Effective multi-sectoral approach for rapid reduction in maternal and neonatal mortality: the exceptional case of Bangladesh.

Autor:	Tasnim Hossain A; International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b), Dhaka, Bangladesh., Hazel EA; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Rahman AE; International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b), Dhaka, Bangladesh., Koon AD; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Jue Wong H; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Maïga A; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Akseer N; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Tam Y; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Walker N; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Jiwani SS; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Munos MK; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., El Arifeen S; International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b), Dhaka, Bangladesh., Black R; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA., Amouzou A; International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA aamouzo1@jhu.edu.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2024 May 06; Vol. 9 (Suppl 2). Date of Electronic Publication: 2024 May 06.
DOI:	10.1136/bmjgh-2022-011407
Abstrakt:	Background: Bangladesh experienced impressive reductions in maternal and neonatal mortality over the past several decades with annual rates of decline surpassing 4% since 2000. We comprehensively assessed health system and non-health factors that drove Bangladesh's success in mortality reduction. Methods: We operationalised a comprehensive conceptual framework and analysed available household surveys for trends and inequalities in mortality, intervention coverage and quality of care. These include 12 household surveys totalling over 1.3 million births in the 15 years preceding the surveys. Literature and desk reviews permitted a reconstruction of policy and programme development and financing since 1990. These were supplemented with key informant interviews to understand implementation decisions and strategies. Results: Bangladesh prioritised early population policies to manage its rapidly growing population through community-based family planning programmes initiated in mid-1970s. These were followed in the 1990s and 2000s by priority to increase access to health facilities leading to rapid increases in facility delivery, intervention coverage and access to emergency obstetric care, with large contribution from private facilities. A decentralised health system organisation, from communities to the central level, openness to private for-profit sector growth, and efficient financing allocation to maternal and newborn health enabled rapid progress. Other critical levers included poverty reduction, women empowerment, rural development, and culture of data generation and use. However, recent empirical data suggest a slowing down of mortality reductions. Conclusion: Bangladesh demonstrated effective multi-sectoral approach and persistent programming, testing and implementation to achieve rapid gains in maternal and neonatal mortality reduction. The slowing down of recent mortality trends suggests that the country will need to revise its strategies to achieve the Sustainable Development Goals. As fertility reached replacement level, further gains in maternal and neonatal mortality will require prioritising universal access to quality facility delivery, and addressing inequalities, including reaching the rural poor. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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