Bangladesh: Innovation for Universal Health Coverage 1 The Bangladesh paradox: exceptional health achievement despite economic poverty
Bangladesh: Innovation for Universal Health Coverage 1 The Bangladesh paradox: exceptional health achievement despite economic poverty
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DOI：
10.1016/s0140-6736(13)62148-0
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发表时间：
2013-11-23
期刊：
影响因子：
168.9
通讯作者：
Chen, Lincoln C.
中科院分区：
文献类型：
--
作者：
Chowdhury, A. Mushtaque R.;Bhuiya, Abbas;Chen, Lincoln C.
孟加拉国是世界上第八大人口大国，人口约1.53亿，最近被誉为杰出的健康表演者。在本系列的第一篇论文中，我们提出证据表明孟加拉国在健康方面取得了实质性进展，但不能简单地概括该国的成功，因为孟加拉国的健康存在出生率和死亡率的急剧和持续下降以及持续的发病率负担这一悖论。取得如此出色的成绩可能要归功于一个多元化的保健系统，许多利益攸关方通过广泛部署到所有家庭的社区保健工作者的工作，在计划生育、免疫接种、口服补液疗法、妇幼保健、结核病、维生素A补充和其他活动中推行以妇女为中心、注重性别平等和高度重视的保健方案。政府和非政府组织开创了许多创新，并在全国范围内推广。然而，这些在公平和覆盖率方面的显著成就被儿童和产妇营养不良的持续存在以及对与产妇有关的服务的低使用率所抵消。孟加拉悖论显示了成功的直接卫生行动在健康的积极和消极社会决定因素方面的净结果--即妇女赋权、普及教育和减轻自然灾害影响等积极因素；以及国内生产总值低、普遍贫困和持续存在的收入不平等等消极因素。孟加拉国提供了一些经验教训，如性别平等如何改善卫生结果、如何扩大卫生创新以及直接卫生干预措施如何部分克服社会经济制约因素。
Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health-ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints.