also provide support. Under the U.S.-Japan Common Agenda, Japan supports immunization and reproductive health activities, including vaccines and limited clinic construction. USAID is the second largest donor in the sector and is an active member of the Bangladesh Health Donors Consortium.
Principal Contractors, Grantees, or Agencies: USAID implements activities through U.S. and local private firms, universities, and NGOs. They include: Pathfinder International for rural service delivery; John Snow, Inc., urban service delivery and logistics; Social Marketing Council, social marketing; the International Centre for Diarrheal Disease Research, Bangladesh, operations research; EngenderHealth, quality improvement and surgical contraception; Management Sciences for Health, technical support to immunization and other child-health activities, including polio; the University of North Carolina, healthworker training; the Bangladesh Centre for Communications Programs, communication activities; Family Health International, technical assistance in HIV/AIDS; and Helen Keller International, nutrition surveillance.
FY 2002 Performance Table
Bangladesh: 388-001
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Total fertility rate (TFR) 3.3 NA NA 3.3 3.1 NA NA Indicator 2: Sales of ORS Packets by the SMC As noted in last year's R4 this indicator will not be reported on in the R4 2003. 53 62 70.3 NA NA 80 84 Indicator 3: Sales of Oral Contraceptives (OCs) by the Social Marketing Company (SMC As noted in last year's R4 this indicator will not be reported on in the R4 2003. 8.0 12.1 15.8 NA NA 21 23 Indicator 4: Acute Flaccid Paralysis (AFP) Surveillance As noted in last year's R4 this indicator will not be reported on in the R4 2003. 0.10 0.30 0.81 NA NA 1.0 1.0 Indicator 5: Infant mortality rate 82 NA NA 66 78 NA NA Indicator 6: Child mortality rate 37 NA NA 30 34 NA NA Indicator 7: National Immunization Day (NID) coverage 90 81 76 89.5 90 94 96 Indicator 8: Percent of operating costs funded by NGOs As noted in last year's R4 this indicator will not be reported on in the R4 2003. 6 7 10 NA NA NA NA Indicator Information:
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: IR Average number of children that would be born alive to a woman during her lifetime, assuming present age-specific fertility rates Bangladesh Demographic and Health Survey (BDHS) 1999-2000 Rates refer to the three-year period preceding the survey. Indicator 2: IR Millions of packets sold Millions of packets sold Millions of packets sold Indicator 3: IR Millions of cycles sold SMC reports Number of cycles of OCs sold by the SMC Indicator 4: IR Rate of non-polio AFP cases per 100,000 children under 15 years of age. GOB/WHO surveillance reports This measures the effectiveness of polio surveillance, which, in turn, monitors progress toward polio eradication. A country is considered polio-free when the non-polio AFP rate is maintained at 1 for three years. This rate is calculated by dividing by 100,000 the number of AFP cases detected among children under 15. If the quotient is 1 and if none of the AFP cases is confirmed as polio by WHO-certified laboratories, the surveillance system is considered effective and the population in question is considered polio free. Indicator 5: IR Number of deaths to infants under age 12 months per 1,000 live births Bangladesh Demographic and Health Survey (BDHS) 1999-2000 Infant mortality rate is a widely accepted indicator of infant health. The baseline of 82 was established in 1997. The target for 2004 of 55 was revised from 72, given recent achievement in reducing infant mortality. Indicator 6: IR Number of deaths of children 1-4 years of age per 1,000 children aged a year Bangladesh Demographic and Health Survey (BDHS) 1999-2000 Child mortality rate is a widely accepted indicator of child health. The baseline of 50 was established in 1997. The 2004 target of 28 was revised from 32, based on recent achievements in reducing child mortality. Indicator 7: IR Percentage of children receiving 2 doses of oral polio vaccine per campaign round National Immunization Day Survey Mass vaccination of children during NIDs is the principal means of eradicating polio. Indicator 8: IR Percent of the total (aggregate) operating costs of USAID-supported NGOs covered by program generated revenues CA reports The numerator is the total of all NGOs' cost recovery fees collected, plus the value of the community contributions to the clinic (such as rent or land value) based on a standard calculation. The denominator is the total value of the USAID NGO grant funds, excluding the one-time costs of capital equipment. This indicator will be dropped and be replaced by National Immunization Day Coverage. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 75,669 DA 42,954 DA 32,715 DA 40,423 CSD 20,530 CSD 19,893 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 18,975 DA 24,942 DA 15,300 CSD 12,866 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 94,644 DA 67,896 DA 26,748 DA 55,723 CSD 33,396 CSD 22,327 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 26,000 DA 14,000 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 26,000 DA 14,000 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 23,000 DA 15,047 DA 158,691 DA 14,000 CSD 12,586 CSD 96,309 CSD 1,000 ESF 0 ESF 1,000 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
