Huge gaps in health services for would-be mothers

IN the latest Human Development Report Bangladesh has been lauded as one of the two best performers among 95 developing countries, despite repeated natural disasters, the population burden and political hassles. Its achievement in mother and child health care was specially noted. Yet, an in-depth report which claimed to have visited several health centres and district hospitals in the country recently, concluded that the state of essential health services for would-be mothers in most is quite deplorable despite honest efforts at enhancing facilities. The government is avowedly committed to meeting the Millennium Development Goals(MDGs) and have been taking appropriate measures. Nonetheless, there are huge gaps between the expressed intention and the reality on the ground. This must be bridged urgently if at least one of the MDGs is to be achieved -- that of bringing down maternal mortality, from the present 320 deaths per hundred thousand live births to 143 by the year 2015.

The reasons behind the scandalous maternal mortality are well known -- post-partum bleeding, eclampsia, obstructed labour and unsafe delivery-- and the government is said to have put in place programmes to cope with such emergencies, complete with the hardware necessary. But the problem is with the 'software', so to say. The manpower assigned to deliver the service is either not adequate, or the few who are on the job seem seldom to be on duty or are not skilled enough to use the necessary equipment. The health directorate's reproductive health unit, as expected, is looking after the above programmes countrywide. In 2009-10 fiscal Taka 620 million (62 crore) was said to have been allocated for the purpose, but at most of the upazila health centres and district hospitals, the programme failed to function properly. In the current fiscal (2010-11) the allocation was raised to Taka 900 million (90 crore). It remains to be seen how much the enhanced funds would improve services, given the fact that the core problems -- poor work ethics, low skills and inadequate manpower -- are seldom addressed seriously and sustainably.

Efforts to bring down maternal mortality began in 2003, first in 132 upazila health centres and then in 59 district hospitals and all government medical colleges and hospitals. The services were focused on addressing emergency cases due to pregnancy- related complications, and each hospital was to gradually have one anaesthetician and one surgeon. Seven years on, the programme is reportedly working properly only in 34 upazila health centres; 27 of them have given it up altogether while in the remaining 71 centres it is just limping along somehow with nurses giving stop-gap services, due largely to absenteeism among the key professionals who have been assigned to serve in the emergency programme. Some of them have reportedly been found to have 'joined' the job on paper only and have been drawing the pay and perks without ever earning it.

Given the above situation, meeting the MDGs on maternal health care in the next five years, is likely to remain elusive, unless deeper 'systemic' change can be effected to make the reproductive health units deliver as needed. There are suggestions that public-private partnerships in this sector might be a viable option although many pro-people health activists believe such initiatives might make a bad situation worse by excluding the poor completely from access to essential health care. But recommendations as to what would improve the work ethics and professional behaviour of personnel in these centres and hospitals have not been forthcoming as yet.