Dhiraj Kumar Nath
International Conference on Population and Development held in Cairo on September, 1994 adopted a different outlook integrating population with development and individual wellbeing like reproductive health and empowerment of women in particular. The concept of ‘reproductive health’ emerged due to strong opposition of groups supporting the Holy See, opposing the word ‘family planning’. Bangladesh delegation comprising of government, non-government organisations played a significant role in the ICPD emphasising on regional cooperation and south-south collaboration. Bangladesh delegation also made their voice heard in the group of 77 during the ICPD + 5 held in 1999.
A lot of changes have taken place since the ICPD, also referred to as Cairo Consensus, particularly regarding empowerment of women in third world countries. People from these countries voiced concern over the ongoing and newly arising challenges for human development: exclusion, rapid urbanisation, ageing, changing family pattern and household structures, trend of migration and emerging environmental risks, etc.
The visible challenges of migration, food adulteration, counterfeit medicine, illegal trafficking and abuse of narcotics as well as changes in the family structure and housing system with other types of discrimination appeared as major threats to socio-economic development and individual wellbeing.
The UN Secretary General supporting this position of third world countries stated, “Too many people are being left behind – by growing income and wealth inequalities, by gender inequality and gender-based violence, by discrimination and stigma, by exclusion from participation in governance and even by data and knowledge systems that fail to count or account for many of the most vulnerable people.”
The ways to improve and overcome visible challenges are being discussed around the world. The UN has convened a special session on 22nd September, 2014 to deliberate on Sustainable Development Goals – Post 2015: Development Agenda. In fact, this session might deliberate on the achievement of MDG and program of actions, post 2015.
Bangladesh made remarkable successes in achieving all eight Millennium Development Goals, especially in reducing child mortality, promoting gender equality and empowerment, improving maternal health and combating HIV/AIDS, malaria and other deadly diseases. In reducing poverty, eliminating hunger and improving the level of universal primary education, the country made commendable achievements. Bangladesh is one of the 12 countries of the world that achieved, well ahead of time, four goals out of eight while on track to achieve the rest of the goals. The population growth rate has declined to 1.34% with maternal mortality rate reduced to 194 per 100, 000 live births. Similarly, infant mortality reduced to 29 per 1000 live birth, life expectancy at birth raised to 67.2 years and EPI coverage extended to 82% with massive awareness about safe drinking water and sense of sanitation.
With these success stories, Bangladesh can take leadership in the UN special session and raise a few issues for discussion.
The policymakers must look ahead, to the needs of the millions of young women who will enter reproductive age in the coming decades. With this end in view, institutional delivery (only 28%) must be increased to ensure safe delivery with the help of skilled birth attendants and functional emergency obstetric care (EOC) encouraging at least four pre-natal visits. Developed countries must cooperate in these areas with technical and financial assistance so that no mother dies during birth.
National Health Account has been introduced as modest beginning to identify gaps of financing. The out of pocket expenditure of individual is 65% meaning the public is paying significantly from their own scarce resources which a poor can hardly afford. This is contrary to the spirit of universal health coverage that refers to organised healthcare system in which “all people must have access to essential health services without financial hardship associated with payment.”
Out of pocket payments for accessing healthcare are one of the most regressive ways of financing healthcare. It pushes many households back into poverty.
Health insurance as an alternate source of financing should be introduced by adopting the PPP model and practiced in order to overcome any eventuality. Here also remains a scope for global cooperation.
There must also be efforts to build sustainable cities that enrich urban and rural lives. Urban and rural health divide must be well coordinated with the implementation of urban health strategy developed by the local government division. The disease profile in urban areas is different from rural areas with the intensification of HIV/AIDS, STI/RTI and sexual diseases like gonorrhoea and other serious venereal diseases that demand different way of medical dispensing.
The critical issue is the transparency and accountability that must be established in the management of health and family planning programmes and healthcare delivery services. Allegedly, in the procurement of goods, services, etc. absence of integrity is widely prevalent. Good governance must be established at all levels and at any cost. This needs to be practiced globally and supervised intensively.
In the light of Bangladesh’s experience, there should be specific proposals made in the special session to transform global economy into one to sustain future of the planet and ensure a common future of human rights, dignity and well-being for all in the years beyond 2014.
Dhiraj Kumar Nath is a former secretary and adviser to the caretaker government.