Healthcare delivery

       That healthcare delivery in Bangladesh is in need of a major overhaul has been underlined by numerous studies beside observations on the ground. The poor continue to die of completely preventable diseases, and infant and maternal mortality rates in Bangladesh remain high. Adding new insights to the assessment is a recent study by the donor agencies which once again emphasises that the funds and schemes meant for the poor in Bangladesh do not always reach them . Evidence shows that health services are primarily accessed by the comparatively better off rather than the poor. The study which looked at 11 programmes worldwide, discovered initiatives that have ensured that 30 to 40 per cent of benefits reached the population's poorest 20 per cent . For instance, three projects run by non-governmental organisations in Bangladesh, especially in remote rural areas, demonstrated greater success in reaching the poorest in the community. Some of the reasons for this were that the services were convenient for the poorest preoccupied with their own livelihood concerns, mobile vans delivered health at the doorsteps, and the delivery was through women who are seen as having a greater reach among poor women. The study also found that specific programmes in countries as diverse as Argentina, Cambodia, Ghana, Zambia, and Nepal were more effective in their reach because of innovative approaches in delivery. For example, some strategies that effectively reduced inequalities in health services delivery in these countries envisaged contracting with NGOs to provide primary care and using immunisation programmes to distribute insecticide-treated bed nets.
   None of the government's well -intentioned plans will be effective unless the grossly inadequate budgetary allocations to the health sector are increased, and more importantly, mechanisms of monitoring and accountability are firmly put in place. Real change can only occur when there is strong political will and recognition, particularly among interventions are not effectively addressing the needs of the most disadvantaged.