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While child mortality rate in Bangladesh has reduced significantly over the last two decades, indicating, among other things, a notable progress in health care services. However, variation in mortality and disparities in the coverage of health services by different districts, urban slums and rural areas have also remained visible.
Children under 18 years represent 40 per cent of the country’s 150 million people. According to the UN Inter-agency Group for Child Mortality Estimation, the under-five mortality rate (U5MR) in Bangladesh stood at 46 deaths per 1,000 live births in 2011, which matches the MDG 4 target of reducing child deaths by two thirds between 1990 and 2015. The U5MR declined remarkably from 133 (1991) to 46 (2011) per 1000 live births; being higher for the lowest quintile compared to the wealthiest in absolute terms but the ratio of poorest to richest is virtually static at 1.9 (1994) compared to 2.0 (2007), indicating the perpetuation of equity gap.
But variation in mortality rate is evident by rural and urban (55 versus 50), by geographic divisions (71 the highest in Sylhet and 42 the lowest in Rangpur) and by wealth quintiles (37 in highest quintile and 64 in lowest quintile) . Under-five mortality rate in urban slums is worst at 95 per live 1000 births, compared to rural or non-slum urban areas, according to a 2009 study conducted by the UNICEF.
Despite significant progress in immunization services, coverage of fully vaccinated children by 12 months of age is 75 per cent among the lowest quintile compared to 84 per cent for the wealthiest.
According to experts, accessibility to healthcare services depends largely on economic status. Children from poor households tend to suffer from more diseases than those who are better off. Children from poor households are considerably excluded from health services for a variety of reasons.
According to Mohammad Shafiqul Islam, social policy specialist of Unicef, reducing the existing disparities require ensuring access to quality basic health services backed by equity focused budgeting and effective expenditure; while making the service providers accountable to right holders. “The budget needs to be more focused on areas with obvious equity gaps and child health challenge.”
Delivering healthcare services to children living in urban slums, working on the streets and those in hazardous environments requires special programme backed by adequate budgetary provisions, he added.
Continued equity based funding is needed to improve the health status of children living in char, haor, coastal and hilly areas and urban slums.
Citing a 2011 Unicef and Unnayan Shamannaystudy, Islam said that health sector budget per child has been estimated to be a mere Tk 606 in the provisional budget of Fiscal Year (FY) 2012-13, implying, on average, 14.3 per cent increase per annum from actual expenditure of FY2009-10.
On the other hand, per capita national budget rose from Tk 6,836 to Tk 12,458. The average annual growth of per capita total budget was about 27.4 per cent during this period. Hence, the growth of health budget per child is just half of the growth of per capita total budget, indicating possible shift in fiscal priority from child health care to other priorities, he informed.
The lowest quintile households are less likely to receive health care services from hospitals as only about 17 per cent can access government health care services while the top quintile receives about 25 per cent.
If children are the future of the country then it is imperative to invest into their health early enough with focus on populations most deprived of life saving high impact interventions. Will the 2013-2014 health sector budget address the inequities in child health for deprived population groups? Time will tell.