Transcript Slide 1

National Institute of Population Research and Training
Ministry of Health and Family Welfare

Background of BDHS surveys

BDHS as monitoring tool for health sector
program

Utilization of BDHS data

BDHS data dissemination approaches

BDHS surveys are designed to provide
estimates for HPNSDP program indicators
for:
 National level
 urban and rural areas, and
 seven administrative divisions
Bangladesh
Fertility
Survey
(BFS)
1975
1989
Bangladesh
Contraceptive
Prevalence
Survey
(CPS)
Bangladesh
Demographic
and Health
Survey
(BDHS)
1979
1981
1983
1985
1989
1991
1993-94
1996-97
1999-2000
2004
2007
2011

Survey design and implementation goes
through constant review process by
 Technical Working Group
 Sampling Committee
 Technical Review Committee
 Ethical clearance from BMRC

Four weeks training for data collection staff

At least 3 days stay in each EA

Four stages of quality control
 Each team has Field Editor for spot editing
 Independent quality control team
 Field check table and debriefing
 Data consistency check and secondary editing

Produces demographic and health data to support
MOHFW for monitoring and evaluation of HPNSDP

Collects and analyses socio-economic,
programmatic and community information

Provides regional differentials, equity analysis,
public-private-NGO contributions, and gender
segregated data

Provides trends data

Provides compatible data with other countries

Provides data for advanced studies, postgraduate
and doctoral research
Goal: Ensure quality and equitable health care for all
citizens of Bangladesh

BDHS provides 6 out of 8 indicators
Indicators
Neonatal mortality rate
Infant mortality rate (IMR)
Under 5 mortality rate
Total fertility rate (TFR)
Stunting among <5 children (%)
Underweight among <5 children (%)
Baseline
37
52
65
2.7
43
41
BDHS
2011
32
43
53
2.3
41
36
Target
2016
21
31
48
2.0
38
33


Result: Increase utilization of essential HPN services
BDHS provides 8 out of 9 indicators
Indicators
Baseline
Delivery by skilled birth attendant
26%
Antenatal care coverage 4+
20%
Postnatal care within 48 hours
21%
Contraceptive prevalence rate
62%
Unmet need for family planning
17%
Measles immunization by 12 months
82%
<5 Children with ARI receiving antibiotics
38%
Children (6-59 months) receiving
83%
Vitamin A in last 6 months
BDHS
2011
32%
26%
27%
61%
12%
84%
71%
60%
Target
2016
50%
50%
50%
72%
9%
90%
50%
90%


Result: Improve equity in essential HPN service
utilization
BDHS provides 2 out of 3 indicators
Indicators
Proportion of births in health
facilities by wealth quintiles
Baseline
1:8
Use of modern contraceptives
in low performing areas
Syl:25%
Ctg:38%
BDHS
2011
1:6
Target
2016
<1:4
Syl:35%
Syl &
Ctg:45% Ctg:50%


Result: Improved awareness of healthy behaviour
BDHS provides 2 out of 2 indicators
Indicators
Rate of exclusive breastfeeding
in infants up to 6 months
Children 6-23 months fed with
appropriate IYCF practices
Baseline
43%
BDHS
2011
64%
Target
2016
50%
42%
21%
52%

3 of 7 divisions are at
replacement fertility
(RF = 2.1).

Sylhet is 48% and
Chittagong is 33%
above replacement
fertility.
National
CPR = 61.2

West divisions high CPR

Dhaka & Barisal medium
CPR

Eastern divisions (Sylhet &
Chittagong) below national
CPR.

Data on contraceptive method mix over time
shows no increase in use of long acting and
permanent methods (LAPM) like sterilization,
IUD and implants.
Findings resulted in a number of interventions to:
 improve the quality of service provision
related to LAPM
 create demand for LAPM through behavior
change and communication activities

Data showed that to reach
MDG 4, Bangladesh needed
to reduce neonatal mortality

This led to:
 advocacy for development
of the Bangladesh Neonatal
Health Strategy 2009
 introduction of programs
to improve newborn care

DHS shows high inequity in use
of maternal health by wealth
Interventions on demand-side financing
being tried to increase use of maternal
health services by the poor.
Improving equity gap now a national target

DHS highlights that Bangladesh women
are marrying and bearing children
at a very young age.
Led to strong advocacy for assessing
interventions that can raise age of
marriage and delay childbearing.

Data revealed drowning
to be a major cause of
child death

This led to:
 operations research
to test appropriate
interventions
 activities to raise
awareness against
child drowning
 teaching swimming
skills to children

National Nutrition Services has launched a
media campaign to focus feeding practices
for infant and young children.

This is in response to BDHS, which showed
little improvement in children’s malnutrition.

Currently 41% of children under age five are
stunted or too short for their age.

Data show no increase in exclusive breastfeeding practices between 1993 and 2007
 Government enacted law increasing maternity
leave for 6 months
 Efforts continue to enforce a law against promoting
infant formula and breast milk substitutes

BUDGET SPEECH 2012:
“According to BDHS 2011, under-5 mortality rate
has been reduced to 53 from 65 per thousand over
the past four years. Currently, one third of women
receive the assistance of the trained health workers
during child birth. To increase this number further,
 taking initiative to train 40,000 health workers of
various tiers
 ‘Maternal Health Voucher Scheme’ will be
expand to another 27 upazilas
 24-hour emergency maternal care service will
be provided in 96 upazila health complexes.”

BUDGET SPEECH 2012:
“We want to increase the rate of contraceptive use
by 80% within 2021 to address the problem arising
from the growing population.
 We have made adequate budget allocation
 We have built up sufficient stock of contraceptives
 Contraceptive use has increased to 61% from 56%
during the period from 2007 to 2011.”
“BDHS has been used by the government and the development
partners for annual review of the Bangladesh health sector
program. …… I could not live without it”
Senior Health Economist, South Asia Region, The World Bank
“UNFPA uses BDHS for advocacy, in policy dialogue with
government, and in reviewing program strategies. It is an
invaluable source of information for us”
UNFPA Representative, Bangladesh
“BDHS is the Bible of the health sector. It gives us direction on where
we need to focus to improve performance. Use it as your guide”
Director of Family Planning, Khulna Division, Bangladesh

Release of preliminary results within 3-4
months of completion of field survey

National dissemination of final report and
policy issues

Divisional dissemination

Special dissemination in all upazilas
of Sylhet division

Dissemination for targeted audience
 HPNSDP evaluation team
 Professional bodies
 Internee medical students
 Private medical practitioners (unqualified doctors,
pharmacists)
 Journalists

31 articles in national newspapers, 37 articles
in local newspapers and 5 television reports
were made by the 20 national and local fellow
journalists.

One of the fellows, Mahbuba Zannat, staff
reporter for The Daily Star, received the World
Population Day Media Award 2010 by Ministry
of Health and Family Welfare for an article on
maternal mortality which she published under
the fellowship program.

Another fellow, Mintu
Deshwara, staff reporter of
The Daily Shyamol Sylhet
reported on shortage of
health care providers that
was limiting the effective
-ness of the FP program
at Sylhet.

Story prompted the upazila
authorities to begin active
recruitment of new
personnel.

BDHS is a part of health sector program

Tries to produce quality data

Ensure participation of stakeholders and
professionals in the implementation process

Comprehensive efforts have been made
to increase utilization of data using targeted
approach