THE United Nations General Assembly, after a long debate on April 1 and 2, 2008, reaffirmed that "Millennium Development Goals are achievable if we act now." It was also observed that "getting back on track" should be the appropriate strategy to attain the targets fixed almost eight years back. Out of the 8 goals of MDGs, three -- reduction of maternal mortality, improvement of maternal health and combating HIV/AIDS, malaria and other diseases -- are directly related to health policy.
Three other goals -- eradication of extreme poverty and hunger, achievement of universal primary education and promotion of gender equity and empowerment of women -- are very closely connected with the health service delivery system.
Besides, environmental sustainability and global partnership for development are also related to the implementation of health policy. In fact, health poverty is no less serious an issue than income poverty if we mean to build up sound human resource in the country.
Similarly, health education makes a person prudent, and can contribute toward creating good mothers, eventually leading to empowerment of women. A good health policy can speed up the progress of the nation, and make the people less vulnerable to disease and infirmity.
In consideration of the above, the health adviser has recently expressed his desire to formulate a new health policy incorporating emerging issues. Although appreciated by many, a quarter has expressed apprehension that the government might get involved in a debate, as happened in the case of the women development policy.
True, there are many stakeholders and vested groups involved in health infrastructure construction and maintenance, supply of food to hospitals, trading in and producing drugs and medicines, practicing as quacks and traditional healers, and running unauthorised clinics etc.
They might mobilise resistance to any move repugnant to their interest and limiting their share. We, therefore, support the revision of the health policy, and incorporation of issues like reproductive health, environmental health, adolescent health, and global health, and building of a capable human resource network to deliver quality health care and combat future challenges.
It is true that the health sector of Bangladesh has many success stories with remarkable achievements, innovations and interventions. The promotion of oral re-hydration therapy, expanded program of immunisation, polio virus treatment, distribution of Vitamin A capsules, breast feeding campaign, safe water drinking education etc. are interventions of the health sector that are highly appreciated round the world. Equally, the performance of family planning has been termed as a success under a challenging environment.
The population growth rate has been brought down to 1.48 per cent as against 3 per cent in 1975, fertility rate declined to 2.7 per cent from 6 per cent, contraceptive prevalence rate rose to 56 per cent from 7.7 per cent in 1975, and infant mortality rate has come down to forty six from more than a hundred per thousand. Life expectancy has reached to 62 years, indicating the success of the health care delivery system.
The overall health infrastructure in the country is one of the best in the third world. The government, non-government and private sector partnership in Bangladesh is regarded as example by many nations. The Sector Wide Approach and Health, Population and Nutrition Sector Strategy were innovations of Bangladesh
There are many weaknesses in the health and family planning programs of Bangladesh. The discriminatory health services, under-utilisation of infrastructure, rapid urbanisation, protecting health from climate changes, adolescent health care, reproductive health, aging population, high risk sexual behaviour, arsenic, and above all, donor dependence and sustainability of the programs are major challenges to this sector.
About 15,000-mothers die annually at the time of delivery, with 3.2 maternal mortality per thousand, and 7000 infants die every day. About 70 percent of pregnant mothers suffer from anaemia, 85 percent of deliveries take place at home, 50 percent of children are stunted, and 45 percent of babies are born with low weight. STI/TRI are increasing rapidly.
To address these challenges, it is necessary to take note of reformation in the formulation of the health policy. The health policies of 1986 and 2000 should be reviewed and revised substantially, with scientific changes in the medical arena. The health policy might make fresh look at the following areas:

Manpower
Since there is shortage of service providers -- with only one doctor for 4645 patients, one medical assistant for 28,443 patients -- and rampant absenteeism, community health volunteers could be engaged like community police at grassroots level, especially in hard to reach areas. Bare-foot doctors, paramedics, medical assistants and sub-assistant community medical officers could be trained in collaboration with the private sector.

Infrastructure management
There could be outsourcing in the management of infrastructure, with leasing out of the UHFWC, THC, and community clinics. There might be a second shift in all medical colleges and specialised government hospitals.
A regulatory framework for approval and management of private clinics should be devised to ensure quality care and proper medication. The tendency of going abroad should be stopped with improved counseling and appropriate treatment.

Drugs, medicine and MSR
The drug administration department should be totally redesigned, quality medicine should be produced, and exporters of drugs should be encouraged. Private sector entrepreneurs should be given rebate and loan to establish such industries in the country. Social Marketing Company and Essential Drugs Company Limited can take the leadership.

BCC strategy
Health education and behaviour change communication strategy should have a new look to generate awareness in low performing and hard to reach areas. School health education programs, use of community radio, involvement of women groups, and partnership with local governments should be part of BCC strategy to reach to the un-served and under-served population.
NGOs and the corporate sector, like Grameen Phone, should be involved, and some electronic media be taken as partners to create a climate in favour of health and hygiene.
Sound pollution, spitting and smoking should be banned, and enforcement should be strict.

Administrative measures
There could be more devolution and decentralisation of administrative and financial power to CS and DDFP, making them more accountable and transparent. The budgetary provision for the health sector could be increased, with enhanced allocation for training and research.
There should be more grants for hospitals and service centers like BIRDEM, medical colleges etc. There should be serious punishment for negligence in diagnosis and treatment. A client charter of rights should be observed in all service centers.

Alternate medicine
The role of ayurvedic, unani, homeopathic and alternate medicine practitioners should not be undermined in any way, since almost 60 per cent of the rural population depends on them at the initial stage. Every thana or district hospital should have a place of posting for such medical practitioners.
Finally, health insurance should be introduced in the private sector with support from the government, and a voucher scheme should be undertaken as a safety net for the poor. Physically handicapped and mentally retarded persons should be brought under the policy to be addressed with adequate care.
A good health policy can direct a nation towards economic progress and poverty alleviation, including the achievements of millennium development goals.

Dhiraj Kumar Nath is a former Secretary to the government.