Tackling noncommunicable diseases in Bangladesh : now is the time

140 Pages·2013·3.681 MB·English

by  El-Saharty, Sameh

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Tackling Noncommunicable Diseases in Bangladesh

Directions in Development
Human Development
Tackling Noncommunicable
Diseases in Bangladesh
Now Is the Time
Sameh El-Saharty, Karar Zunaid Ahsan, Tracey L. P. Koehlmoos, and
Michael M. Engelgau
© 2013 International Bank for Reconstruction and Development / The World Bank
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Attribution—Please cite the work as follows: El-Saharty, Sameh, Karar Zunaid Ahsan, Tracey L. P.
Koehlmoos, and Michael M. Engelgau. 2013. Tackling Noncommunicable Diseases in Bangladesh: Now Is
the Time. Directions in Development. Washington, DC: World Bank. doi:10.1596/978-0-8213-9920-0.
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ISBN (paper): 978-0-8213-9920-0
ISBN (electronic): 978-0-8213-9921-7
DOI: 10.1596/978-0-8213-9920-0
Cover photo: © Karar Zunaid Ahsan. Used with the permission of Karar Zunaid Ahsan. Further permission
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Library of Congress Cataloging-in-Publication Data has been requested.
Tackling Noncommunicable Diseases in Bangladesh • http://dx.doi.org/10.1596/978-0-8213-9920-0
Contents
Preface ix
Acknowledgments xi
About the Authors xiii
Abbreviations xvii
Overview 1
The Growing Burden of Noncommunicable Diseases in
Bangladesh 1
Health System and NCD Capacity 4
Health Policies, Activities, and Challenges 5
Key Policy Options and Strategic Priorities 7
Note 13
References 13
Chapter 1 Contexts and Transitions 17
Global, Regional, and Country Contexts 17
Demographic and Epidemiological Transitions 22
Note 25
References 25
Chapter 2 Burden of Disease and Risk Factors for NCDs 27
Global and Regional Burden of NCDs 27
Bangladesh NCD Burden 30
NCD Risk Factors 38
Economic and Social Impact 49
Notes 53
References 53
Chapter 3 Health System and NCD Capacity Assessment 61
Introduction 61
Health Service Delivery 61
Health Workforce 67
Health Information Systems 69
Pharmaceuticals and Medical Technology 70
Health Financing 70
Tackling Noncommunicable Diseases in Bangladesh • http://dx.doi.org/10.1596/978-0-8213-9920-0   v
vi Contents
Health Sector Governance 72
Note 74
References 74
Chapter 4 National NCD Activities and Challenges 77
Orientation of the Public Sector 77
Country Activities 79
Challenges 82
References 85
Chapter 5 Key Policy Options and Strategic Priorities 87
Stewardship and Regulatory Policy Options and Strategies 88
Population-Based Policy Options and Strategies for
the Non-Health Sector 93
Population-Based Policy Options and Strategies for
the Health Sector 98
Policy Options and Strategies for Individual Clinical
Interventions for the Prevention of NCDs in
the Health Sector 99
Policy Options and Strategies for Individual Clinical
Interventions for the Treatment of NCDs in the Health
Sector 101
Lead Role of the Ministry of Health and Family Welfare 103
References 104
Appendix 1 Leading Causes of Mortality and Disability-Adjusted
Life Years and Risk Factors for Bangladesh,
2010 Estimates 107
Appendix 2 NCD Treatment, Research, and Training Institutions in
Bangladesh 109
Appendix 3 Assessment and the Program Management Cycle 115
Boxes
1.1 Chapter One Summary 18
2.1 Chapter Two Summary 28
2.2 Methods to Describe the Health Situation in South Asia 29
2.3 Arsenic—Still a Major Public Health Threat 49
3.1 Chapter Three Summary 62
4.1 Chapter Four Summary 78
4.2 Strategic Plan for Surveillance and Prevention of NCDs
in Bangladesh, 2011–15 80
5.1 Chapter Five Summary 88
5.2 “Sin Tax” Reform in the Philippines 96
Tackling Noncommunicable Diseases in Bangladesh • http://dx.doi.org/10.1596/978-0-8213-9920-0
Contents vii
Figures
O.1 A Policy Options Framework for the Prevention and Control
of NCDs 8
1.1 Population in the 21st Century, Bangladesh 22
1.2 Changing Age Structure of the Population in Bangladesh, 2001,
2026, and 2051 23
1.3 Projected Impact of Population Growth and Aging on Total
Health Expenditure in the South Asia Region, 2000–20 23
1.4 NCD Mortality Increases in Rural Bangladesh (Matlab),
1986–2006 24
2.1 Main Causes of Global DALYs and Top Five Risk Factors for
Poor Health, 1990 and 2010 28
2.2 BOD as a Proportion of Total Forgone DALYs by Cause,
Global and South Asia, 2010 29
2.3 Proportion of Total Deaths and Forgone DALYs Due to NCDs,
South Asia, 2004 30
2.4 Leading Causes of Mortality and Morbidity in Bangladesh, 2010
Estimates 31
2.5 Leading Causes of Premature Deaths in Bangladesh, 2010
Estimates 32
2.6 Causes of Deaths among Women of Reproductive Age
(15–49 Years), Bangladesh, 2010 33
2.7 Causes of Mortality among Women of Reproductive Age in
Bangladesh, 2001 and 2010 35
2.8 Distribution of People Who Suffered from Asthma/Respiratory
Diseases in the Preceding 12 Months by Locality,
Bangladesh, 2005 and 2010 36
2.9 Death Rate in Each Age Group from the Five Leading Injury
Causes among Children 37
2.10 Diabetes Prevalence (Self-Reported) among Adults, Aged
25 Years and Above, by Locality and Gender, Bangladesh, 2010 39
2.11 Leading Risk Factors for Bangladesh, 2010 Estimates 40
2.12 Tobacco Use among Adults, Aged 25 Years and Above, by Locality,
Bangladesh, 2010 41
2.13 Prevalence of High Blood Pressure/Hypertension
(BP ≥ 140/90 mmHg or on Medication) among Adults Aged
25 Years or More by Locality and Gender, Bangladesh, 2010 44
2.14 Low Birth Weight and the Transgenerational Effect in Increasing
the Risk of NCDs 45
2.15 Overweight and Obesity Status among Males and Females,
Bangladesh, 2011 47
2.16 Prevalence of Physical Inactivity in Four Sites in Bangladesh 48
2.17 The Macroeconomic Effects of NCDs 50
2.18 Social Determinants, NCDs, and Their Relationship to Poverty 51
Tackling Noncommunicable Diseases in Bangladesh • http://dx.doi.org/10.1596/978-0-8213-9920-0
viii Contents
3.1 Building Blocks of a Health System 63
3.2 Structure of the Health Service Delivery System in the
MOHFW 64
3.3 Types of Health Care Providers in Bangladesh, 2007 68
3.4 Share of Public Health Expenditure in Total Health Expenditure
and in Total Public Expenditure 71
3.5 Bangladesh Governance Indicators, 2000–09 73
tables
1.1 Demographic, Economic, and Health Profiles for South Asian
Countries, 2011 19
2.1 Diabetes Prevalence among Urban Men and Women, Aged
35 Years and Above, by Background Characteristics,
Bangladesh, 2006 39
2.2 Per Capita Edible Oil Consumption in Bangladesh 43
5.1 Policy Options Framework for Prevention and Control of NCDs
in Bangladesh 89
5.2 Estimated Cost of Interventions to Reduce NCD Risk Factors in
Three Countries 92
5.3 Effects of Salt-Intake Reduction and Tobacco Control
Interventions in Bangladesh, 2006–15 93
5.4 Role of the Different Sectors in the Prevention and Control
of NCDs 94
5.5 Recommended Services at Various Levels of Care in the
MOHFW in Bangladesh 102
Tackling Noncommunicable Diseases in Bangladesh • http://dx.doi.org/10.1596/978-0-8213-9920-0