SOUTH ASIAN CONFERENCE ON CHILDREN BANGLADESH SITUATION ANALYSIS
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SOUTH ASIAN CONFERENCE
ON CHILDREN
BANGLADESH SITUATION ANALYSIS - extracted text
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CH'
SDA-RF-CH-1B.3
SOUTH ASIAN CONFERENCE
ON CHILDREN
BANGLADESH SITUATION ANALYSIS
ECONOMY
CHAPTER 1
AREA
Bangladesh has a surface area of 55,598 sq. miles of which
about 15 percent is covered by forest and 20 percent by rivers,
lakes ponds, tidal creeks, roads, buildings, and homesteads.
About 65 percent of the total area is classified as cultivable.
In 1983/84 about 60 percent of the total area or 33,400 sq.
miles was actually cultivated.
POPULATION
The population of Bangladesh increased from about 50.8
million in 1961 to 87.1 million in 1981. The intercensal growth
rates for the 1961-74 and 1974-81 periods were 2.6 and 2.8
percent respectively. The growth rate for the Second Five-Year
Plan period (1980-85) was 2.6 percent; it is projected to drop
to 1.8 percent for the Third Five Year Plan period (1985-90).
The total population is projected to increase from an estimated
100.5 million in 1985 to 139.7 million by the year 2000.
Table 1).
(See
Two noteworthy features are a very high population density
(See Table 2) and a rapid rate of urban growth (See Table 3).
Except for the ’city states' Bangladesh has the highest
population density in the world (1807 per sq. mile in 1985).
Its urban population has grown from about 2.1 million in 1961
(3.8 percent of total population) to 7.5 million in 1985 (17.4
percent of total population) and is projected to reach 37.3
million (26.4 percent of total population) by the year 2000.
The urban growth is primarily due to "push" factors such as
.pervasive poverty and widespread unemployment in the ruralareas.
The under-15 years population was an estimated 44.5
*—
—.——— million or about 44.2 percent of total in 1985. The under-5
population was an estimated 15.9 million or 15.8 percent of
total in 1985.
2
5'
EMPLOYMENT
The Bangladeshi labour force of 28.2 million comprised
about 30 percent of its total population in 1984. Of this
number some 58.5 percent were employed in agriculture, forestry,
and fisheries and another 8.7 percent in manufacturing.
The labour force structure for 1984 indicates a very low
female participation rate of 8 percent compared to 76.8 percent
for males.
The situation is, however, improving, as indicated
by a more than doubling in the female participation rates
between 1974 and 1984, and the increase in the proportion of
females in the total labour force from 4.1 percent to 8.9
percent during this period.
The improving trend is likely to
continue due to the pervasive poverty situation in rural areas,
increasing migration to urban areas, improvements in female
literacy and educational opportunities, and government policies
promoting women’s employment.
Another disturbing feature of the employment situation is
the large number of school-age children in the labour force.
It
appears that in 1984 there were 3.7 million children under 14
years in the labour force of whom about 600,000 were in the 5-9
age group.
It seems that up to 350f000 children under 14 years
could be working in urban areas, with girls constituting about
one-third of this total. Comparisons with 1974 data indicate a
^slow but steady growth in child participation in the labour
(See Table 4) The high population growth rates, the
yiforce.
high dependency ratio, endemic rural poverty, and the associated
rural-urban migration have contributed to this situation.
GROSS DOMESTIC PRODUCT(GDP)
The Gross Domestic Product at factor cost increased by an
average of 4.7 percent yearly between 1972/73 and 1984/85 when
\it stood at Taka 328,340 million. The GDP is projected to grow
3
by 5.4wpercent yearly to Taka 427,100 million (at 1984/85 factor
cost) by the last year of the Third Plan (1989/90). Per capita
GDP at factor cost would therefore be Taka 3,267 (about US$123)
in 1985, rising to a projected Taka 3,780 by 1990.
During the 1972/73 to 1984/85 period the 3.8 percent
average annual growth rate in the agricultural sector was less
than the 4.7 percent GDP growth rate, and its share of GDP
declined from 60.1 to 54.3 percent. The industrial sector did
better with a 6.2 percent growth rate, and its GDP share
increased from 7.3 to 8,6 percent. The rest of the economy
grew by a yearly average of 5.8 percent and saw its share
increase from 30.6 to 37.1 percent.
By 1989/90 the agricultural share of the GDP is projected
to decline further to 46.9 percent; industry will increase
somewhat to 10.1 percent, and the rest of the economy will have
an increased share of 43 percent of GDP.
INCOME DISTRIBUTION
The 4.7 percent GDP growth rate was encouraging but never
theless not quite enough to have any significant impact on
poverty reduction or on income distribution. The extent of
poverty varies according to the indicators used. According to
one estimate the proportion of functionally landless (owning
less than 0.5 acres) rural households increased from 35 percent
or 2.9 million households in 1960 to 46 percent or 6.2 million
households in 1984.
Another estimate based on minimum FAO recommendations of
poverty line incomes (minimum calorie needs plus basic needs
items) indicates that the number of rural households below the
poverty line went up from 75 percent in 1963/64 to 83 percent
in^1976/77. (See Table 5) There appears to be no significant
improvement in the situation since then.
4
In 1963/64 the share of national income enjoyed by the
highest: 20 percent and lowest 20 percent of the population was
45.7 percent and 7.7 percent respectively; by 1981/82 the
corresponding distribution was 45.3 percent and 6.6 percent
respectively. For rural areas the figures were 42 percent and
8.5 percent for 1963/64 and 42.4 percent and 7.1 percent for
V
1981/82.
FOOD PRODUCTION
This endemic poverty and unbalanced income distribution
may explain why the nutrition situation in rural Bangladesh
appears to have deteriorated over the years despite the
encouraging fact that foodgrains production in Bangladesh has
increased from^9.9 milliori^tonnes in 1972/73 to 16.1 million
tonnes in 1984/85. This 3.8 percent annual growth rate in food
production thus kept somewhat ahead of the population growth
rate during the same^period. Bangladesh^ which produced about
87.5 percent of its food grains requirements in 1985, plans to
attain self-sufficiency with a 20.7 million tonnes production (
*-------------- ---------------------------- -
target by 1990.
■
•
(See Table 6 for agricultural trends).
The
production of fish, pulses, and vegetables have registered
dramatic decline in the period since 1979/80, and the per
/
.f
j
capita availability of these key nutritional foods has gone /
down sharply.
This distressing trend merits serious government
attention, which may be concentrating too much on the macro
aspects of foodgrains and cash crops production.
There is scope for increased crop production through
improvements in cropping intensity and crop yields.
------ --- ----- -------------------
In 1983/84
chemical plant protection measures covered only about 10 percent
of the net cropped area; the ratio of gross cropped area to net
cropped area was only 1.53; and less than 23 percent: of the net
In ‘1984/85 the intensity of
cropped area was under irrigation.
fertilizer use wasonly 21". 1 kg per acre compared to 28.7 kg
for Sri Lanka and 114 kg per acre for South Korea; paddy yield
per acre was about 815 kg in Bangladesh, 1170 kg in Sri Lanka
and 2490 kg in South Korea.
5
TRADE ftND AID
Bangladesh has traditionally had a rather large negative
trade balance, with its exports fluctuating at between 30 to 40
In 1984/85 the country
percent of the value of imports.
exported items worth US$ 971 million and imported goods worth
US$2,647 million. The major exports are raw jute and jute
goods, tea, leather, fish and shrimp, and garments. The major
imports are capital goods, food grains, crude oil and petroleum
products, fertilizers, yarn and textiles, and edible oils, A
noteworthy feature has been the growth in remittances from
Bangladeshi nationals abroad, primarily those working in the
Middle East. Foreign exchange earnings from this source peaked
at US$598 million in 1982/83 but was lower at US$398 million in
1984/85.
Debt service payments have increased steadily in both
absolute terms and as a percentage of total export earnings.
In 1984/85 they stood at US$170 million or 18.1 percent of
export earnings. The total outstanding debt of Bangladesh
stood at US$5,268 million as of June 1985; this was about 42.5
percent of 1984/85 GDP at factor cost.
The country is heavily dependent on foreign aid and loans
X__________________
to fill both its export/import~gap and its savings/investment
gap. Foreign aid constituted nearly 71.9 percent of total plan
size during the First Plan period (1973-78), 76.8 percent during
the Two Year-Plan (1978-80), and 63.5 percent during the Second
Plan (1980-85). For the Third Plan period (1985-90) foreign
aid, projected at US$7,245 million, will account for 54.5
percent of total plan outlay (76.2 percent of public sector
outlay and 14.5 percent of private sector outlay).
■-------------------------- ------------------ -- ------------------------------------------------------------------------------------------------------------------------------------------ -
6
THIRD fIVE-YEAR PLAN: 1985-90
The major socio-economic imperatives governing the Second
Plan period (1980-85) were endemic poverty, mass
mass. .unemployment,
malnutrition, illijtexacy, rapid pogulatign growth, an inadequate
nati_onLaJL^esojinc£ base, and a heavy dependence on. foreign aid.
These imperatives continue to be significant for the Third Plan
period.
Poverty alleviation remains the primary objective of the
Third Plan. The related major objectives are: reduction of
population^growth (to 1.8 percent by 1990); expansion of
productiv£_employment (5.1 million new jobs by 1990); national
food selX^sujfficiency (foodgrain production to rise to 20.7
million tonnes by 1990); the univer^aLization of primary
education (enrolment to reach 11.6 million pupils, equivalent
ZP_pgrcent of primary school age-group children, by 1990);
satisfaction of the minimum basic, needs of the people;
acceleration of ^economi^growth (GDP growth rate of 5.4
percent); the development of human resources; the development
of a technolggicalbase for long-term structural change; and
the promotion of self-reliance.
To finance the Third Plan the following resource will be
needed:
Public Sector
(Million Taka)
Private Sector
Total
Foreign Aid
190,400(76.2$)
19,880(14.5*)
210,280(54.5*)
Domestic Resources
59,600(23.8*) 116,120(85.5*)
175,720(45.5*)
Total
250,000(100*)
386,000(100*)
136,000(100*)
(Public Sector 65*; Private Sector 35*; Total 100*)
7
S_£e Table 7 for the sectoral allocation during the Third
Plan period. Of the social development sectors of particular
f— _______________ _— ------------------------------------------------------- relevance to child survival and developnienX—liealth gets 2.2
percent^of .total ^ubJLii^ou^lay; primary education gets 2.2
percent.; rural water supply and sanitation gets 0.3 percent;
-------------women's jjeyelopment gets 0.2 percent; and social welfare gets
0.3 percent.
Population Control and Family Planning gets 3.5
percent of total public sector outlay. Block allocations to
local development councils are unlikely to effect any
significant changes in the relative allocations to the above
areas. The primary concentration is on agriculture and
irj^igatiMj energy and natural resources, industries
and
-----minerals, and transport and communications.
-:
Table 1: Population projection-by
1985
1990
1995
(Th
0-4
5-9
10-14
15-24
25-34
35-
T 88507
T 15093
T 14317
T 11687
T 15566
T 11432
T 80
M 45582
M
7599
M
7250
M
6158
M
7800
M
5788
M 42
F 42925
F
7494
F
7067
F
5529
F
7766
F
5644
F 37
T100468
T 15859
M 51754
M
F 48714
F
T113005
T 16548
M 58213
M
8g35
M
7977
F 54792
F
8013
F
7372
T126341
T 17463
M 65063
M
F 61278
F
T 139693
T 17561
T 17110
71916
M
8983
M
67777
F
8578
F
2000
F
*
Source:
sex and age group 1980 - 2000
Total
Year
1980
8
T 14499
T 14118
T 19942
T 12850
T 92
8207
M
7336
M
7162
M 10391
M
6362
M 48
7652
F
7163
F
6956
F
F
6488
F 44
9551
T 14329
T 25242
T 14870
T107
M
7261
M 13060
M
7478
M 54
F
7068
F 12182
F
7392
F 52
T 16117
T 15198
T 27850
T 19174
T1218
8963
M
8345
M
7909
M 14173
M 10022
M 605
8500
F
7772
F
7289
F 13677
F
9152
F 612
T 15988
T 28960
T 24413
T1420
8813
M
8288
M 14952
M 12666
M 717
8297
F
7700
F 14008
F 11747
F 703
T 15349
Statistical Yearbook of Bangladesh: 1984-85. Bangladesh Bureau of Statistics
-:
9
T
:-
Table 2^Population Projection & Density by Regions (Old Districts): 1961-90
Regions(Old
Districts)
Area(sq.
miles)
1. Bandarban
1738
2. Chittagong
2879
3201
(1112)
3. CHTs
3351
4. Comilla
1961
1974
Populations (1000)
|
1981
~~~1985
1990
178
(102)
198
(114)
224
(129)
4683
(1627)
5729
(1990)
6332
(2199)
7122
(2474)
414
(124)
547
(163)
606
(181)
669
(200)
752
(224)
2549
4106
(1846)
6255
(2454)
7179
(2816)
7935
(3113)
8925
(3501)
5. Noakhali
2108
2558
(1213)
3482
(1652)
3981
(1889)
4401
(2088)
4951
(2349)
6. Sylhet
4911
3741
(762)
5115
(1042)
5901
(1202)
6523
(1328)
7337
(1494)
7, Dhaka
2884
5465
(1895)
8327
(2887)
10448
(3623)
11548
(4004)
12989
. (4504)
8. Faridpur
2657
3409
(1283)
4360
(1641)
4971
(1871)
5497
(2069)
6179
(2326)
9, Jamalpur
1293
2559
(1979)
2829
(2188)
3181
(2060)
10. Mymensingh
3733
5933
(1589)
8127
(2177)
6852
(1836)
7574
(2029)
8519
(2282)
11. Tangail
1314
1592
(1212)
2226
(1694)
2549
(1940)
2816
(2143)
3167
(2410)
12. Barisal
2818
3289
(1167)
4221
(1498)
4869
(1728)
5382
(1910)
6053
(2148)
13. Jessore
2538
2351
(926)
3574
(1408)
4194
(1652)
4636
(1827)
5214
(2054)
-:
Regions (Old
Districts)
Area (sq.
miles)
10
:-
1961
Populations (*000)_____
1974
1981
1985
1990
14. Khulna
4698
2529
(538)
3875
(825)
4517
(961)
4993
(1063)
5616
(1195)
15. Kushtia
1328
1249
(941)
2018
(1520)
2391
(1800)
2643
(1990)
2973
(2239)
16. Patuakhali
1581
1281
(810)
1617
(1023)
1923
(1216)
2125
(1344)
2391
(1512)
17. Bogra
1501
1691
(1127)
2396
(1596)
2846
(1896)
3146
(2096)
3539
(2358)
18. Dinajpur
2535
1832
(723)
2758
(1088)
3338
(1317)
3690
(1456)
4153
(1638)
19. Pabna
1827
2100
(1149)
3020
(1653)
3573
(1956)
3950
(2162)
4443
(2432)
20. Rajshahi
3651
3016
(826)
4583
(1255)
5498
(1506)
6077
(1664)
6834
(1872)
21. Rangpur
3705
4074
(1100)
5847
(1578)
6792
(1833)
7507
(2026)
8443
(2279)
55,598
54531
(981)
77031
(1315)
90894
(1634)
100468
(1807)
113005
(2033)
Bangladesh
Note:
Figures in parenthesis indicate density.
Source:
Statistical Yearbook of Bangladesh: 1984-85. Bangladesh
Bureau of Statistics, pp 59 and 143.
11
- ***
Table 3: Distribution of Population by Rural and Urban Areas: 1961-2000
Total Po
pulation
(Millions)
Urban Po
pulation
(Millions)
Rural Po
pulation
(Millions)
Urban
Growth
(% p.a.)
Share of Urban
to Total Popu
lation (%)_/a
1961
54.5
2.1
52.4
2.1
3.8
1974
76.4
6.8
69.6
9.5
8.9
1981
90.0
13.5
76.5
10.3
15.1
1985
100.6
17.5
83.1
6.5
17.4
1990
113.7
22.9
90.8
5.4
20.1
1995
126.8
29.4
97.4
5.0
23.2
2000
141.1
37.3
103.8
4.8
26.4
/a
Values for the percentage of urban population after 1981- ■
are taken from the UN urban/rural projections, adjusted
for the revised 1981 percentage of urban population taken
from 1981 census results.
Source: Bangladesh: Recent Economic Developments and Medium Term
Prospects. Vol 1. World Bank, 17 May 1986, p. 149.
14
/
Tgfole 7- Third Plan Sectoral Allocation (1984-85 Prices)
Sector
(Million Jlakh')____
Private
Public
'Sector
Sector
Total
1
2
Agriculture, Water Resources & Rural Development 70,600
44,000
114,600
Industries & Minerals Development.
26,000
32,000
58,000
3
Energy & Natural Resources.
56,750
5,000
61,750
4
Transport and Communication.
30,250
15,000
45,250
5
Physical Planning, Housing & Water Supply.
5,500
36,500
42,000
6
Education & Religious Affairs
12,200
1,500
13,700
7
Health
5,500
500
6,000
8
Population Control & Family
8,700
700
9,400
o
SCYSWAM
3,070
150
3,220
(a) Social welfare
750
(b) Women,s Affairs
500
(c) Youth Development
170
170
(d) Mass Media
500
500
(e) Cultural Development
510
510
(f) Development of sports
640
640
10. STR
600
600
11. Manpower & Labour
930
930
12. Public Administration
650
650
13. Block Allocation
750
150
650
29,250
29,250
(a) Upazila Infrastructure
10,000
10,000
(b) Upazila & Zila Dev. Assistance Fund
12,500
12,500
(c) Pourashava
920
.920
(d) CHT
2,130
2,130
(e) CDST
1,200
1,200
(f) ATAP
2,500
2,500
14. Other Sectors
250,000
Source:
650
650
136,000
386,000
Thrrd Five Year Plan: 1985-90, Planning Commission, Ministrv
of Planning, Government of Bangladesh, Dhaka, December 1985-,
Table 6, p. 32.
15
CHAPTER 2
PRIMARY EDUCATION
The education system of Bangladesh comprises about 50,000
institutions, 250,000 teachers and administrators and over 10
million students. At the base of the system is the primary
school which lasts for five years and is intended for 6-10 year
old children.
Of the approximately 47_^000 primary schools in
the country, around 80 percent are Government schools where no
f^es are charged and the teachers are Government employees.
Other types of primary schools include a small number of
government-recognized private fee-paying schools predominantly
in urban areas, non-recognized private primary schools which do
not meet government requirements for teacher and curriculum
standards, and the Ibtedaee which are part of the parallel
Madrasah religious education system.
Between 1^72 and 1^84^the number of primary schools
(Government and Government-recognized) increased from 31,613 to
43,162, an increase of 37 percent. The School Mapping exercise
carried out in 1981-83 revealed that 87 percent of the
/
country's school-age children had a primary school within two //
miles. Unfortunately it al~so revealed a number of les^satisfactory factors: there was an average of only two class
rooms per school; 73 percent of schools were in~~need of major
repaTrs^or Tfbtal reconstruction; 78 percent of schools were
unusable during the wet season (about half the academic year);
30^percent were unusable throughout the year; 15 percent of
schools has no outside walls, 37 percent had not partitions, 7
percent had no roofs, and 77 percent had dirt floors or floors
of hardened earth; only about 21 percent of schools Jiad working
tubewells on the premises; and only about 6 percent had working
toilets.
16
The above situation refers to Government schools. For the
vast majority of non-government schools the situation is thought
to^be^worse. The general picture appears to be of a school
environment that is crowded, uncomfortable, unsanitary, and with
insufficient teachers and inadequate teaching/learning
materials.
There appears to be_no noticeable rural/urban bias in the
relative distribution of schools. One source indicates that in
1981 about 92 percent of primary schools were in rural areas
and 8 percent in urban. Another source indicates that in 1983
the teacher/pupil ratio in rural and urban schools was about
the same (1/50 and 1/51 respectively). The teachers per school
and the pupils per school (also the enrolment rate) was higher
in urban than in rural areas.
The proportion of female teachers was still only about
12jJ7_^per^eiit^of the total of nearly 184,000 primary school
feachers in 1984; this despite a slightly more than nine-fold
increase in female teachers since 1971.
There is need for
further improvement, particularly if female enrolment ratios
are to be improved. (See Table 1).
Enrolment figures have tended to be somewhat unreliable
and inconsTs^tent and can only be used as a rough indication. In
1985 the school age population (6-10) was estimated by the
Planning Commission to be in the region of 14.8 million with
enrolment around 9 million giving a GER of approximately 60
percent. Even this comparatively low figure does not give a
true picture as many of those enrolled are over—age children
and some are pre-schoolers. The number of pre-schoolers in the
unrecognized but tolerated "baby” sections within grade-1 in
most primary schools is thought to constitute up to 50 percent
of total grade-1 enrolment.
17
Primary school enrolment increased by 628,000 pupils or
7.6 percent overall to a level of 8.92 million pupils during
the Second Plan (1980-85). This is rather low considering the
increased attention given to Universal Primary Education during
this period. During the Third Plan period (1985-90) total
primary school enrolment is projected to increase by about 2.72
million or about 30.5 percent overall to a level of about 11.64
million pupils or 70 percent of primary school age children.
An encouraging feature is the increase in the number of
l
girl pupils from 32 percent of total primary school enrolment II
in 1971 to 41 percent in 1984.
During the Second Plan period ll
itself the figure went up by only 1.8 percent, and, to achieve
this, total female enrolment had to improve by about 25
percent. With regard to gender participation rates one source
indicates that in the period 1970-81 the participation rate of
girls went up from 38 to 56 percent and that of boys from 53 to
68 percent.
Social, religious and economic barriers affect the
enrolment of girls though many of these are being gradually
overcome.
In addition the fact that only a small proportion of
teachers have been women has acted as a further discouragement
to parents though once again attitudes are changing and
moreover, in accordance with official policy, more female
teachers are being recruited.
In Bangladesh the poor quality of classroom teaching
coupled with a somewhat rigid (and not very useful) testing
system at the end of each Gra^FTesult in a high rate of
repeaters among enrolled children. A sample survey carried out
as part of the School Mapping exercise in 1983 found that out
of the total enrolment (797,796 children) 20 percent were
reported as being repeaters. The phenomenon was most
noticeable in Grade-1 and diminished with each Grade as the
following Table shows.
18
TABLE 2
REPETITION RATES BY GRADE
Grade
Enrolment as
% of total •
Percentage of
Repeaters
Repeaters in Grade
as % of Totai
I
II
III
IV
V
41.6
19.6
16.6
50
12.4
9.7
24
19
17
17
14
100.0
20
100
I
V
Source:
17
14
11
7
School Maps, Facilities Department, Table-9
No figures are available on how many children are more
than first time repeaters (within the same Grade or in earlier
Grades) but the simple fact that 20 percent of all enrolled
children are repeaters and that half of these are in Grade-1
points to a serious enough problem. Although the general
practice in schools seems to be that children who spent a year
in the "baby class" do not get classified as repeaters when
they enter Grade-1 proper the following year, the high
percentage of repeaters in Grade-I may be the result of the
"baby class".
Although initial enrolment in Grade-1 is reasonably high
(partly swelled by the so-called baby class), there is a
dramatic decline in subsequent Grades due to repetition and
It has been estimated that out of every 100
drop-outs.
children that enrol in Grade-1, less than 20 reach Grade-5. The
dropout problem is particularly severe in Grades-1 and 2 (where
it could be as high as about 37 percent and 22 percent
respectively) but continues throughout the five year cycle.
19
TABLE 1
NUMBER OF TEACHERS IN PRIMARY SCHOOLS 1951-1984
Year
____ Number of Teachers
Total
Male ____ Female
Percent
Female
Teachers
per school
Pupils
per teache
1951
64,815
61,942
2,873
4.4
2.46
36
1961
80,524
78,803
1,721
2.1
3.02
41
1971
117,275
114,734
2,541
2.2
4.08
43
1972
136,508
133,270
3,238
2.4
4.32
47
1973
155,742
151,806
3,936
2.5
4.26
50
1974
150,267
144,378
5,889
3.9
4.10
52
1975
164,617
156,220
8,397
5.1
4.12
51
1976
172,448
163,690
8,758
5.1
4.28
1977
48
174,384
163,537
10,847
6.2
4.24
48
1978
171,024
157,176
13,848
8.1
4.09
1979
44
172,781
158,560
14,221
8.2
4.07
45
1980
174,161
159,323
14,838
8.5
4.09
1981
46
174,447
158,821
15,626
9.0
4.11
47
1982
175,871
158,830
17,041
9.7
4.12
1983
49
178,589
158,028
20,561
11.5
4.15
50
1984
183,$58
160,386
23,272
12.7
4.25
52
Increase
66,383
45,652
20,731
1971-84
56.6%
39.8%
X 9
Source:
Based on BBS Table 1.2
20
PRE-SQHOOL LEARNING
As far as the Education Sector is concerned, any form of
pre-school—Activity in the Government sector, be it formal or
informal, has been discouraged since it is feared that it would
lead to demands for institutionalizing and -f-o-rmaj izing a
pre-school class which the Government ^eel^-Lt—ea^mt^afford
ee
when it already faces such tremendous organizational and
financial problems in dealing with the normal primary schools.
Despite official positions, however, pre-school education is a
The last few
growing sector, both openly as well as hidden.
years have seen a veritable explosion in the number of private
pre-schools and kindergartens catering mostly to the middle and
upper classes and located predominantly in urban areas. The
phenomenon is largely the result of the intense competition
that has developed for admission to the better Government and,
especially, private primary schools.
In absolute terms, however, the numbers involved are small.
In 1982/83 there were 407 pre-primary schools with 3,026
teachers and 59,136 pupils.
The vast majority of these schools
are in urban areas, some 39 percent in the Dhaka Metropolitan
area itself.
Reference has already been made to the "baby class" of
pre-schoolers who accompany their elder siblings to school and
comprise upto 50 percent of grade-1 in many primary schools.
The baby class is not officially recognized but it is tolerated
and to some extent taken into account when calculating such
requirements as teachers and textbooks. There also appears to
be a shift recently towards actual recognition of this
-—-_________________________
phenomenon — the distribution of specially developed
"readiness learning materials" from 1986 to all primary schools
is a step in”that direction
21
NON-FOftMAL EDUCATION
The fact that the literacy rate is still below 30 percent
coupled with the fact that Universal Primary Education through
the formal system is not, according to current plans, going to
be achieved before the turn of the century means that
alternatives have to be provided. The educational needs of
those children who do not enrol in primary schools, who will
continue to drop out, or those youth and adults who were unable
to avail of educational opportunities in the past cannot be
In fact, with the increasing emphasis that has been
ignored.
given to Universal Primary Education during the last few years,
non-formal strategies have almost been regarded (not the least
wTthirr^tKe" Education SectoraltselF) as ^^unnecessary distractj^on^, taking effort and resources away from what is seen as the
only way of achieving universal education and literacy,
The
potential contribution of non-formal strategies to the
achievement of UPE, as a necessary complement to the formal
system, has generally been ignored.
Despite the lack of official Government recognition a
both local as well as national
la£§e Jiumber^f^
and international, have been involved in non-formal education
activities, some for many years. While many of these include
literacy as a component and some have only literacy in their
programmes, many have tried to run activities that truly
reflect the spirit of non-formal education and respond to basic
needs.
Unfortunately, the proliferation of such efforts^has
not meant that significant numbers of people have benefitted
from them. Their impact has in fact been rather limited except
perhaps that of one or two of the larger ones such__asBRAC
while the effectiveness and relevance of many has been highly
Moreover, many so-called "non-formal" programmes
questionable.
are no more than poorly-run primary schools whose only claim to
"non-formality” is that they do not come under the Government's
ry
22
primary education structure but are locally supported and run.
(In fact the goal of many such local groups is to get formal
Government recognition as primary schools.)
Nevertheless, in
that they represent an addition to Government efforts through
the formal system they play a positive role particularly since
they tend to be more flexible in things such as scheduling and
curricula than the formal primary schools.
What is needed is a national commitment to the concept of
non-formal education as a viable option and necessary complement
to the formal system and the articulation of a coherent policy
within the framework of the country’s education or even overall
development policies that encompasses not only literacy but all
the other educational needs that exist.
LITERACY
~ t?z
The 1974 Census, which defined literacy as the ability to
read and write in any language, showed that only 25.8 percent
of^ the population over 15 years of age were literate. By the
1981 Census the rate for the same age group had risen to 29.2
percent, an increase of only 3.4 percent.
More alarming was the increase in the absolute number of
i^lliterates. While the number of adult literates increase!
from over 9 million in 1974 to over 13 million in 1981 (an
increase of 42 percent, well above the population increase of
25.4 percent in this age groupT? the number of illiterates grew
from over 27 million to almost 33 million, an increase of
almost 20 percent.
Thus while around 4 million more people
became literate, more than six million were added to the total
of illiterates.
It is clear that unless a greater effort is
made to prevent the younger generations from becoming
illiterate, the absolute number of illiterates will continue to
increase dramatically.
23
Although there was a notice able improvement in female
literacy rates between 1974 and 1981, the gap between male and
female literacy rates remained high,
The rate for females
increased by 4.8 percentage points compared with the increase
of 2.5 for males.
The absolute number of female literates
increased by over 73 percent while the increase in literate
males was only 32 percent.
This would seem to indicate that
increasing^a ttention to primary echication for girls was
Unfortunately more recent data
beginning to make an impression.
which would probably show an even more marked effect are not
available.
Nevertheless the fact remains that females were at
a substantial disadvantage compared to males and accounted for
56 percent of the total number of illiterates in 1981 .
TABLE 1
MALE AND FEMALE LITERACY RATES 1974
Male 15+
Popu
lation
19 7 4
Number of
Literates
Lit.
Rate
Popu
lation
19 8 1
Number of
Literates
Lit.
Rate
19,469
7,242
37.2
24,061
9,560
39.7
23.6
92.0
2.5
22,457
4,035
18.0
27.3
73.3
4.8
46,518
13,595
29.2
25.4
42.0
3.4
% increase
Females 15+
17,638
2,328
13.2
% increase
Total 15 +
1981
37,107
9,570
25.8
% increase
Source: Bangladesh Bureau of Statistics.
24
TJie literacy rate in rural areas has been consistently and
significantly below that of urban areas although between 1974
and 1981 the gap narrowed somewhat as the literacy rate in
urban areas actually declined while in rural areas it
increased.
The decline in urban areas is thought to be the
direct result of increasing migration of the rural poor (and
therefore predominantly illiterate) to urban areas.
(See Table
2)
TABLE 2
LITERACY RATES 1961-1981 POPULATION 5 YEARS AND ABOVE
1961
1974
1981
All areas
Male & Female
Male
Female
20.9
30.8
10.1
24.3
32.9
14.8
26.2
35.4
16.4
Urban areas
Male & Female
Male
Female
48.1
59.1
32.1
45.4
54.0
33.8
39.0
49.2
26.8
Rural areas
Male & Female
Male
Female
19.4
29.0
9.1
22.2
30.6
13.2
24.1
33.7
14 .*7
Despite the relative geographic homogeneity of the country,
the 1974 and 1981 censuses revealed wide variations in literacy
rates between different districts.
(See Table 3).
A wide
variety of factors appears to influence the variations in
literacy rates between districts: presence of significant urban
areas (Dhaka, Khulna and Chittagong);
the general economic
status of areas (e.g. Jamalpur is regarded as one of the
poorest districts in the country); and geographic and ethnic
factors as in the case of the hilly Banderban district which
also has a majority tribal population.
25
TABLE 3
ADULT LITERACY RATES 1974 & 1981 BY DISTRICT
(In ascending order of 1974 rate for both sexes)
__________ 1974
Both sexes Male
_______1981
Both sexes
Male
Female
Bandarban
17.3
26.4
5.6
Jamalpur
18.1
25.4
10.7
District
Female
Mymensingh
18.9
26.8
10.3
21.5
29.2
13.4
Pabna
19.5
28.4
11.1
24.3
33.6
14.7
Kushtia
20.2
28.9
10.9
22.3
30.7
13.3
Chittagong H T
20.8
31.8
7.3
26.6
38.1
11.1
Rangpur
20.9
32.3
8.6
22.7
33.6
11.3
Tangail
21.5
31.5
10.6
25.3
45.9
15.5
Faridpur
21.7
32.5
10.4
26.2
37.0
15.5
Sylhet
22.2
33.5
10.6
23.6
32.8
13.8
26.0
36.4
14.5
12.8
29.1
39.7
18.6
3^.6
ComiIla
Jessore
-26_1
38 .4
12.9
29.5
41.4
-L O . O
Noakhali
27.2
40.3
12.6
32.5
44.4
21.5
40.3
23.0
28.3
39.6
Bogra
Dinajpur
27.3
42.3
10.6
27.4
•- 40.4
13.3
Chittagong
30.5
43.7
14.1
33.8
45.2
20.3
Patuakhali
30.8
44.0
16.8
37.5
48.6
26.1
Dhaka
32.3
43.4
18.5
37.8
48.3
24.9
Barisal
34.5
45.7
22.3
40.9
50.2
31.1
Khulna
35.2
48.7
19.6
38.3
50.5
24.2
below average
10
9
1 Q
14
12
15
- above average
9
10
6
7
9
6
No. of districts
26
T>e Second Five-Year Plan (1980-85) accorded high priority
to the eradication of illiteracy. The Mass Education Programme
(MEP), started in in 1980, and which was to be continued during
the SFYP, envisaged covering about 40 million illiterates in
the 10-45 year age group. By 1982, however, the Programme had
been abandoned having fallen well short of its targets. An
Evaluation Committee set up by the Government in early 1982
found that as against the declared target for the period of
covering 10 millionilliterates, only about 700,000 people were
supposedly made literate at a cost of about Tk. 78 million.
Among the reasons given for its failure were: insufficient
motivation among the learners; lack of commitment among
officials serving at the lower tier'~as^well as local Teaders;
ineffective methods of teaching; faulty approaches to the
organization of the programme; minimum involvement of
non-government organizations; lack of any direct application of
skills learned in the programme; and a feeling among the target
groups that the programme has no relevance to their immediate
needs and requirements. Basically the programme had been too
ambitious, poorly thought out and planned and consequently
suffered from organizational, logistic, operational and
problems.
----- conceptual
__
It has been estimated that between 1980 and 1984 the
sixteen major NGOs and quasi-government organizations involved
in various types of activities that include literacy training
imparted training to less that 400,000 adults.
Their efforts
could become much more meaningful and their output increase
significantly if they were integrated into a coordinated
national ^1 iteracy drive that the country obviously needs if the
problem of illiteracy is to be attacked in any systematic way.
27
The Third Five-Year Plan (1985-90) has targeted a
relatively modest 2.4 million new adults to be made literate by
1990. For this a sum of Tk. 250 million (2.05 percent of the
total allocation for the education sector) has been allocated.
The newly-elected Upazila (sub-district) authorities will be
responsible for the implementation of the Third Plan literacy
programme.
Technical and material support will be provided by
the Centre and by central government officials posted in the
Upazilas. Whether and to what extent the newly empowered
Upazila Councils can perform the many local development
functions delegated to them, including illiteracy eradication
movements, remains to be seen.
It appears that the Government is placing the main burden
for achieving universal literacy on formal primary education.
Yet the disadvantages of relying only on this strategy are
obvious: it is slow; the needs of a large part of the already
illiterate will be ignored; and, perhaps most seriously, even
if children achieve literacy through primary schools, there is
no guarantee that they will retain it. Post-literacy activities
through non-formal strategies are therefore of vital importance.
28
CHAPT^fi 3
NUTRITION
1.
Situation
Hunger and malnutrition affect most of the people of
Bangladesh, especially children under five years of age, and
pregnant and lactating women. Only 5 percent of the population
consume an adequate quantity and quality of food. Malnutrition,
which begins during fetal development, lowers resistence to
infections and prohibits healthy growth and development from
infancy through childhood, with subsequent detrimental affects
In particular, the malnutrition of girls on adult health.
<r
which is widespread in Bangladesh - has serious consequences
for the reproductive process including pregnancy and lactation.
The weight and heights of pregnant women, measured in different
income groups in urban and rural areas (See Table 1) show how
large the percentages of women are who have sub-normal weight
and height. Data on post-delivery maternal weights are
The
consistent with the low mean weight of adult females.
pervasiveness of maternal malnutrition in Bangladesh is also
evidenced by the high incidence of low birth weight babies (See
Table 2). Moreover, it is known that a high proportion of the
low birth weight babies are small-for-gestational age.
Nutrition surveys made since 1981 consistently record the
high levels of second and third degree malnutrition in children,
including both chronic and acute cases.
One survey of rural
children aged 0-59 months found 60 percent identified as having
2nd or 3rd degree malnutrition. The greatest prevalence of
acute malnutrition was found among rural children aged 12-23
months, at a rate of 61 percent; and the greatest prevalence of
chronic malnutrition was also found among children 48-59 months
at a rate of 75 percent. All available evidence shows that the
condition seems to have deteriorated since the early 1370!s.
29
The nujnbers of severely malnourished children have increased,
and the numbers of mildly malnourished children have decreased.
The proportion of rural households falling below the minimum
standards of nutrition increased from 59 percent in 1975-76 to
76 percent in 1981-82, and went down to 64 percent in 1984-85.
There are indications that the proportion of children of
0-5 years of age suffer from severe forms of malnutrition at a
rate more than double that of children of the age group of 5-14
years. This wider incidence of malnutrition in younger children
reflects the problems of poor weaning practices coupled with
inadequate food supplementation during "the most critical period
of their growth and development. Poor weaning practices is one
of the most critical areas.
Malnutrition in the later years of 5-14, though half the
incidence, shows a prevalence of stunting which persists among
3/4 of these children, due to the cumulative effects of
long-term nutritional deprivation.
Evidence shows that there is considerable sex-differential
of malnutrition in early and late childhood: females having
greater rates of acute, chronic and concurrent acute and
chronic malnutrition. Male preferences in feeding and dietary
patterns exist, as do male preferences for health care; the two
combine to put females at a distinct disadvantage nutritionally.
Female children have almost three times the rate of malnutrition
af males and a 45 percent higher mortality rate among the
severely malnourished.
Broken down by food consumption patterns, it has been shown
that per capita caloric consumption has deteriorated signifi
cantly in'^the^last two decades, desp4_te^the overall positive
foodgrain situation. Available data on daily per capita protein
consumption suggest severe deficiencies in both quantity and
l JL-
30
quality. Assessment of other nutrient intake reiterates this
decline in intake. Average per capita intake of Vitamin A is
less than one-third of the recommended daily allowance; Vitamin
A deficiency among children 0-6 is the main cause of child
blindness in Bangladesh. It is estimated that approximately 5
percent of rural children aged 6-59 months have xerophthalmia.
Approximately 30,000 children (0-6) become blind each year due
to macro and micro nutrient deficiencies, especially Vitamin A;
about 50 percent of these children do not survive.
Iodine deficiency in affected districts is reported in 30
percent of the general population, and 80 percent among
pregnant and lactating women.
Out of the total population of
5.6 million in the 10 districts where goitre is hyperendemic,
it is estimated that on an average, 3.8 million are suffering
from iodine deficiency.
Iron folate deficiency is very high in young children and
women in the reproductive age group; approximately 82 percent
of under-5 age children have anaemia., and 74 percent of adult
women.
Although the vast majority of women breastfeed their
infants, there is a problem of not feeding coiosTmin
unr in -the
first critical days of life.
The problems of malnutrition cannot be isolated from the
poor health conditions, as they are closely interconnected
causally. This is especially relevant to the young children
and women in the reproductive age group. The high incidence of
diarrhoeal diseases, fevers, measles and intestinal parasites
among other infections in children contributes to the high rates
of malnutrition in this group.
31
Tjie causes of malnutrition are complex and involve problems
inherent in the vicious cycles of poverty and underdevelopment,
which characterize the daily situation of more than 80 percent
of the population of Bangladesh, They include low purchasing
power (low income, unemployment, and underemployment) of
families, particularly of women; high levels of landlessness;
gross inequitable distribution of resources; poor environmental
conditions; and lack of education and information about good
dietary practices, The latter is complicated by the existence
of cultural practices and beliefs about food intake during
pregnancy and lactation, which tend to exacerbate problems of
balanced nutritional intake.
Furthermore, the causes of malnutrition cannot be separated
from the wide ranging political and economic issues involved
with food and agricultural production, pricing, distribution
and so forth.
Food policies are critical since the mere
production of increased levels of foo3T are not adequate for
improving the nutritional situation of the population unless
the nutritional needs are taken into account.
2.
Current Programmes and Resources
Programmes for the prevention and reduction of
malnutrition fall under the aegis of a number of different
government ministries, for example, the Ministries of
Agriculture, Food, Health and Family Planning, Education,
- '
'
4
----------------------Information, and Social Welfare. While it is necessary for all
Ministries to be involved in eliminating or reducing the causes
of malnutrition, there have been probiems of lack of
coordination and of duplication. The problems have persisted
in the absence of a national nutrition strategy.
32
A, National Nutrition Council exists; but, while it has been
instrumental in assisting the development of various small
nutrition activities, it has not played a major role in policy
—- ——"~
It has prepared a standard growth
and strategy development.
chart for use in the country as part of primary health care,
and will be developing a growth monitoring programme. It is
located in the Ministry of Health and Family Planning.
The Institute of Public Health and Nutrition (IPHN) is
responsible for the establishment of child nutrition units in
the Upazila Health Complexes, and provides technical support
for other nutrition activities in the health programmes, So far
only 20 child nutrition units have been established.
The Institute of Nutrition and Food Sciences (INFS) has
played an important role in providing technical support and
carrying out relevant research.
The Ministry of Health and Family Planning has only limited
programmes concerning nutrition, and primarily related to-the
nutritional deficiency diseases:
Vitamin A deficiency:
The Blindness Prevention programme
focuses on the distribution of High Potency Vitamin A Capsules
and aims to cover all children from 0-6 years of age, and
children with night blindness of 7-15 years, twice a year, at 6
monthly intervals.
The target population is 23 million children
per year. Low coverage rates ^less than 50 percent of target)
'have been a problem.
Education activities aimed at encouraging
home production, preservation, and consumption of Vitamin A rich
foods are also part of the programme.
Iodine deficiency: The Goitre control programme concen
trates on the ten hyper-endemic areas in the country. Lipiodol
injections are being administered to boys up to the age of 15,
33
and tq. females, up to 45 years of age.
The target population
is approximately 3.8 million people. Coverage to date has been
rather low. A more ambitious programme is the effort to promote
the nationwide supply and consumption of iodated salt in
Bangladesh through universal salt iodation by 1990.
The Bangladesh Bureau of Statistics is carrying out a
National Household Expenditure Survey which has a nutrition
component.
The vulnerable group feeding (VGF) programme of the WFP is
carried out under the Ministry of Food and Relief,
It provides
bulk food on a monthly basis to selected families in each union.
It is mainly an income transfer activity, without nutrition
targeting or nutrition education.
The Food for Work Programme (FFWP) is also an income
transfer activity.
It aimsat providing employment andr~payment
in the form of foodgrain to landless labourers in rural areas
in the non-agricultural season.
It is an important programme
in the country; in 1982/83 98 million man-days of work were
generated, and about 350,000 tons of wheat were distributed.
A large number of non-governmental agencies provide
nutrition services to mothers and children throughout the
Notable among these are the following:
country.
CARE: Women's Development Project (target population
135,000 women and children)
Concern: Nutrition Rehabilitation Centre
ICDDR,B: Matlab Field Station (target population 80,000
people)
Radda Barnen: MCH Project, Nutrition Department (700,000
population)
34
Save the Children UK: Children's Nutrition Unit
Save the Children USA: Health and Nutrition Programme
(50,000 women and children)
While these programmes are encouraging,
the coverage of
mothers and children in the country does not even come close to
meeting the urgent needs of the vulnerable groups,
The
resources are miniscule compared with the requirements.
There is a need for a coherent and phased nutrition
strategy and the development of a food and nutrition policy
which is relevant to the political and economic situation.
TABLE
1
WEIGHT AND HEIGHT OF PREGNANT WOMEN,
Socioeconomic Sector
1983
% with Weight
below 50 kg
% with Height
below 147 cm
High income Urban
44.8%
32.4^
Low income Urban
83.4^
44.8%
High income Rural
76.9%
38.5%
Low income rural
100.0%
57.1%
Source:
C Canosa. Deterioration of Nutrition in Bangladesh
WHO, 1983 .
35
TABLE
2
BIRTH WEIGHT OF NEW-BORN BABIES (Kq)
New Weight
S. D.
Socio Economic
Category
N
High Urban
112
2.80
0.55
Low Urban
339
2.63
0.46
High Rural
16
2.33
0.61
Low Rural
29
2.38
0.37
Source:
C Canosa.
Deterioration of Nutrition in Bangladesh.
WHO. April 1983
36
CHAPTER
HEALTH
1.
4
Situation
The health conditions of mothers and children in Bangladesh
are very poor; estimates of maternal, neonatal, infant and
in
childhood mortality and morbidity rates are extreme
Maternal
relation to other developing countries in Asia.
ive births (See Table 1).
mortality is estimated ate
e
The major causes of death are eclampsia, infections (childbirth
and septic abortion), complications of labour, and haemorrhage.
The nature of these causes indicate the significance of
unhygienic practices and inadequate care as contributing
factors. The distribution of maternal deaths per age group and
by parity show the importance of family planning as a maternal
health measure; the fact that septic abortion is a frequent
cause of death also confirms this.
The neonatal mortality rates shown in Table 2 average 85
per 1000 live births. Neonatal death (up to one month)
continues to comprise a large proportion of infant mortality,
which reflects the very low levels of women’s health and
nutrition as well as the poor birth practices prevalent in
Bangladesh.
These rates correlate positively with the figures
/
for low birth weight; the fact that most of the low birth
weight babies are small-for-gestational age is another
'
____ _____________________ _________
indicator of poor maternal health and nutrition.
Tetanus
contributes to about one-third of all neonatal deaths, with
about 135,000 deaths per year.
The high infant mortality rate of 125 per 1000 live births
is officially given, though there is evidence of much higher
rates in some areas (See Tables 3 and 4). Childhood mortality
(ages 1-4) is given at^25 to 30 per 1000 population of that
age (See Tables 5 and 6). The main causes of neonatal, infant
37
and childhood mortality include birth trauma, tetanus,
diarrhoeal diseases, pneumonia and measles, in combination with
malnutrition.
At least 50 percent of the causes of infant
deaths are due to tetanus, respiratory infections and
diarrhoeal diseases. Malnutrition, combined with diarrhoeal
diseases cause over 50 percent of childhood mortality, followed
by measles and its complications (See Table 7).
Infectious diseases such as cholera, typhoid, tuberculosis,
tetanus, diphtheria, whooping cough, measles, and parasitic
diseases (eg. malaria and worm infestations) are major cause of
morbidity of women and children. For example, the incidence of
2,5
cases per year, with an estimated 45,000
mea^les
deaths; paraplytic polio effects an estimated 10,000 new
persons per year.
Malaria in particular is on the increase and
of great concern.
In addition, the levels of morbidity of women
in the childbearing ages have not been adequately studied,
It
is known from clinical evidence however that of these 20,000,000
women, at least 50 percent are suffering from nutritional
anaemia, and a considerable proportion are also suffering
episodes of genital tract infections due to complications or
side effects of certain family planning methods, septic
abortion and childbirth, among other causes.
Nutritional deficiency diseases in children also make up an
important percentage of morbidities; for example xerophthalmia
(Vitam,in A deficiency) is estimated at ~5 percent of rural
children under 6.
Infant and childhood mortality and morbidity are closely
related to the educational level of the mother. Women’s
literacy in Bangladesh is estimated at 18.8 percent, and thus
this relationship is especially significant in the country.
Other factors comprising the low status of women in Bangladesh
such as lojv income and low access to the public sector are
closely associated with poor infant and child health and
development. The synergistic interaction of malnutrition and
38
infections as causes of infant and childhood mortality and
morbidity is heightened in the rural and urban settings where
there is a lack of safe drinking water and sanitation.
The maj^r health problems of mothers and children in
Bangladesh are striking because the proportion of death and
illness which could be prevented is so high. They could be
prevented by applying relatively simple interventions which
available now, at an affordable cost, and which are possible to
deliver within the health and family planning system.
2.
Current Programme and Resources
The government's health sector infrastructure and resources
are amalgamated within the Ministry of Health and Family
Planning, which consists of two wings, or directorates, under
the Secretary of Health and Family Planning, namely the Health
Wing and the Family Planning Wing. Programmes and services
concerning the health care of women and children are included
within both these wings. The official policy is that services
are integrated at the level of Upazila and below. This bifurca
tion of health and family planning has caused problems of
coordination, particularly in terms of maximum utilization of
facilities and staff.
Institutional facilities: the Upazila Health Complex (UHC)
and the Union Health and Family Welfare Centres (UHFWCs)
constitute the peripheral network of static health and family
planning centres. There are District hospitals and specialized
hospitals which make up the referral points for primary health
care, as well as medical college hospitals and others (See
Table 8J.
It is estimated that health care facilities have so
far overec only 30 percent of the total populationT^*
____/
39
-t
The problems include inadequate maintenance of buildings,
inadequate water and sanitation facilities, lack of essential
physical and functional facilities (eg. laboratories), and
inadequate supply of drugs, supplies and equipment. While
financial limitations exist, some of these problems are
exacerbated by poor management of the logistics system, and by
lack of supervision.
In the area of health manpower resources, substantial
progress has been made in terms of the education and training
of health and medical personnel (See Table 9).
However, there
is a need to reorient curricula towards a primary health care
approach, and to introduce more practicaltraining~~IiT~~skillsrelevant to the needs in the rural areas.
The staffing pattern of the health and family planning
systems includes centre-based and field workers, who are based
at the ward level. There are also community-based health
volunteer schemes in many areas. The health personnel to
population ratio, though not completely satisfactory, is__jDei.ng
improved; for example there has been a procfr_ess_iye—•Tner-ea^e in
the ratio of female field workers (FWAs) to population
(currently 1: 4000 population) in the rural areas. There are
serious problems of supervision and personnel management
Particularly in the rural periphery. Moreover, there is a
problem of the rational utilization of health and family
planning staff, especially at the Union and ward levels, where
integration of MCH/FP services is needed. A harmonization of
job descriptions and training is required to ensure maximum use
of the time, training and motivation of field-based staff and
to improve their acceptability by the community,
The team work
approach needs to be institutionalized.
The main service programmes are Family Planning and
Population Control, Malaria Control, TB Control, Diarrhoeal
Diseases Control, Blindness Prevention, Expanded Programme on
Immunization, Control of Iodine Deficiency Disorders, MCH,
Nutrition and curative services at health centres and hospitals.
In general, however, coverage tends to be rather inadequate.
40
ripreover, there is a serious problem of underutilization of
services in the rural areas, due in part to the generally poor
quality of services arising out of inadequate technical and
management systems coupled with an inadequacy of essential
supplies. Also, lack of information and education of the
people about the importance of primary health care for mothers
and children, and other social factors (including the low
status of women) inhibit the use of health care services.
3.
Health and family Planning Policies and Strategies
Successive health plans have emphasised Primary Health Care
(PHC) as the key approach to the improvement of the health
status of the people. The global strategy of Health For All By
The Year 2000 has been accepted by the government as the
national objective.
The national drug policy adopted in 1982 emphasizes the
provision of a limited number of selected essential drugs for
primary and secondary health care, and their local production.
A Comprehensive National Strategy for Maternal and Child
Health was endorsed by the Secretary of Health and Family
It gives priority to the three areas of
Planning in 1985.
V i mmun ization, saf e birth practices, and oral rehyriyAt i on
\ Jzherapy, in addition to family planning. The Strategy
represents a puSling together of the aims and approaches of the
priority component programmes of immunization, safe birth
practices, oral rehydration, and family planning, as well as
looks forward to an integrated and more comprehensive MCH
programme, which will gradually be developed in response to all
of the health problems of mothers and children. The Strategy
emphasizes the prevention of major causes of death, by
widespread implementation of a small number of interventions.
41
The overall goal of the MCH programme for the Third Five
Year Plan, 1985-1990 is to improve the health conditions of
mothers and children, through the reduction of mortality and
morbidity, specifically to
reduce maternal mortality from 6 to 4 per 1000 live
births
reduce infant mortality from 125 to 100 per 1000 live
births; and neonatal mortality from 85 to 65 per 1000
live births
The overall objectives are:
to ensure access of women to care during pregnancy and
delivery by trained persons
to reduce mortality, morbidity and disability from
tuberculosis, tetanus, diptheria, pertussis, measles,
and poliomyelitis, through immunization
to reduce morbidity and mortality due to diarrhoeal
diseases and diarrhoea-related malnutrition:
to reduce mortality due to diarrhoeal disease by
30 percent
to reduce hospital utilization of intravenous
fluids by 50 percent
to reduce hospital/other visits by diarrhoeal cases
by 30 percent
to reduce crude birth rate of women in extreme age and
high parity groups through family planning
42
to develop self-sufficient MCH care as part of primary
health care and increase coverage of comprehensive
services to mothers and children.
The process or specific objectives are:
1. to ensure that at least 30 percent pregnant women have
been contacted, and are
assessed for risk; provided knowledge on safe
deliveries;
educated on nutrition; informed of availability of
trained birth attendants in health facilities or of
trained TBAs;
in addition, the trained FWV will provide antenatal and
postnatal care to about 2000 population around each
static facility.
2 . to have 30 percent of deliveries in rural areas
attended by trained birth attendants; and about 10
percent of all births, urban and rural, in
institutions, equipped for handling high risk cases
3 . to cover 30 percent of women of childbearing age with
two doses of TT
4 . to cover 55 percent children 0-2 years in areas with
primary EPI centres with BCG, DPT, Measles and OPV
(0.63 million)
5 . to cover 30 percent children 0-2 years in areas with
UHFWC’s with BCG, DPT and Measles (0.60 millions)
6 . to cover 75 percent families in rural areas with
information on prevention and treatment of diarrhoeal
diseases; and to have 35 percent of households using ORT
43
7v to achieve a 40 percent contraceptive prevalence rate
8 . to cover 30 percent of mothers and children with
curative care in areas surrounding the static health
facilities
9. to educate 50 percent of households in MCH practices
including hygiene, maternal nutrition, and infant
feeding.
In late 1985 the government committed itself to reaching
the target of universal child immunization by 1990. The EPI
related objectives of the MCH strategy have been amended
accordingly and detailed programme guidelines prepared for the
accelerated EPI programme.
The policy basis of the health programmes are generally
Greater efforts are needed in their planning and
satisfactory.
implementation.
Table 1:
Maternal Mortality Rates (per 1000 live births) Found in
Different Studies in Bangladesh
Approx, size Study Time
of pop.(1000)
Studies
Conducted by
Study Area
ICDDR,B
ICDDRzB
BAMANEH
Matlab
Matlab
Islampur and
Jamalpur
Gopalpur and
Bhuapur
Chandina, Gabtali & Tongi
Alauddin
BAMANEH
Project
Maternal Mortality Rates
180
180
267
1967- 68
1968- 70
1982-83
7.7
5.7
6.2
300
1982-83
5.7
137
1982-83
4.8
Source: National Strategy for A Comprehensive Maternal and Child
Health Programme, Ministry of Health and Population Control
Population Control Wing, Dhaka, January 1985.
44
TABLE 2
Neonatal Mortality Rate (per 1000 live births
Found in Different Studies in Bangladesh
Author
Agency
Year of Study
Place of
Study
Rate
Islam et al 1981
ICDDR,B
1976-77
Teknaf
89.0
Rahman, M et al 1981
ICDDR,B
1976-77
Matlab
73.4
Rahman, S et al 1981
NIPORT
1979
Ghatail
70.1
Rahman,
NIPORT
1979
Ghatail
85.2
Jahan,F A et al 1984
BAMANEH
1982-83
Jamalpur
80.5
Alauddin, M 1984
ISWR
1982-83
Tangail
117.0
S et al
Source: National MCH Strategy, p.4.
TABLE 3
Infant Mortality Rates Derived from Different Sources
for Different Time Periods
Year
ICDDR,B
(Matlab)
1969-70
125.5
1971-72
146.6
1974
137.9
1975
191.8
1976
102.9
121.0
1978
125.8
115.2
1980
114.0
1982
114.5
Source:
BRSFM
BFS/WFS
CSD
Companiganj
150.0
139.7
153.0
National MCH Strategy, p.4.
45
TABLE 4
DIVISIONWISE POPULATION SHOWING NUMBER OF CHILDREN
BORN AND INFANTS DIED DURING THE LAST ONE YEAR PERIOD
Infant MortaNo.of Infant Birth Rate
Died in 1 yr. (Estimated)* lity Rate per 1000
Population
Surveyed
Number of
Births
Dhaka
7,877
296
45
37.57
152.02
Chittagong
5,283
192
17
36.34
88.54
Khulna
7,546
291
37
38.56
127.14
Rajshahi
5,173
219
37
42.33
168.94
Total:
25,879
998
136
38.56
136.27
Division
* The population at the time of survey has been used as the denoninator
instead of the mid-year population.
Source:
Morbidity and Mortality Survey on Diarrhoeal Diseases,
Government of Bangladesh, December 1983, p.8.
TABLE 5
Child (1 to 4 years) Mortality Rate in Canpaniganj
and Matlab in Different Years
Year
Companiganj
Matlab
1975
1976
1978
1981
57.1
58.0
14.7
29.6
22.0
Source: National MCH Strategy, p.5.
TABLE 6
AGE SPECIFIC MORTALITY RATE
Age in years
Number of
Children
0
<1
<5
1
0 - <5
998
3,689
4,687
Number of Deaths
136
80
216
* Inclusive of death children
Source: Morbidity and Mortality Survey, p.9.
Mortality Rate
per 1000
136.27
21.58
46.08
46
TABLE 7
Causes of Death Among Children under 5 Years
of age in Matlab (1981) and Canpaniqanj (1975-78)
Causes of
death
0-28 days
%
No.
Conpaniganj
1-11 months
%
No.
1-4 years
%
No.
Birth injury
67
54.2
Tetanus
31
25.0
3
3.2
Measles
1
0.8
4
4.3
12
7.1
Pneumonia
15
12.0
31
32.9
23
13.5
_____ Matlab________
1 year
1-4 years
%
%
No.
No.
340
38.3
30
3.8
14
1.6
65
12.3
103
11.6
54
10.2
Respiratory
diseases
Malnutrition
2
2.4
26
27.7
39
22.9
1
0.8
12
12.8
54
31.8
31
5.5
122
23.1
2
2.1
14
8.2
3
0.3
53
10.0
Diarrhoeal
diseases
Drowning
Others
6
4.8
16
17.0
28
16.5
397
44.7
215
40.6
Total:
124
100.0
94
100.0
170
100.0
888
100.0
529
100.0
Note:
Respiratory diseases include cold, fever, cough, TB, asthma, etc.
Source: National MCH Strategy, p.67.
47
TABLE 8
HEALTH CARE DELIVERY INFRASTRUCTURE
Actual
1984/85
Target
1989/90
a) Health Services
19,661
29,534
b) Others
7,976
11,200
341
397
2,329
4,500
Institutions
1. Hospital Beds
2 . Upazila Health Complex(UCH)
3 . Union Health & Family
Welfare Centres(UHFWCs)
4 . Health Posts(community
based)
5 . Blood transfusion services,
District Hospitals
20
90 coverage
64
90 coverage
20$
100$
b) District Laboratory
25$
60$
c) Simple Tests-UHFWCs.
5$
25$
X-ray facilities in UHCs
20$
60$
6 . Health Laboratory Services
a) Simple diagnostic-UHC
7.
397
Source: Third Five-Year Plan: 1985-90.
Planning Commission, Ministry of Planning, Government
of Bangladesh, Dhaka, December 1985.
48
TABLE 9
HEALTH MANPOWER
Personnel
Actual
1984/85
Target
1989/90
1 . Graduate Medical Doctor
16,000
22, 500
2 . Post-Graduate Doctor
1 f 050
2,100
510
750
4 . Basic Nurse/Midwife
6,500
10,200
5 . Medical Assistant
3,600
4,600
6 . Laboratory Technician
1,350
2,000
7 . Radiographer
350
700
8 . Pharmacist
5,800
8,500
9 . Health Sanitary Inspector
1,265
1,500
10.Assistant Health Inspector
1,870
4,500
11.Health Assistant
15,000
23,000
3 . Dentist
12.Senior Family Welfare Visitor
460
13.Family Welfare Visitor*
4,200
6,000
14.Family Welfare Assistant *
13,500
23,500
Source: Third Five Year Plan: 1985-90: Planning Commission,
Ministry of Planning, Government of Bangladesh, Dhaka,
December 1985.
* Draft TFYP, Population Wing, Ministry of Health and Family
Planning, Government of Bangladesh.
49
WATER AND SANITATION
CHAPTER 5
Water Supply
The hydrology of Bangladesh is characterised by the major
cross-border rivers (Brahmaputra, Ganges and the tributaries
forming the Meghna) and by abundant annual rainfall (2183 mm or
86 inches), of which 80-85% falls in the monsoon months June to
September. The monsoon rains result in widespread flooding.
with the major rivers typically covering almost one third of the
country and another third going under water due to poor
About two-thirds of the annual rainfall is "lost” in
evaporation and evapotranspiration and about 15% percolates
underground, raising the water table close to ground level,
In
the dry season, while flood waters recede and pond and ground
water levels fall, general water availability remains high in
drainage.
most parts of the country,
For the vast majority of the
country, the ground water table never exceeds 15m.
The most significant development in the last decade has
been the dramatic increase in power-driven deep and shallow
tubewells for irrigation.
As most irrigation takes place in
the dry season there is a significant decline in groundwater
levels during this period, particularly in localised areas of
In addition, there is a more severe but
high extraction.
temporary effect caused by the local depression of groundwater
during operation of power-driven irrigation tubewells. Although
water levels recover in the monsoon, an increasing number of
shallow hand tubewells become inoperative during the last few
months of the dry season, because the water table falls below
the suction limit (7-8 metres).
50
Coverage and Access
Table 1 shows the average national coverage of installed
tubewells by tubewell type. An estimated nine million people
who are served by private shallow tubewells are separated from
It is significant to note that
the coverage calculations.
although national coverage is 143 persons per operating
tubewell, there are enormous differences between shallow wells
(approx. 100), deep wells (approx. 600) and deepset (approx.
1200).
Surveys in 1984 indicated that 82% of rural people used a
handpump for at least some of their water needs; 70% of users
live within the 150m (500 ft) ; 66% of users use a public
handpump; 70% of handpumps serve between 60 and 180 people.
As expected, public handpumps are situated closer to
richer households; 80% of user households owning more than 7.5
acres live within 100 metres of a tubewell, compared to 45% of
landless users. However, there is surprisingly little
difference in water use patterns between rich and poor tubewell
users.
(These figures are applicable only to shallow tubewell
areas).
Water Use
It is a positive achievement that over 82% of rural
villagers say they use tubewell water for drinking,
However,
even if they drink tubewell water, children will still contract
diarrhoea as long as they remain exposed to faecal pollution in
surface water and in the home environment. Only 12% of tubewell
users use it for all their water needs, which means that the
vast majority of rural people still use ponds and other surface
water bodies. Encouraging the use of tubewell water for all
purposes will reduce exposure of under-five children to polluted
51
water when they accompany their mothers to the water source;
however, in a society with low health awareness, use of
tubewcll water is a function of distance, access, convenience
and user group size. Data from the International Centre for
Diarrhoeal Diseases Research, Bangladesh showed that average
daily per capita consumption was 19 litres where the average
user group size was 82, and 53 litres where the average size
was 12 .
Tubewell platforms are too small for simultaneous use
by more than one person, and only those living very close to
the tubewell will find it more convenient than the nearest pond.
Furthermore, whereas caretakers of public tubewells usually
permit beneficiaries to draw the limited amounts currently
utilized, they may discourage dramatically greater use of the
tubewell if this becomes seen as a "nuisance" by the caretakers.
Ways to increase tubewell water consumption include:
a ) reducing user group size and distance to the tubewell
by installing more tubewells.
b) increasing platform size.
c) increasing perceived right of access by involving all
beneficiaries in tubewell installation.
d) creating greater public awareness of health hazards to
young children of exposure to surface water sources.
Sanitation
A survey in 1984 indicated that 33% of
the rural population
uses a ’’fixed place” for defecation, 90$ of which lie within
the outer yard of the compound,
Only between 2-4$ of households
have a "sanitary" latrine,
Children find latrines smelly and
are often afraid of falling into the pit; they also dislike dark
enclosures.
(Women, on the other hand, regard the enclosure as
the most important feature).
Children under 5 defecate close
to the home (on average 9 metres from the living room),
whereas
adults go further (women 27 metres, men 35 metres).
52
The most widespread technology for sanitary latrines is the
single pit, pour-flush water-seal slab latrine, which has become
enormously successful in the last ten years. The public sector
sale prices of these latrines is subsidized by approximately
50%; because demand far exceeds public sector production,
private sector production is growing.
For poorer people, the most appropriate technology is the
simple pit latrine made entirely from local materials. The slab
can be made from wood or bamboo,
To avoid collapse, the pit
should be shallow unless the soil is stable or the pit is
lined.
The high water table in the monsoon is a complicating
factor for any sanitation technology.
The usual method to
reduce this is to build up the level of the slab, using the soil
excavated from the pit. There appears to be no solution to the
problem of pit inundation by surface flooding.
Relationship to Infant and Child Mortality and Morbidity
There are no national statistics relating water,
sanitation and health awareness to mortality and morbidity,
A
study conducted in 1983 records that there are an estimated
57.2 million annual episodes of diarrhoea in children under
five, causing an estimated 200,000 child deaths, Discounting
deaths in the first month of life, diarrhoea accounted for 43%
of mortality between the age of 29 days and 5 years. Diarrhoea
and parasitic diseases are also known to be major contributory
factors to the high incidence of child malnutrition.
A study by ICDDR,B suggested that the risk of post
neonatal mortality (i.e. age over one month and under one year)
was three times greater in families without a latrine compared
to those with. Another study by ICDDR,B indicated that in a
community that had received health education through home
visits, the incidence of diarrhoea in children living under 150
metres from a handpump was nearly half the incidence in those
living over 150 metres.
53
Government Programme
There are four main components of the Government’s current
rural water supply programme. The installation of shallow'hand
tubewells is now implemented by the beneficiaries, who them
selves bear the total cost of and responsibility for sinking
the well. The Department of Public Health Engineering (DPHE)
provides logistic support and technical supervision. Current
implementation capacity is approximately 40,000 wells per
year. Secondly, the resinkinq of choked up wells is also
implemented by the beneficiaries at their own cost; 15 - 20,000
wells can be resunk each year. The installation of deepset
hand tubewells is expanding rapidly and will eventually become
larger than the shallow well component.
Fourthly, the
installation of deep hand tubewells (and very shallow shrouded
tubewells) in the coastal belt. This component is constrained
by the high cost of deep tubewells. For deepset and deep
tubewells and VSSTs, installation is done by contractors, with
a nominal contribution from the beneficiaries of Tk. 350 for
deepset and VSSTs and Tk. 1,000 for deep wells.
In all
tubewell components, materials are provided by UNICEF, with the
exception of brick chips and sand for platform construction.
Water supply and sanitation receive reduced priority in
the Third Five-Year Plan (1985/90) in line with the reduced
priority for the social sector as a whole and this is largely a
consequence of increased priority to the development of the
Upazila system and to the Energy and Natural Resources Sector.
(See Table 2 for water sector allocations), There is a shift
in emphasis towards the urban subsector which reflects the
growing rate of urbanization, the higher cost of urban supplies
and the general assumption in Government planning circles that
the rural subsector is comparatively well served with water
supply.
54
Within the rural subsector, priority is once again given
to shallow hand tubewells. Deep and deepset hand tubewell
areas are allocated relatively lower priority, despite being
respectively five and ten times less well-served compared to
the shallow tubewell area.
Other than the Third Five-Year Plan, the Government
currently has no long-term plan for the water supply and
sanitation sector. A Sector Study currently in draft stage,
will propose certain criteria, targets and financial
allocations for the next 30 years.
The Water Master Plan and its Effects on Groundwater
The Government has published a Water Master Plan which
gives a very high priority to accelerating the extraction of
groundwater for irrigation, as part of an overall strategy to
This will accelerate the
achieve food self-sufficiency.
It is estimated that
lowering of minimum groundwater levels.
the percentage of the rural population living is deepset areas
will increase as follows:
1985
1990
1995
20%
45%
2000
60%
8%
The estimated value of the shallow tubewells rendered
prematurely useless due to the lowering of groundwater levels
in this period is Tk. 56 crore ($19 million) and the cost of
replacing them with deepset pumps would be Tk.270 crore ($90
In other
million) without any increase in service coverage.
coverage.
words, the total cost to the rural water supply sector of the
expected increase in irrigation will be Tk. 326 crore, over
$100 million.
55
Water Supply and Sanitation Implementation Po1icies
In the past, the Government has adopted a service delivery
approach to water supply and sanitation. In the rural sphere,
there has been a steadily increasing involvement of the
beneficiaries, both financially and through self-help. The
emphasis has been on "hardware" delivery - the installation of
hand tubewells, laying of pipelines and production of latrine
components.
In terms of hardware, this has been very
successful, especially in the rural areas.
However, in terms
of health and social impacts, there has been very little
measurable improvement.
The Government is now focussing more attention on the
problem of low health impact. There is a growing recognition
of the need for health promotion and awareness-raising
activities and for integrating sanitation with water supply.
DPHE is currently setting up a project to develop a newr
integrated approach, whereby the installation of tubgwells is
linked with health and sanitation promotion specially targetted
Once developed, this approach
on new tubewell user groups.
will be introduced into the regular programme.
56
TABLED
RURAL SERVICE COVERAGE BY TUBEHELL TYPE 1971-1990
1975
1971
352
73.1
453,510
201
is.i'
628
251,910
283
55.2
436,810
158
55.5
60
7.2
8,620
1,111
7.8
12,780
763
8.5
1
3.6
1,250
3,829
4.7
3,920
1,499
7.0
448
69.2
261,790
196,110
362
53.4
6.6
7,530
1,252
Deepset (public)
3.3
750
6,286
Other
4.5
Private Tubewells
1.5
Total rural population
65.6
persons
per opera
ting well
Nationwide
(all public wells)
64.1
204,390
Shallow (public)
49.7
Deep (public)
Notes:
persons
per opera
ting well^
5.4
5.0'
100,000
15
n
target
w
pop’n.
(.illions)
no. of
wells
no. of
wells
No. of
wells
persons
per opera
ting well^
target
pop'n
(millions)
target
pop'n
(millions)
target
pop’n
(■illions)
1980
2.6
175,000
71.8
15
4.5
5.8
300,000
77.6
1.
The number of persons per operating public tubewell is calculated assuming tubewell unserviceablity
as follows: 30* (1971); 25* (1975); 20* (1980); 15* (1985); 15* (1990).
2.
1990 figures are based on iiple»entation estimates, not on targets.
15
8.6
57
85.4
3. •Fro« 1985-1990, the shallow well area will shrink and an estimated 45,000 shallow tubewell will go out of year-round service
4.
♦
Source:
Private tubewell figures estimated by extrapolation from a survey conducted in 1983. Statistical reliability poor.
UNICEF and DPHE records
- :
TA8LE^
5 /
: -
SECTORAL BUDGET ALLOCAI IONS (in crore laka)
First FYP
1973-78
Two Year Plan
1978-80
1.
Total Public Sector Allocation
3,952
3,261
2.
Total Public Sector Expenditure
4,162
3,933
3.
Total Physical Planning and Housing Allocation
Second FYP*
1980-85
20,125
[revised 11,100
(100%)
1,220
574
(6.1V
[revised
4.
Total Physical Planning & Housing Expenditure
5.
Total Hater and Sanitation Allocation
6.
270
(6.5%)
241
DPHE Urban Allocation
8.
DPHE Rural Allocation
(5.2V)
739
(6.1%)
[revised
375
237
(1.9V
(MV)
[revised
125
102
(0.6V
(0.9V)
[revised
70
50
(0.3V
(0.5V)
180
85
(0,9V
[revised
Dhaka and Chittagong HASAs Allocation
7.
(liot)]
9.
DPHE Urban Expenditure
36
10.
DPHE Rural Expenditure
113
11.
Total Rural: Urban Ratio Allocation
12.
DPHE Rural : Urban Ratio Allocation
[revised
48 : 52
36 : 64]
[revised
72 : 28
63 : 37]
(0.8V)
'The Second FYP was revised in 1983.
Out of Tk.1250 crore allocated as development grant to Upazila Parlsbads, between 10% and 17.5% may be spent on hats and
community centres, and rural water supply and sanitation. Actual Investment is at the discretion of the Upazila Parisha
If 3* is spent on rural water supply and sanitation, this represents an extra Tk.40 crore allocation to the rural sector.
Source:
Relevant Five Year Plan Documents
ref: editor/sectable2/cg
58
COMMUNICATION
CHAPTER 6
Development in Bangladesh,
as elsewhere,
is constrained by
a paucity of means of communication — logistical
(roads,
rail
ways , bridges) and otherwise (mass media) — and by high levels
of illiteracy.
Unusually for a small highly populated country,
communication in social terms is also severely hampered by
water; many thousands of villages are stranded many months of
the year, and villagers live in isolation, cut off from casual
contact with the marketplace (literal and metaphorical).
On the other hand, there is a homogeneity in the country,
both within the extended family system and in terms of language,
religion and poverty which accustoms small groups of people to
working, thinking and living together.
Non-government organi
zations have found in their work that these groups cannot be
assumed to extend to whole villages, particularly in the case
of the landless or functionally landless, but that their
responses to innovations may not vary too much round the
country.
The rural-urban disparity 'of resources is reflected in
communication resources like any other;
the press and marketing
infrastructure is poorly developed (5 daily newspaper copies
per thousand people), and the rural share of the most developed
mass media — radio — remains low,
only a small proportion of
broadcast hours.
Although statistics on media exposure are few,
studies
show that only a third of rural women and a half of urban women
have access to a radio that works and listen to it.
A half of
rural women and a quarter of rural men have no access to radio
Two rural women out of three virtually never listen to
the radio.
In contrast, three-quarters of urban men listen to
at all.
the radio at least several times a week.
sets for every 100 people nationally.
600,000 TV sets in the country.
Ownership is five
There are said to be
59
In content, the mass media do not devote much time or space
to development issues. A Radio Bangladesh survey in 1985
classified 21 per cent of programmes as ’motivation'. Less than
10 per cent of TV programmes can be classified as developmental.
Local media, including folk media, continue. Amplifiers,
both in mosques and in the marketplace, are common.
Itinerant
folk singers are a popular medium.
Government Communication Practices
Unfortunately, the many officials tend to have the tradi
tional faith in information as being all that is needed by way
of communication to help induce behavioural change. The limi
tations of information alone as a means of instigating
behavioural change with an unreceptive audience have not been
absorbed by government extension workers, and staff are still
untrained in the concepts of dialogue and participation when
dealing with rural societies; all wisdom is felt to lie in the
hands of authority to be handed down along with other
development inputs.
The considerable body of health educators,
for instance, are not in the mainstream of development projects
and are generally considered ineffectual and peripheral.
Communication methodologies found effective by leading NGOs
have yet to be adapted to the ways of government.
Social Marketing
Some success in breaking the mould of traditional ways of
disseminating government policies is claimed in the field of
family planning. The social marketing of contraceptives was
started in 1976, when usage of modern contraceptive techniques
was under 8 percent; prevalence among eligible couples in 1983
was estimated at 27 percent, partly due to the activities of
the Social Marketing Project.
60
The same project is about to use similar advertising
techni*ques to market oral rehydration salts (ORS) , an idea that
has been proven in several countries.
The strategies for
marketing both ORS and contraceptives hinge on one essential
factor — a monetary transaction for a tangible product, With
other social innovations that are free and intangible (eg
immunization) marketing techniques have yet to be tried and
proven, but they will be attempted in the Expanded Programme of
Immunization (EPI), using not private ’retailers' but government
vaccinators.
Approaches to the Community
Some non-government organizations have achieved notable
success in communicating self-help in the villages and have
developed methods of interpersonal communication that have been
noticed round the world.
The strategy of one such organization,
the Bangladesh Rural Advancement Committee (BRAC), has evolved
from one of conscientization and training, to integrated
services, credit support and training, and (today) to group
mobilization and support as a means of empowering the poorest
to solve their own problems. Conventional communication and
extension methods play a supporting role only, and the emphasis
is on the process rather than the medium, and on the group
dynamics of the poorest sections of society.
In supporting some of the NGO successes, however, the mass
media have played a notable part in what they do best — awareness creation and reinforcement.
Separate studies of the BRAC
Oral Therapy Extension Programme (OTEP) have shown high awareness (87%) of ORT throughout the country and almost universal
familiarity (up to 99%) in the areas where the BRAC extension
staff were operational.
61
*
I
Up to two-thirds of women had heard media messages on ORT,
and radio was by far the most important source. And the
messages were remembered, somewhat better in OTEP areas than
elsewhere, although reported ability to make ORT was
considerably higher in the extension areas. Whatever the
practices (which remain to be evaluated in terms of health
impact), the fact is that about half the women sampled reported
they used ORS, whether or not there had been extension activity
on the ground; this is powerful testimony to the effectiveness
of radio in creating awareness and thus as one tool in the
development process.
Understanding the Community
Rural people are not inarticulate about their needs, and
the possibilities of using their testimony to educate
government front-line workers can be explored, perhaps using
The Grameen Bank has plans for
inter-active video techniques.
an 'electronic newsletter’ as a tool for small communities
which have developed 'ideas that work* to communicate their
experiences to others.
The use of simpler technology like audio
cassettes could also be explored.
This may be especially so in
the case of groups of women, who are denied access to communi
cation channels even more than men.
Advocacy
The extent to which private and commercial resources can
be mobilized in support of rural development is unknown. While
there are a large number of voluntary organizations engaged in
development work of one kind or another, large philanthropic
initiatives drawing support from the commercial or industrial
sectors are rare. Advocacy for children has to be done within
a climate of widespread acceptance of the burden and effect of
poverty; government, heavily supported by foreign aid, is
perceived to bear the main responsibility for its alleviation.
- Media
SDA-RF-CH-1B.3.pdf
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