Health care systems in transition III. Bangladesh, Part I. An overview of the health care system in Bangladesh

Although the adoption of economic structural adjustment and health sector reforms have been a more recent phenomenon in Asia compared with many other developing regions, considerable concern has been raised about the impact of these policies on the poor in Asia. In Bangladesh, the influence of the World Bank and other donor agencies has also raised many questions about the role of the international aid community in the developing world. Bangladesh is one of the most densely populated and poorest countries in the developing world. The population, which is estimated to be over 120 million, is projected to double to around 250 million before demographic growth stabilizes. Although Bangladesh is still in the early stages of both the demographic and epidemiological transitions, the government faces major issues concerning its capacity to plan and implement a broad range of both health and population services. The present GNP per capita is US260. The capital city of Dhaka has grown rapidly and about 20 per cent of the total population now lives in urban areas. Nearly 40 per cent of the GDP comes from agriculture, with rice, jute, tea and fish being important commodities. The manufacturing sector has recently grown substantially, particularly the ready-made garment industry, which has resulted in a large rise in rural to urban migration for employment, especially by young women. Before the partition of India at independence, most of present-day Bangladesh was within the province of East Bengal, but from 1947 until 1971 the country was known as East Pakistan. Bangladesh became an independent country in 1971 following a war of liberation, and it recently celebrated its 25th anniversary. Present-day Bangladesh occupies large parts of the Ganges river delta area and, although surrounded on most sides by India, it also shares a border with Myanmar. The country is subject to annual river flooding, which on occasions can be very severe, and to cyclones from the Bay of Bengal to the south. Although there have been long periods of military rule from 1975 to 1990, democratic parliamentary elections were held in early 1991 and, despite episodes of considerable political unrest, civilian governments have ruled the country since then. The last general election was held in June 1996. Islam is the faith of 85 per cent of the population, with Hindus, Christians and Buddhists making up most of the remaining 15 per cent.