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Civil Society Participation in Health Sector Reforms in Bangladesh

Following the Cairo conference, which changed population policy and where the Bangladesh government played a significant role, IWHC worked on behalf of the Swedish government to redesign Bangladesh’s population policy from a conventionally narrow emphasis on family planning services alone to inclusion of essential obstetric care, improved antenatal services, attention to adolescents and young married couples, and initiation of an HIV/AIDS program along with other STD services.

Thanks to this coordinated government and civil society initiative, the percentage of women receiving antenatal care rose from 26 percent to 56 percent, female life expectancy increased from 58 to 60 years, and the maternal mortality ratio fell from 440 maternal deaths per 100,000 live births to 322, between 1998 and 2003. The use of emergency obstetric care rose from 5% to 27%, and the mortality rate for children under five in Bangladesh also dropped significantly.

While health indicators for women and girls generally continue to improve, women’s and other civil society groups continue to be excluded from policy design and implementation. For example, a draft Health Law was recently created by the government, which had no input from civil society.

IWHC has worked to build civil society participation in Bangladesh to have a stronger voice in impacting health policy and programming. This continues to be important as donor funding for reproductive health has fallen dramatically in recent years in the country. A 2006 IWHC-supported research project focused attention on the need to involve civil society throughout the reform process. Through documentation, public advocacy, and a series of workshops and dialogues on reproductive health with civil society, village health watch committee members, government officials, researchers, service providers, and the press, the project built local advocacy capacity to hold government accountable.

Researchers affiliated with IWHC’s work in Bangladesh established a National Health Watch which is housed in the Bangladesh Rural Advancement Committee (BRAC) School of Public Health, to ensure implementation of the national health agenda. The Health Watch hosts national meetings bringing together health activists, policy makers and researchers to address gaps in policy. IWHC has also supported researchers at BRAC to train civil society to integrate a human rights and sexuality approach to their health advocacy.