Bangladesh Demographic and Health Survey:

A key source of informationfor health sector program

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

This presentation contains…

BDHS surveys are designed to provide estimates for HPNSDP program indicators for:

National level

urban and rural areas, and

seven administrative divisions

Aims

Bangladesh FertilitySurvey(BFS)

19751989

Bangladesh Contraceptive Prevalence Survey (CPS)

197919811983198519891991

Bangladesh Demographicand HealthSurvey(BDHS)

1993-941996-971999-2000200420072011

National surveys

Survey design and implementation goes through constant review process by Technical Working Group Sampling Committee Technical Review Committee

Ethical clearance from BMRC

How BDHS produces quality data?

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

How BDHS produces quality data?

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

BDHS

BDHS provides 6 out of 8 indicators

Monitoring progress of HPNSDP

 Indicators

 Baseline

BDHS 2011

Target 2016

Neonatal mortality rateInfant mortality rate (IMR)Under 5 mortality rateTotal fertility rate (TFR)Stunting among <5 children (%)Underweight among <5 children (%)

3752652.74341

3243532.34136

2131482.03833

Goal: Ensure quality and equitable health care for all citizens of Bangladesh

BDHS provides 8 out of 9 indicators

Monitoring progress of HPNSDP

 Indicators

 Baseline

BDHS 2011

Target 2016

Delivery by skilled birth attendantAntenatal care coverage 4+Postnatal care within 48 hours Contraceptive prevalence rateUnmet need for family planningMeasles immunization by 12 months<5 Children with ARI receiving antibioticsChildren (6-59 months) receiving Vitamin A in last 6 months

26%20%21%62%17%82%38%83%

32%26%27%61%12%84%71%60%

50%50%50%72%9%

90%50%90%

Result: Increase utilization of essential HPN services

BDHS provides 2 out of 3 indicators

Monitoring progress of HPNSDP

 Indicators

 Baseline

BDHS 2011

Target 2016

Proportion of births in health facilities by wealth quintiles Use of modern contraceptives in low performing areas

1:8 

Syl:25% Ctg:38%

1:6

 Syl:35% Ctg:45%

<1:4

 Syl &

Ctg:50%

Result: Improve equity in essential HPN service

utilization

BDHS provides 2 out of 2 indicators

Monitoring progress of HPNSDP

 Indicators

 Baseline

BDHS 2011

Target 2016

Rate of exclusive breastfeeding in infants up to 6 months Children 6-23 months fed with appropriate IYCF practices

43% 

42%

64% 

21%

50% 

52%

Result: Improved awareness of healthy behaviour

Targeted programming

3 of 7 divisions are at replacement fertility (RF = 2.1).

Sylhet is 48% and Chittagong is 33% above replacement fertility.

West divisions high CPR

Dhaka & Barisal medium CPR

Eastern divisions (Sylhet & Chittagong) below national CPR.

Targeted programming National

CPR = 61.2

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

New health initiatives

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

New health initiatives

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 assess-ing interventions that can raise age of

marriage and delay childbearing.

New health initiatives

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

New health initiatives

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.

Expansion of health campaigns

Data show no increase in exclusive breast- feeding 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

Legislation

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.”

High level responses

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.”

High level responses

Using BDHS: Feedback from users

“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

Extensive Dissemination of BDHS

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

Extensive Dissemination of BDHS

Dissemination for targeted audience HPNSDP evaluation team Professional bodies Internee medical students Private medical practitioners (unqualified doctors,

pharmacists) Journalists

BDHS: Journalist Program 2010-11

31 articles in national newspapers, 37 articles in local newspapers and 5 television reports were made by the 20 national and local fellow journalists.

Success story 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.

BDHS: Journalist Program 2010-11

Success story 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: Journalist Program 2010-11

Conclusion

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

Thank you

Bangladesh ….on the move to better health