Abstract
The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh embarked on a sector-wide approach (SWAp) modality for the health, nutrition and population (HNP) sector in 1998. This programmatic shift initiated a different set of planning disciplines and practices along with institutional changes in the MOHFW. Over the years, the SWAp modality has evolved in Bangladesh as the MOHFW has learnt from its implementation and refined the program design. This article explores the progress made, both in terms of achievement of health outcomes and systems strengthening results, since the implementation of the SWAp for Bangladesh’s health sector. Secondary analyses of survey data from 1993 to 2011 as well as a literature review of published and grey literature on health SWAp in Bangladesh was conducted for this assessment. Results of the assessment indicate that the MOHFW made substantial progress in health outcomes and health systems strengthening. SWAps facilitated the alignment of funding and technical support around national priorities, and improved the government’s role in program design as well as in implementation and development partner coordination. Notable systemic improvements have taken place in the country systems with regards to monitoring and evaluation, procurement and service provision, which have improved functionality of health facilities to provide essential care. Implementation of the SWAp has, therefore, contributed to an accelerated improvement in key health outcomes in Bangladesh over the last 15 years. The health SWAp in Bangladesh offers an example of a successful adaptation of such an approach in a complex administrative structure. Based on the lessons learned from SWAp implementation in Bangladesh, the MOHFW needs to play a stronger stewardship and regulatory role to reap the full benefits of a SWAp in its subsequent programming.
Highlights
Sectoral contextThe Ministry of Health and Family Welfare (MOHFW) is responsible for the formulation, implementation, management, coordination, and regulation of national health, nutrition and population (HNP) related activities, programmes and policies
In line with the general system of public administration in Bangladesh, the MOHFW management structure comprises the Secretariat, responsible for policy development and administration comprising eight functional wings and units, and the Directorate General of Health Services (DGHS) and the Directorate General of Family Planning (DGFP), which are responsible for implementation of HNP services in the field
MOHFW ownership and leadership were relatively weak in the early years of the sector-wide approach (SWAp), which were reflected in a) management of SWAp’s annual program reviews (APR) by the development partners (DPs)-supported and World Bank-run Programme Support Office (PSO) (IEG 2006; Vaillancourt 2009); and b) DPs’ reluctance to relinquish control over the aid management and coordination due to ‘weak government capacity, inadequate accountability and compromised integrity’ (Buse 1999; Negin 2010)
Summary
Sectoral contextThe Ministry of Health and Family Welfare (MOHFW) is responsible for the formulation, implementation, management, coordination, and regulation of national health, nutrition and population (HNP) related activities, programmes and policies. In line with the general system of public administration in Bangladesh, the MOHFW management structure comprises the Secretariat, responsible for policy development and administration comprising eight functional wings and units, and the Directorate General of Health Services (DGHS) and the Directorate General of Family Planning (DGFP), which are responsible for implementation of HNP services in the field. Apart from these two, several other Directorates (e.g. Directorate of Nursing Services, Directorate of Drug Administration, etc.) perform designated administrative duties under MOHFW.
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