Following
the International Conference
on Population and Development
(ICPD) held
in Cairo in 1994, the Government
of Bangladesh initiated a process
to develop a population policy to
take into account the challenging
issues. The draft national population
policy 2000 is the outcome of the
efforts to address the outstanding
issues and to make the programmes
sustainable. The idea of cost sharing,
cost recovery and community participation
were taken into account with high
priority. In this paper, the proposed
population policy is examined critically
with particular emphasis on effectiveness
of the policy in the past, present
and future contexts.
Some
of the targets and objectives of
the proposed population policy are
replicated from the previous policies,
namely providing health and family
welfare services to the people,
evolving and implementing more effective
family planning and reproductive
health services, improving maternal
and child health care services,
ensuring quality of care, etc. However,
a number of new objectives are included
in the policy with greater emphasis: (i)
Achievement of replacement level
fertility by 2005 and stable population
by 2050, (ii) reduction of malnutrition,
particularly
among children and females,
(iii) fifty per
cent reduction of IMR and MMR by 2005, (iv) achievement
of increased awareness among health
service providers so that they can
provide improved services for physical
and mental violence against women,
(v) finding appropriate systems to
provide emergency care, (vi) to
make health and family planning
services accountable and cost-effective,
(vii) to consider the increasingly
important problem of ageing, (viii)
to ensure integrated and balanced
population distribution to face
the challenge of rapid urbanisation,
etc.
The principles of the ICPD 94 have
been undertaken as the stated principles
of the proposed population policy
with some major exceptions. The
principles that are stated as the
basis for the proposed population
policy cover the following issues:
(i) human rights, (ii) right to
an adequate standard of living, (iii)
advancement of gender equality and
equity, (iv) right to development
in order to meet the needs of present
and future generations, (v) improved
quality of life, (vi) highest attainable
physical and mental health, (vii)
strengthening of family as the basic
unit, and (viii) population and
development needs of the indigenous
population. All these principles
deal with mainly improvement of
quality of life through improved
health care, equity and empowerment
of women, human rights and cultural
interests. However, the principles
related to the linkage between population
and development, which are given
high priority in the ICPD 94, are
not included in the proposed population
policy.
A close examination of some of the
important strategies that are being
implemented shows that the client-centred
approach of the HPSS is supposed
to provide essential service package
on the following components: (i)
reproductive health care, (ii) child
health care, (iii) control of communicable
diseases, (iv) limited curative
care, and (v) behaviour change communication.
For an effective service delivery
system for ESP, it is necessary:
(1) to integrate family welfare
and health directorates at all levels,
(2) to establish community clinics
at a close proximity for about 6000
people, (3) to ensure rigorous training
at all levels in accordance with
the needs of the transformed system,
(4) to ensure the
presence of trained
personnel at the service centres,
(5) to ensure adequate supplies
of family planning methods and drugs
for communicable diseases and curative
care, (6) to ensure participation
of stakeholders and community leaders
in the process of planning, management
and financing of activities, (7)
to ensure cost recovery through
improved quality of care, (8) to
evolve a new process of providing
services to poor people and
for those who will not be able to utilise the one stop services, (9)
to create willingness to avail the
one stop services among those who
were used to door-steps services
in the past, (10) to promote behavioural
change communication through widespread
use of modern facilities, (11) to
evolve an effective evaluation and
monitoring system through a unified
management system in order to assess
the weakness and strength of the
program.
However,
there is no evidence mentioned either
in the HPSS document or in the proposed
population policy document that
can refer to any justifiable pre-testing
on the basis of which these preconditions
can be assumed to be realistic.
The strategies of the proposed population
policy deal mostly with a transition
in the service delivery system from
door-step service of maternal and
child health and family planning
methods to a one-stop service of
ESP instead of addressing the broader
perspective of population dynamics
as an integral part of the development
process.
The
interrelationships between population
and development actors are ignored
in the population policy, which
will not only delay our economic
growth but will also delay the process
of stabilisation of our population
to a great extent and will
eventually lead us to a vicious
cycle of poverty.
There are three
components of human development:
health,
education and standard of living.
The proposed population policy
deals only with health without
making any realistic attempt to
take account of other two
components that can provide
necessary inputs for
population-development
interrelationships. Malnutrition
is identified as one of the major
concerns of the population policy,
but without addressing the issues
of education and income generating
activities, little can be achieved
in reducing the level of
malnutrition in Bangladesh.
Education does not mean only
general education, it may include
basic education with different
kinds of skills that can enable
common people engage in income-generating
activities It is worth mentioning
that the policy appears to be
formulated in order to facilitate
a short-term experimental project
funded by stakeholders.
The impact of population momentum
on the number of women of
reproductive
age and the problem of rapidly
growing elderly population have
not been addressed adequately in
the HPSS or in the proposed strategies
of the population policy. According
to the projections of the size of
the population under different scenarios,
the extent of the increase in the
number of women of
reproductive
age will occur so rapidly that
the strategies, in terms of allocations,
targets, supplies, logistics, providers,
quality of care, number of one stop
and mobile centres, will need to
be updated at regular intervals.
During the period 1991-2021, the
number of elderly people will increase
2.5 times while the size of
the elderly
population will increase 7.4 times
during the period 1991-2051. If
these figures
are not taken into account
in our planning process with high
priority then the socio-economic
and health hazards will make the
proposed population policy redundant.
This paper shows that the preconditions
for the implementation of the strategies
stated in the proposed population
policy were not explicitly pre-tested.
In that case, the uncertainties
involved in
the implementation
of such strategies will make the
process of transition extremely
vulnerable and the targets set in
the population policy will be unlikely
to be achieved.
To obtain the full text of this
report please contact:
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Pages: 19
