What's happening in Bangladesh?
What's happening in Bangladesh?
复制标题
孟加拉国正在发生什么？
DOI：
10.1016/s0140-6736(13)62162-5
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
A. Sen
中科院分区：
文献类型：
--
作者：
A. Sen
评论www.柳叶刀。 com 第 382 卷 2013 年 12 月 14 日 1967 年的劳动者，尽管工作安全的忽视已成为该行业记录中的一个巨大污点，但这一严重缺陷只是迟来才得到解决，而且可能还不够强烈。妇女还受到孟加拉国强大的非政府组织 (NGO) 的特别关注——从 BRAC 和格莱珉银行等大型倡议到较小的组织——而动员妇女的积极主动性一直是推动孟加拉国前进的愿景的一个显着特征。独立后的孟加拉国普遍决心消除女性在不同行动领域的不利地位，包括孕产妇和儿童生存。 4 消除女性劣势和利用女性能动性甚至提高了孟加拉国的成就记录，但事实上，妇女能动性也为所有人——男人、女人和儿童——的生活和自由的进步做出了巨大贡献。释放妇女在社会和经济中的积极作用对孟加拉国来说是一项极其富有成效的举措，这与印度大部分地区发生的情况形成鲜明对比。 7 孟加拉国在更多地利用妇女机构方面取得的巨大成就是对玛丽·沃斯通克拉夫特在 1792 年所说的“维护妇女权利”的重要性的显着肯定。 8 事实上，事实证明，消除束缚妇女的社会枷锁对于所有人——无论性别和年龄——的进步都发挥着至关重要的作用。孟加拉国故事的第二个显着特征是公共和私营部门普遍接受多种手段来促进社会快速进步。正如国家举措得到认真落实一样，非政府组织和私营企业也一直在有力地补充公共部门的努力。正如赛义德·马苏德·艾哈迈德 (Syed Masud Ahmed) 及其同事2所言，多元化的运用使孟加拉国能够快速起步，使该国更接近健康转型。这并不是否认，随着时间的推移，孟加拉国发展道路的各种手段将需要严格审查，因为整体的实质性进步可能与卫生转型利益分享方面持续低效和不平等并存。这些评估问题仍然可以接受审查和批判性审查，但必须立即并坚定地认识到，孟加拉国一直在以自己的方式快速前进，而不是因在更多以意识形态为导向的举措中追求“纯粹性”而常常导致的缓慢而陷入瘫痪，这些举措要么完全依赖私营企业，要么专门使用国家计划。孟加拉国通过复杂的政治和社会进程接受的实用主义已经取得了显着的成功，这给世界留下了深刻的印象，并且在很大程度上令世界感到惊讶。第三个特征与第二个特征密切相关，是在提供卫生服务和医疗保健时明智地使用基于社区的方法。正如 Shams El Arifeen 及其合著者3所概述的那样，动员社区参与具有许多优势，不仅有利于促进社会合作，而且有利于扩大卫生倡议的范围及其影响。孟加拉国人能够从卫生服务提供方面的创新中受益，部分原因在于社会变革过程中的这些参与性特征。创新的重要性也......
Comment www. thelancet. com Vol 382 December 14, 2013 1967 labourers, even though the neglect of safety at work has been a huge blot in the record of that industry, a serious deficiency that is only belatedly being addressed, and perhaps not yet strongly enough. Women have also received special attention from Bangladesh’s powerful non-governmental organisations (NGOs)—from large initiatives like BRAC and Grameen Bank to smaller organisations—and the mobilisation of the active agency of women has been a distinctive feature of the vision that has moved Bangladesh forward. And there has been a general determination in post-independence Bangladesh to target the elimination of female disadvantage in different fields of action, including maternal and child survival. 4 The removal of female disadvantage and the use of female agency have raised Bangladesh’s record of achievement even on its own, but it is in fact the case that women’s agency has also contributed greatly to the advancement of the lives and freedoms of all—men, women, and children. The unlocking of the power of women’s active role in the society and in the economy has been an extremely productive move for Bangladesh and contrasts with what has happened in much of India. 7 Bangladesh’s powerful achievement in making much greater use of women’s agency is a remarkable affirmation of the importance of what Mary Wollstonecraft called, in 1792,“the vindication of the rights of woman”. 8 Indeed it turns out that the removal of the social shackles that restrain women has a crucial part to play in the progress of all people—of both sexes and of all ages. A second striking feature of the Bangladesh story is the general acceptance of a multiplicity of instruments in the public and private sectors for rapid social advancement. Just as state initiatives have been seriously undertaken, NGOs and private enterprises have been forcefully supplementing the efforts of the public sector. As Syed Masud Ahmed and colleagues2 argue, the use of pluralism has allowed Bangladesh to get off to a quick start bringing the country a little closer to a health transition. This is not to deny that the mixture of instruments that characterise Bangladesh’s path of development will demand critical examination over time, since substantial overall advancement can coexist with persistent inefficiency and inequalities in the sharing of the benefits of health transition. These evaluative issues remain open to scrutiny and critical examination, but what has to be immediately—and firmly—recognised is that Bangladesh has been, in its own way, going ahead rapidly, rather than remaining paralysed by the slowness that is often entailed by the pursuit of “purity” in more ideologically oriented initiatives which favour either exclusive reliance on private enterprise or exclusive use of state-based programmes. The pragmatism that Bangladesh came to accept through a complex political and social process has yielded noticeable success, which has impressed—and to a considerable extent surprised—the world. A third feature, closely related to the second, is the intelligent use of community-based approaches in the delivery of health services and medical care. As Shams El Arifeen and his coauthors3 outline, the mobilisation of community-based participation has many advantages, not only for the fostering of social cooperation, but also for extending the reach of the health initiatives and their impact. The innovations in health-service delivery from which Bangladeshis have benefited have been possible partly because of these participatory features in the process of social change. The importance of innovations is also …