By Sir Fazle Hasan Abed.
Dhaka, 21 November,
"2013 Hon’ble President of the People’s Republic of Bangladesh His Excellency Mr Md Abdul Hamid, Hon’ble Minister, Editor in Chief of the Lancet Dr Richard Horton, Excellencies, Ladies and Gentlemen,
It is indeed a great pleasure for me to be here and chair the launch of the Lancet Series on Bangladesh. The Series as we have heard has portrayed Bangladesh’s achievements in the health sector over the past four decades. We are very proud of our achievements and also mindful of our responsibilities to keep the momentum going and bring better health and wellbeing to our people.
Many people here from the government, civil society, private sector have worked hard, and continue to do so, improving conditions for others. Rarely do we take the time to reflect on the gains we have made here in Bangladesh. It is worth doing so, for these gains are historically unprecedented. And I am convinced they are of value to other countries facing circumstances similar to what we experienced in our recent history.
Ladies and gentlemen, we are all witnesses to a health revolution!
Within the lifetime of all of us, we have seen a quiet revolution in the quality of health in this country. It has been said that such rapid gains in quality of life have never been seen before – in the history of all humanity.
To give but one example: Within recent memory, the situation was grim for an expectant mother in rural Bangladesh. In the 1990s, despite the gains we had seen since liberation, we still had a frighteningly high maternal mortality rate, comparable to what we see today in many parts of sub-Saharan Africa. For every 100,000 live births in the country in 1990, we had 500 to 600 dying from complications during childbirth – usually for entirely preventable reasons.
Now, in most parts of the country, we are likely to meet the Millennium Development Goal of bringing maternal mortality down to less than 150 deaths per 100,000 live births. There is still much to be done, of course. In Sri Lanka that rate is just 35, and in Norway it is 3.
Still, when combined with other gains, the progress is staggering. As I wrote in my commentary for this publication, maternal mortality has dropped 75% since 1980, infant mortality has more than halved since 1990, and life expectancy at birth has risen to 69 years. Such changes have almost no historical precedent. It is said that only Japan’s modernization in the 19th century, following the Meiji Restoration, can rival this change.
So how did we do it? One answer is by turning to poor rural women to carry out the task of improving public health. And importantly, we worked on her terms. I will give an example. BRAC, took oral rehydration therapy to a national scale in the 1980s. Our mission was to put an end to needless deaths from children’s diarrhoea, one of the greatest killers.
To combat this, we turned to the solution first reported in The Lancet in 1968, when this journal published the first results from a successful trial of oral rehydration therapy, which used a simple but precise mixture of water, sugar and salt to quickly rehydrate children suffering from diarrhoea.
But when we tried to scale this up, we initially found that many rural women understandably didn’t recognize the concept of a “half litre of water.” Without that basic knowledge, it might seem difficult to mix the solution properly. And we knew that lack of precision in mixing the solution could be a dangerous thing.
But what the women did know very well was their own household containers. So we began by asking them for the containers they normally use, and then we helped them scratch marks on them – so they knew exactly how much a half litre was.
And of course there was much more trial and error. An initial evaluation found that only 6% of these women had retained and used the knowledge. So we went back again and refined the training. By 1990, we had reached 70% of the households in the country, and today nearly every Bangladeshi household use oral rehydration therapy.
I feel this story is important because it underscores the necessity of putting the most vulnerable patients – who are often rural women and their children – at the heart of public health interventions. Eventually we realised that gender equality and women’s rights would drive public health gains.
Ladies and gentlemen, I believe this is true everywhere – in other parts of Asia, as well as in sub-Saharan Africa. Everywhere that women struggle, anyplace that poor people fall victim to preventable diseases, it is vital to put empowered women at the centre of the intervention.
As we all have seen in Bangladesh, the result is a virtuous circle. Better health leads to prosperity, and prosperity in turn leads to better health.
Based on this experience, I believe that the women of Bangladesh are a model for the world – and that the revolution we have seen in our lifetimes can be repeated elsewhere.
Thank you Hon’ble President for gracing this event. Your presence means a lot to the efforts that the government, civil society, the private sector and, more importantly, the people are undertaking in creating a healthy and prosperous Bangladesh. May I also take this opportunity to express our gratitude to the Lancet for publishing such an illuminating Series exclusively on our country.