Introduction

Health promotion is a core function of public health and is effective in reducing the burden of
disease (both from communicable and non communicable diseases), and in mitigating the
social and economic impact of such diseases.

WHO support focuses on promotion of

healthy living, creating an empowering environment and generation of evidence for

programmes and policies that aim to reduce lifestyle-based risk factors for individuals as well
as communities.
Country situation
The economic and demographic transition in Bangladesh is increasingly causing adverse
effects on both health and wealth of the population. High consumption of tobacco, changes in
eating habits, increasing substance abuse, lack of physical activity and mushrooming of
unregulated food and beverage industries are behind this increase. Health promotion, though
a priority programme of the Government of Bangladesh, is continually challenged by other
health programmes in terms of resource allocations. Communication channels, both
electronic and print, are channeling information for public consumption. Children are being
appraised by information inclusion in the school curriculum. In spite of all these measures
health promotion is yet to gain the desired momentum, and this is due to dearth in resource
allocation in this area. Taking precedence from other counties, use of dedicated taxes (from
alcohol and tobacco) for health promotion could be a sustainable solution.

UNIVERSAL QUALITY HEALTHCARE

Key massage:

Inadequate healthcare services to the marginalized citizens due to lack of availability of

doctors in rural areas and high cost of services in health facilities.

From a healthcare administration point of view, challenges exist with respect to

accountability, promptness of service and timely decisions regarding strategic
interventions.

Vission:
Quality healthcare services to doorsteps of all citizens.
Outcome:
The capacity and management strength of the healthcare delivery system ensure that citizens
access quality health care services and are adequately prepared for emerging health threats
and challenges.
Strategic Priorities:
HEALTHCARE MANAGEMENT The government will set a holistic healthcare vision and
will design a plan towards a coordinated goal. The Ministry of Health will play a stewardship
role guiding and coordinating efforts. All related departments will ensure better transparency
and accountability ensuring citizens access to health related information and services.
HUMAN RESOURCE AND ACCESS TO KNOWLEDGE The government will focus on
address shortage of ICT manpower. It will put in place proper monitoring system to monitor
attendance, absenteeism and quality of service delivery. Health education will be arranged to
service providers using ICT. Medical faculties will be connected to address remote medical
needs.
HEALTHCARE SERVICES Telemedicine, particularly mobile phone based solutions will
be launched at a national scale to provide medical information, consultation and services. For
clinics and hospitals standard operating procedures will be developed. Patients information
and queue management protocol will be automated. Availability of essential drugs will be
monitored. Health promotion and communication will be strengthened. Systems will be
designed to ensure access to person with disabilities.
HEALTH AND DEMOGRAPHIC INFORMATION National data on health indicators
will be consolidated and updated. To maintain an integrated health record the electronic
health record (EHR) will be developed. The geographical reconnaissance database will be
completed. Access to research reports will be ensured. Health data will be standardized and
cooperation among large health facilities in disease surveillance will be strengthened.

Like most developing countries, Bangladesh also faces significant challenges in ensuring
adequate healthcare services to the marginalized section of the population. Some of the wellknow reasons for that include lack of availability of doctors in rural areas and high cost of
services in health facilities leading to mushrooming of exploitative health-agents in local
communities. From a healthcare administration point of view, challenges exist with respect to
accountability, promptness of service and timely decisions regarding strategic interventions.
The government has been exploring ways of using Information and Communication
Technologies (ICTs) for addressing these challenges with some innovative initiatives and
setting grounds for broad level changes in healthcare service delivery mechanisms and
administrative reforms.
The Government of Bangladesh has placed a high priority on e-Health, which is reflected in
the ICT Policy 2009. The strategic areas/issues relevant to health in the ICT Policy 2009
include the following (Clauses 7.1-7.4 of ICT Policy):

Improve healthcare delivery management through use of telemedicine and modern

technology
Create awareness at all levels, including hard-to-reach areas with particular importance in
making maternal, child and reproductive care available.

Ensure quality of care

Increase the capacity of health care delivery system

The Policy details a breakdown under each of these priority areas and provides targets to be
achieved at the end of each term. While this is a positive way forward in planning specific
ICT interventions, it is also important to match up the priorities with goals set in HNPSP and
the new National Health Policy so that all guiding documents point to a definite direction and
its execution is clear to the implementers, both in public and private sector. Specifically,
clause 16 of the NHP 2010 emphasizes on the provisions of the ICT Policy of 2009 and the
Vision 2021 for Digital Bangladesh.

The NSAPR II emphasizes the need for the government to focus on effective service delivery
and preparedness for emerging health threats and challenges. The NSAPR II also identifies
affordable, attainable and acceptable quality health care, nutrition and family welfare
services, increased health status, reduced health inequalities, expanded access to social safety
net (with specific focus on the poor and the vulnerable), and affordable service delivery as
governments priority areas at a macro level. It is important to specify actionable areas
through which quality of health, better equality, social safety net, community participation
and ownership in this sector can be ensured.
The government emphasizes on ensuring health facilities to all citizens, adoption of a revised
health policy, operationalizing the 18,000 community clinics, updating the population policy
and addressing birth control and reproductive health accordingly, addressing the arsenic
problem by supplying pure drinking water and providing sanitation facilities in every
household, and devising an appropriate pharmaceutical policy.
While national policies and visions constitute guiding documents for implementation in the
health sector, international commitments such as the millennium development goals (MDGs)
also play an important role in setting national priorities. MDGs 4, 5, 6 and 8E have direct
implications for the health sector.

VISION
Quality healthcare services to doorsteps of all citizens.
OUTCOME STATEMENT
The capacity and management strength of the healthcare delivery system ensure that citizens
access quality health care services and the system adequately prepared for emerging health
threats and challenges.
SITUATION ANALYSIS
The Ministry of Health and Family Planning has made significant progress with respect to
developing management information systems in health care. The Department of Health and

the Department of Family Planning both have dedicated ICT personnel for managing and
constantly improving their systems.
DEPARTMENT OF HEALTH SERVICES
Increased connectivity: The Bangladesh government connected 800 health care facilities in
May 2009 and other access points through the Internet with the aim to improve health
systems efficiency. All facilities from Upazilla and upwards are included in this scheme and
are connected through unlimited wireless connectivity.
Telemedicine: People in rural Bangladesh struggle to access timely and quality medical
service either due to the distance of the health care facilities, or due to lack of adequate
medical providers. Telemedicine or tele-health enables patients-providers to exchange
information, which leads to an appropriate diagnosis and treatment plan that can then be
administered by moderately trained health staff or even the patient alone.
Provisions are being created for video conferencing with civil surgeons. The government is
planning to provide mini laptops for 18,000 community clinics and to train staff to utilize the
tools for appropriate situations. This initiative will offer web conferencing which will address
a number of challenges related to professional consultation currently faced by medical
professionals in remote communities.
Mobile phone health service for emergency situations is also a project that was launched in
May 2009 with an aim to enable qualified government doctors to provide free medical
advice. A mobile phone device was given to all 64 district hospitals and 418 upazila hospitals
and one doctor on roster attends calls. Phone numbers are disseminated through local
channels and website.
Training and capacity building of health workforce: A state-of-the-art digital training
facility has been created at the health directorate with all modern facilities.
Health promotion and education to community people: A rich indigenous health content is
being developed for dissemination among all community clinics and upazila health outlets. M
Health (i.e. mobile-based health systems) tools are also being utilized for health promotion
and awareness. Non-government agencies through health workers and information workers

(e.g., info-ladies) promote basic health care information targeting prevention and linking with
health care institutions in case of need.
Patient management and communication with staff: SMS services are soon to be launched
for management of TB patients, queue management, receiving complaints, instructions to
health managers and staff, and email and data communication.
Geographic Information System: Health facility information is being recorded on Google
maps and is made available online for all locations in the country. The aim of the GIS facility
is to also map disease surveillance and health services availability.
Citizens permanent electronic registry for demographic and health information: This is
an initiative that the government aims to complete in 2-3 years beginning from FY 2010-11.
Health workers will collect household data using specially designed paper forms or the
Geographic Reconnaissance (GR) form with Intelligent Character Recognition (ICR)
capabilities for digitization of data. Data entry will be done by ICR machines. The aim is to
create a comprehensive national online database with demographic and health record for all
citizens of the country.
SERVICE PRIORITIES
Telemedicine/Tele-health: Telemedicine is the use of telecommunications to provide
medical information and services in a variety of contexts. Almost all specialties of medicine
have been found to be conducive to tele-consultation: psychiatry, internal medicine,
rehabilitation, cardiology, pediatrics, obstetrics, gynecology and neurology and other
diseases. The government will take steps to allow tele-consultation to get access to remote
medical advice from doctors based in Dhaka or other national and international locations.
Following are areas that can be explored for specific initiatives on telemedicine:

Utilize opportunities such as the SAARC Telemedicine Network

Treatment compliance and follow up for conditions such as Tuberculosis and Diabetes

Proper implementation of following up with pregnant women through mobile

communication.

Development of Standard Operating Procedures for clinics and hospitals: One of the
longer term goals for efficient operation of e-Health can be ensured by devising Standard
Operating Procedures (SOP) for all public and private hospitals. This would enable better
exchange of data and services between primary, secondary and tertiary care facilities.
Automated patient management protocol: Patient information and queue management is a
necessary tool to bring about discipline and system in large public hospitals such as DMCH,
BSMMU, etc. Such systems are already operational in some large private and semi-public
institutions like BIRDEM, United Hospital, Square Hospital, Apollo Hospital, etc. The
government will automate the internal systems in its public hospitals in a phase-wise
approach, starting with in-patients.
Monitoring of availability of essential drugs: Making essential drugs available to the needy
is a critical function of the government. The government will develop a strategy to keep an
updated database of essential drugs and its distribution. Mobile-phone based tracking system,
where citizens can access to information related to availability of free medicine and stock
status will be introduced to bring intransparency and ensure proper distribution.
Central database of blood supply sources: Crisis of safe blood supply in times of
emergency has been one of the causes of death or delayed care. A central repository of
information on availability of different blood groups can be maintained by connecting all the
certified blood banks.
Health promotion and health communication: The phenomena of rise in prevalence of
chronic diseases and increased awareness on healthy living have re-emphasized the need for
health promotion and health communication. Historically, Bangladesh has effectively
employed a number of innovative approaches in using ICT media to disseminate important
health and behavioural messages and raise awareness, both in the public and private arena.
Lessons from those campaigns will form the foundation for ICT media planning for the
future. The government will use various ICT channels for raising awareness about potential
health hazards and preventive measures.
Some relevant examples are family planning messages, video clips with first aid and quick
response manuals e.g. what to do in case of snake bite, drowning, burn, etc. that are typical
causes of accidents, and also video clips with messages on preventive behaviour, such as

what to do to avoid contracting infectious diseases such as swine flu, malaria, tuberculosis,
and HIV/AIDS.
Addressing needs of the disabled and marginalized: When a system is designed to meet
the needs of the marginalized, disabled and the hard-to-reach population, it automatically
covers the needs of the able and privileged population. One of the priorities that will be kept
into consideration is design of e-Health systems according to the needs of the most
disadvantaged.
Mission mode programmes: The government will undertake mission-mode programmes for
specific diseases or specific target groups for achieving certain targets set in MDGs and
HSNSP, where ICTs will be integrated for making services reached to the target audiences
and ensure complete cycle of being informed up to accessing quality treatment. For example,
programme for reducing maternal and neo-natal death as per national and MDG targets.
PARTNERSHIP STRATEGY
The following areas represent possible areas of multi-stakeholder partnership, the
stakeholders and their respective roles:
Local Access to Health Information and Services: Three kinds of organizations will be
invited to work together to provide local access to health services through ICT systems 1)
those that have ICT facilities at local level such as telecenters; 2) those that have the relevant
health content or medical algorithms; 3) those that actually provide various health services
directly.
Mobile-based Tele-consultation: Health organizations can also partner up with organizations
that provide mobile-phone based teleconsultation services either on the basis of phone calls
or data sent from the ground level.
Online or ICT Systems-based Skills Up-gradation for Medical Professionals: Health
organizations can also partner up with institutions which provide customized capacity
building or training services through ICT-based systems. International programmes in the
area of health care promotion will be invited to collaborate with national agencies both in the
government and non-government sector. Bi-lateral and multilateral development partners and
country government-led initiatives will be approached for contributing in all types of resource

mobilization - financial, technical and intellectual. For example, building partnership with
Mobiles for Health Initiative of White House will be useful in addressing specific challenges
in the areas of maternal and child health care.