https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/15 Tue, 02 Aug 2016 07:57:45 +0000 Ibrahim Med. Coll. J. 2007; 1(2): 21-24 Key Words: Performance indicators, health attainment. Address for Correspondence: Azaher Ali Molla, Institute of Health Economics, University of Dhaka   A substantial number of countries have indicated their interest in collaborating with the World Health Organization (WHO) in reviewing their own health system, and relate this to policy, thus contributing to future development of the assessment of methods and tools.   To provide the health improvement in the past and the present status of some selected indicators, the author has gone through different reports and publications. The Directorate of Health Services published the first organized report in 1985 followed by the 2nd in 1989, third in 1996, fourth in 1998-99 and the fifth in 1999-20001-5. These reports are reviewed here to see the trends of performance indicators in respect of good health. Data from UNICEF’s State of the Worlds’ Children, 1996, 1999 and 2003 are also included6-8. Low Birth Weight Data are obtained from National Low Birth Wight Survey 2003-049. Infant Mortality Rates for the year 1989 to 2003 period are provided from BDHS 200410 . Two other goals of the health sector performance i.e. fair financial contribution and responsiveness were not reviewed here due to lack / shortage of data. Health Attainments Crude Birth and Death Rate (CBR and CDR): The crude birth rate per 1,000 population was 33.6 in 1985. This rate remained unchanged in 1989, followed by a trend of decline up to 2001, where it stood at 19.9 per 1,000 (figure 2). The crude death rate per 1,000 population also showed a decreasing pattern, from 11.6 in 1985 to 4.6 per 1,000 in 2001 (figure 3). Maternal Mortality Ratio (MMR): The data showed a remarkable decline from 7 in 1985 to 3/1000 live births in 2001 (figure 6). There remains a possibility that some of the reported ‘accidental’ deaths might have been included in the MMR.   These days, the long-term measure of good health is life expectancy. For the nation as a whole, life expectancy has increased from just over 53 years at birth to 61 years between 1985 and 2001. Women in developed countries almost always have higher life expectancies than men11.Currently, the worldwide life expectancy for all people is 64.3 years but for males it is 62.7 years while for females, it is 66 years, a difference of more than three years. The sex difference ranges from four to six years in North America and Europe to more than 13 years between men and women in Russia, whereas in Bangladesh females had a lower life expectancy than males till 200111. This reverse statistics indicates a disadvantageous position of women in this society. At the same time, narrowing the gap between life expectancies of male and female over this period indicates that ‘inequality’ and ‘gender discrimination’ issues are being rightly addressed in different health, education and awareness programs. WHO credits this increase in life expectancy to the decline in infant and child mortality due to the successful implementation of certain health programs like immunization as well as disease control programs such as those for ARI and diarrhoeal diseases11. The infant mortality rate (IMR) has been criticizedas a measure of population health because it is narrowly basedand likely to focus the attention of health policy on a smallpart of the population to the exclusion of the rest. More comprehensivemeasures such as disability-adjusted life expectancy (DALE)have come into favor as alternatives. But IMR and DALE data for 1997 obtained from the WorldBank and the World Health Organization for 180countries found a strong (generally) linear association betweenDALE and IMR (r=0.91). Countries with high DALE tend to havea high IMR and so for countrieswith limited resources that require an easily calculatedmeasure of population health, IMR may remain a suitable choice12. The reduction in maternal mortality in the past 15 years is 22%, right on target towards Millennium Development Goal (MDG) of a 75% reduction between 1990 and 201513. However, the Maternal Mortality Ratio (MMR) still remains unacceptably high (320 per 100,000) in Bangladesh, which is one of the highest, even by the standards of other developing countries14. The National Strategy for Maternal Health will be successful only when families are motivated to make use of the medically trained providers for dealing pregnancy related complications15.   The results suggest that Bangladesh has gone far to achieve the targets of MDG, but still there are a lot of formidable challenges to be met. The author admits the limitation of this review. Here only a few indicators were analyzed to show trends in different health status achievements, most of whom were mortality indicators. Different countries are now using composite indicators to evaluate their morbidity and disability status; unavailability of such data did not permit to do such analysis in this review for Bangladesh. References 2.   MOHFW, Directorate General of Health Services, Bangladesh Health Service Report, 1989. 4.   MOHFW, Directorate General of Health Services, Bangladesh Health Bulletin, 1998-99. 6.   UNICEF: The State of the Worlds’ Children, 1993. 8.   UNICEF: The State of the Worlds’ Children, 2003. 10.  NIPORT, Mitra and Associates, ORC Macro, Bangladesh Demographic and Health Survey (BDHS) 2004, Dhaka Bangladesh, and Calverton, Maryland USA: NIPORT, Mitra and Associates and ORC Macro, 2005. 12. Reidpath D D and Allotey P, Infant mortality rate as an indicator of population health, Journal of Epidemiology and Community Health 2003; 57: 344-346. 14. NIPORT, ORC Macro, JHU and ICDDR,B: Bangladesh Maternal Health Services and Maternal Mortality Survey, 2001. 2026 Ibrahim Medical College. All rights reserved.