Introduction      

Health promotion is a core function of public health and is effective in reducing the burden of

disease (both from communicable and non communicable diseases), and in mitigating the

social and economic impact of such diseases.   WHO support focuses on promotion of

healthy living, creating an empowering environment and generation of evidence for

programmes and policies that aim to reduce lifestyle-based risk factors for individuals as well

as communities.

 Country situation

The economic and demographic transition in Bangladesh is increasingly causing adverse

effects on both health and wealth of the population. High consumption of tobacco, changes in

eating habits, increasing substance abuse, lack of physical activity and mushrooming of

unregulated food and beverage industries are behind this increase. Health promotion, though

a priority programme of the Government of Bangladesh, is continually challenged by other

health programmes in terms of resource allocations. Communication channels, both

electronic and print, are channeling information for public consumption. Children are being

appraised by information inclusion in the school curriculum. In spite of all these measures

health promotion is yet to gain the desired momentum, and this is due to dearth in resource

allocation in this area. Taking precedence from other counties, use of dedicated taxes (from

alcohol and tobacco) for health promotion could be a sustainable solution.

UNIVERSAL QUALITY HEALTHCARE

Key massage:

Inadequate healthcare services to the marginalized citizens due to lack of availability

of doctors in rural areas and high cost of services in health facilities.

From a healthcare administration point of view, challenges exist with respect to

accountability, promptness of service and timely decisions regarding strategic

interventions.

Vission:

Quality healthcare services to doorsteps of all citizens.

Outcome:

The capacity and management strength of the healthcare delivery system ensure that citizens

access quality health care services and are adequately prepared for emerging health threats

and challenges.

Strategic Priorities:

HEALTHCARE MANAGEMENT The government will set a holistic healthcare vision and

will design a plan towards a coordinated goal. The Ministry of Health will play a stewardship

role guiding and coordinating efforts. All related departments will ensure better transparency

and accountability ensuring citizens access to health related information and services.

HUMAN RESOURCE AND ACCESS TO KNOWLEDGE The government will focus on

address shortage of ICT manpower. It will put in place proper monitoring system to monitor

attendance, absenteeism and quality of service delivery. Health education will be arranged to

service providers using ICT. Medical faculties will be connected to address remote medical

needs.

HEALTHCARE SERVICES Telemedicine, particularly mobile phone based solutions will

be launched at a national scale to provide medical information, consultation and services. For

clinics and hospitals standard operating procedures will be developed. Patients’ information

and queue management protocol will be automated. Availability of essential drugs will be

monitored. Health promotion and communication will be strengthened. Systems will be

designed to ensure access to person with disabilities.

HEALTH AND DEMOGRAPHIC INFORMATION National data on health indicators

will be consolidated and updated. To maintain an integrated health record the electronic

health record (EHR) will be developed. The geographical reconnaissance database will be

completed. Access to research reports will be ensured. Health data will be standardized and

cooperation among large health facilities in disease surveillance will be strengthened.

Like most developing countries, Bangladesh also faces significant challenges in ensuring

adequate healthcare services to the marginalized section of the population. Some of the well-

know reasons for that include lack of availability of doctors in rural areas and high cost of

services in health facilities leading to mushrooming of exploitative health-agents in local

communities. From a healthcare administration point of view, challenges exist with respect to

accountability, promptness of service and timely decisions regarding strategic interventions.

The government has been exploring ways of using Information and Communication

Technologies (ICTs) for addressing these challenges with some innovative initiatives and

setting grounds for broad level changes in healthcare service delivery mechanisms and

administrative reforms.

The Government of Bangladesh has placed a high priority on e-Health, which is reflected in

the ICT Policy 2009. The strategic areas/issues relevant to health in the ICT Policy 2009

include the following (Clauses 7.1-7.4 of ICT Policy):

Improve healthcare delivery management through use of telemedicine and modern

technology

Create awareness at all levels, including hard-to-reach areas with particular importance in

making maternal, child and reproductive care available.

Ensure quality of care

Increase the capacity of health care delivery system

The Policy details a breakdown under each of these priority areas and provides targets to be

achieved at the end of each term. While this is a positive way forward in planning specific

ICT interventions, it is also important to match up the priorities with goals set in HNPSP and

the new National Health Policy so that all guiding documents point to a definite direction and

its execution is clear to the implementers, both in public and private sector. Specifically,

clause 16 of the NHP 2010 emphasizes on the provisions of the ICT Policy of 2009 and the

Vision 2021 for Digital Bangladesh.

The NSAPR II emphasizes the need for the government to focus on effective service delivery

and preparedness for emerging health threats and challenges. The NSAPR II also identifies

affordable, attainable and acceptable quality health care, nutrition and family welfare

services, increased health status, reduced health inequalities, expanded access to social safety

net (with specific focus on the poor and the vulnerable), and affordable service delivery as

government’s priority areas at a macro level. It is important to specify actionable areas

through which quality of health, better equality, social safety net, community participation

and ownership in this sector can be ensured.

The government emphasizes on ensuring health facilities to all citizens, adoption of a revised

health policy, operationalizing the 18,000 community clinics, updating the population policy

and addressing birth control and reproductive health accordingly, addressing the arsenic

problem by supplying pure drinking water and providing sanitation facilities in every

household, and devising an appropriate pharmaceutical policy.

While national policies and visions constitute guiding documents for implementation in the

health sector, international commitments such as the millennium development goals (MDGs)

also play an important role in setting national priorities. MDGs 4, 5, 6 and 8E have direct

implications for the health sector.

VISION

Quality healthcare services to doorsteps of all citizens.

OUTCOME STATEMENT

The capacity and management strength of the healthcare delivery system ensure that citizens

access quality health care services and the system adequately prepared for emerging health

threats and challenges.

SITUATION ANALYSIS

The Ministry of Health and Family Planning has made significant progress with respect to

developing management information systems in health care. The Department of Health and

the Department of Family Planning both have dedicated ICT personnel for managing and

constantly improving their systems.

DEPARTMENT OF HEALTH SERVICES

Increased connectivity: The Bangladesh government connected 800 health care facilities in

May 2009 and other access points through the Internet with the aim to improve health

system’s efficiency. All facilities from Upazilla and upwards are included in this scheme and

are connected through unlimited wireless connectivity.

Telemedicine: People in rural Bangladesh struggle to access timely and quality medical

service either due to the distance of the health care facilities, or due to lack of adequate

medical providers. Telemedicine or tele-health enables patients-providers to exchange

information, which leads to an appropriate diagnosis and treatment plan that can then be

administered by moderately trained health staff or even the patient alone.

Provisions are being created for video conferencing with civil surgeons. The government is

planning to provide mini laptops for 18,000 community clinics and to train staff to utilize the

tools for appropriate situations. This initiative will offer web conferencing which will address

a number of challenges related to professional consultation currently faced by medical

professionals in remote communities.

Mobile phone health service for emergency situations is also a project that was launched in

May 2009 with an aim to enable qualified government doctors to provide free medical

advice. A mobile phone device was given to all 64 district hospitals and 418 upazila hospitals

and one doctor on roster attends calls. Phone numbers are disseminated through local

channels and website.

Training and capacity building of health workforce: A state-of-the-art digital training

facility has been created at the health directorate with all modern facilities.

Health promotion and education to community people: A rich indigenous health content

is being developed for dissemination among all community clinics and upazila health outlets.

M Health (i.e. mobile-based health systems) tools are also being utilized for health promotion

and awareness. Non-government agencies through health workers and information workers

(e.g., info-ladies) promote basic health care information targeting prevention and linking with

health care institutions in case of need.

Patient management and communication with staff: SMS services are soon to be launched

for management of TB patients, queue management, receiving complaints, instructions to

health managers and staff, and email and data communication.

Geographic Information System: Health facility information is being recorded on Google

maps and is made available online for all locations in the country. The aim of the GIS facility

is to also map disease surveillance and health services availability.

Citizens’ permanent electronic registry for demographic and health information: This is

an initiative that the government aims to complete in 2-3 years beginning from FY 2010-11.

Health workers will collect household data using specially designed paper forms or the

Geographic Reconnaissance (GR) form with Intelligent Character Recognition (ICR)

capabilities for digitization of data. Data entry will be done by ICR machines. The aim is to

create a comprehensive national online database with demographic and health record for all

citizens of the country.

SERVICE PRIORITIES

Telemedicine/Tele-health: Telemedicine is the use of telecommunications to provide

medical information and services in a variety of contexts. Almost all specialties of medicine

have been found to be conducive to tele-consultation: psychiatry, internal medicine,

rehabilitation, cardiology, pediatrics, obstetrics, gynecology and neurology and other

diseases. The government will take steps to allow tele-consultation to get access to remote

medical advice from doctors based in Dhaka or other national and international locations.

Following are areas that can be explored for specific initiatives on telemedicine:

Utilize opportunities such as the SAARC Telemedicine Network

Treatment compliance and follow up for conditions such as Tuberculosis and Diabetes

Proper implementation of following up with pregnant women through mobile

communication.

Development of Standard Operating Procedures for clinics and hospitals: One of the

longer term goals for efficient operation of e-Health can be ensured by devising Standard

Operating Procedures (SOP) for all public and private hospitals. This would enable better

exchange of data and services between primary, secondary and tertiary care facilities.

Automated patient management protocol: Patient information and queue management is a

necessary tool to bring about discipline and system in large public hospitals such as DMCH,

BSMMU, etc. Such systems are already operational in some large private and semi-public

institutions like BIRDEM, United Hospital, Square Hospital, Apollo Hospital, etc. The

government will automate the internal systems in its public hospitals in a phase-wise

approach, starting with in-patients.

Monitoring of availability of essential drugs: Making essential drugs available to the needy

is a critical function of the government. The government will develop a strategy to keep an

updated database of essential drugs and its distribution. Mobile-phone based tracking system,

where citizens can access to information related to availability of free medicine and stock

status will be introduced to bring intransparency and ensure proper distribution.

Central database of blood supply sources: Crisis of safe blood supply in times of

emergency has been one of the causes of death or delayed care. A central repository of

information on availability of different blood groups can be maintained by connecting all the

certified blood banks.

Health promotion and health communication: The phenomena of rise in prevalence of

chronic diseases and increased awareness on healthy living have re-emphasized the need for

health promotion and health communication. Historically, Bangladesh has effectively

employed a number of innovative approaches in using ICT media to disseminate important

health and behavioural messages and raise awareness, both in the public and private arena.

Lessons from those campaigns will form the foundation for ICT media planning for the

future. The government will use various ICT channels for raising awareness about potential

health hazards and preventive measures.

Some relevant examples are family planning messages, video clips with first aid and quick

response manuals – e.g. what to do in case of snake bite, drowning, burn, etc. that are typical

causes of accidents, and also video clips with messages on preventive behaviour, such as

what to do to avoid contracting infectious diseases such as swine flu, malaria, tuberculosis,

and HIV/AIDS.

Addressing needs of the disabled and marginalized: When a system is designed to meet

the needs of the marginalized, disabled and the hard-to-reach population, it automatically

covers the needs of the able and privileged population. One of the priorities that will be kept

into consideration is design of e-Health systems according to the needs of the most

disadvantaged.

Mission mode programmes: The government will undertake mission-mode programmes for

specific diseases or specific target groups for achieving certain targets set in MDGs and

HSNSP, where ICTs will be integrated for making services reached to the target audiences

and ensure complete cycle of being informed up to accessing quality treatment. For example,

programme for reducing maternal and neo-natal death as per national and MDG targets.

PARTNERSHIP STRATEGY

The following areas represent possible areas of multi-stakeholder partnership, the

stakeholders and their respective roles:

Local Access to Health Information and Services: Three kinds of organizations will be

invited to work together to provide local access to health services through ICT systems – 1)

those that have ICT facilities at local level such as telecenters; 2) those that have the relevant

health content or medical algorithms; 3) those that actually provide various health services

directly.

Mobile-based Tele-consultation: Health organizations can also partner up with organizations

that provide mobile-phone based teleconsultation services either on the basis of phone calls

or data sent from the ground level.

Online or ICT Systems-based Skills Up-gradation for Medical Professionals: Health

organizations can also partner up with institutions which provide customized capacity

building or training services through ICT-based systems. International programmes in the

area of health care promotion will be invited to collaborate with national agencies both in the

government and non-government sector. Bi-lateral and multilateral development partners and

country government-led initiatives will be approached for contributing in all types of resource

mobilization - financial, technical and intellectual. For example, building partnership with

Mobiles for Health Initiative of White House will be useful in addressing specific challenges

in the areas of maternal and child health care.