Family Planning in Asia and the Pacific - International Council on ...

MOHFW <strong>and</strong> NGOs, <strong>and</strong> separately for SMC. However,about half of <strong>the</strong> upazilas still do not have proper storagefacilities, <strong>and</strong> generally keep <strong>the</strong>ir supplies <strong>in</strong> a smallroom <strong>in</strong> Upazila Health Complexes or at Upazila ParisadBuild<strong>in</strong>gs (subdistrict adm<strong>in</strong>istrative complex), where it isnot possible to follow basic storage pr<strong>in</strong>ciples. Fur<strong>the</strong>r, <strong>the</strong><strong>in</strong>crease <strong>in</strong> contraceptive requirements could result <strong>in</strong> <strong>the</strong>warehous<strong>in</strong>g system experienc<strong>in</strong>g a shortage of space.The government undertook a number of measures tosimplify <strong>and</strong> modernize <strong>the</strong> public procurement policy<strong>and</strong> procedures <strong>in</strong> order to m<strong>in</strong>imize delays. Despite thoseefforts, delays cont<strong>in</strong>ue to hamper <strong>the</strong> procurement process.Delays arise largely due to: (a) limited technical capacity of<strong>the</strong> DGFP <strong>and</strong> MOHFW officials <strong>and</strong> Tender EvaluationCommittee (TEC) members; (b) high staff turnover atDGFP <strong>and</strong> MOHFW; (c) considerable time <strong>in</strong>volvementfor <strong>the</strong> MOHFW <strong>and</strong> World Bank Review Process; <strong>and</strong>(d) lengthy time for decision-mak<strong>in</strong>g by MOHFW <strong>and</strong>World Bank officials.The high turnover of tra<strong>in</strong>ed procurement staff <strong>and</strong> seniormanagement staff creates a knowledge <strong>and</strong> experience gap,limit<strong>in</strong>g <strong>the</strong> capacity of <strong>the</strong> MOHFW/DGFP to carry outtimely <strong>and</strong> effective procurement. Also, <strong>the</strong> TEC membersdo not have <strong>the</strong> requisite knowledge for prepar<strong>in</strong>gacceptable bid evaluation reports.Lack of adequate supportfor behavioural changecommunicationCommunication is an <strong>in</strong>tegral part of <strong>the</strong> FP programme,facilitat<strong>in</strong>g exchange of <strong>in</strong>formation <strong>and</strong> ideas to promote<strong>and</strong> susta<strong>in</strong> behavioural changes among differentpopulation groups towards <strong>the</strong> small family size norm <strong>and</strong>promote <strong>the</strong> use of contraception.The Information, Education <strong>and</strong> Motivation Unit of DGFPprepares various types of communication materials, suchas posters, h<strong>and</strong>bills, billboards, short television serials,dramas, radio j<strong>in</strong>gles <strong>and</strong> advertisements; however, mostsuch materials are outdated <strong>and</strong> not tailored to meet <strong>the</strong>specific needs of different client groups. Also, <strong>the</strong>re is noseparate cadre of officials at <strong>the</strong> district level for behaviouralchange communication activities.The major behavioural change communication objectivesunder HNPSP <strong>in</strong>clude: (a) encourag<strong>in</strong>g users not todiscont<strong>in</strong>ue FP use without valid reasons <strong>and</strong> to cont<strong>in</strong>uewith <strong>the</strong> option to use o<strong>the</strong>r FP methods; (b) develop<strong>in</strong>gpositive attitudes among people about longer-act<strong>in</strong>g <strong>and</strong>permanent methods <strong>and</strong> promot<strong>in</strong>g male participation;(c) extend<strong>in</strong>g behavioural change communicationactivities to hard-to-reach areas, urban slum dwellers<strong>and</strong> disadvantaged population groups; <strong>and</strong> (d) <strong>in</strong>creas<strong>in</strong>gbehavioural change communication knowledge amongservice providers for better counsel<strong>in</strong>g <strong>and</strong> good-qualitycare services. The key strategies <strong>in</strong>clude: (a) streng<strong>the</strong>n<strong>in</strong>gbehavioural change communication <strong>in</strong>terventionsat service centres, (b) improv<strong>in</strong>g <strong>the</strong> <strong>in</strong>terpersonalcommunication skills of service providers, (c) develop<strong>in</strong>g<strong>and</strong> dissem<strong>in</strong>at<strong>in</strong>g appropriate messages us<strong>in</strong>g a media mix,(d) develop<strong>in</strong>g advocacy programmes for policymakers<strong>and</strong> o<strong>the</strong>r stakeholders, <strong>and</strong> (e) promot<strong>in</strong>g longer-act<strong>in</strong>g<strong>and</strong> permanent methods (GOB, 2008a). To achieve <strong>the</strong>goals <strong>and</strong> objectives outl<strong>in</strong>ed <strong>in</strong> HNPSP, <strong>the</strong> governmentdeveloped its Adolescent Reproductive Health Strategy(GOB, 2006b) <strong>and</strong> National Communication Strategy for<strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> <strong>and</strong> Reproductive Health (GOB, 2008b).Although such strategy documents, as well as <strong>the</strong> previousstrategy documents (for example, see Khuda et al., 1993a),are quite comprehensive, <strong>the</strong>ir implementation has hardlybegun. Accord<strong>in</strong>g to <strong>the</strong> DGFP officials concerned, <strong>the</strong>major constra<strong>in</strong>ts to implementation of such strategies<strong>in</strong>clude: (a) lack of adequate support from <strong>the</strong> higherlevel decision-makers, (b) <strong>in</strong>adequate fund<strong>in</strong>g, (c) lackof adequate numbers of tra<strong>in</strong>ed staff, <strong>and</strong> (d) <strong>the</strong> limitedcapacity of <strong>the</strong> DGFP pr<strong>in</strong>t<strong>in</strong>g press to pr<strong>in</strong>t differenttypes of behavioural change communication materials. Asa result, both FP users <strong>and</strong> service providers have not beenable to ga<strong>in</strong> access to relevant <strong>in</strong>formation from a coherentnational behavioural change communication programme,which promotes small family size norms, counters clients’mis<strong>in</strong>formation <strong>and</strong> misconceptions, provides clients with<strong>in</strong>formation regard<strong>in</strong>g where services are available, <strong>and</strong><strong>in</strong>forms couples about <strong>the</strong>ir FP options. Consequently,basic knowledge of FP methods is low. Provider knowledgeis relatively low, result<strong>in</strong>g <strong>in</strong> poor quality of service, which,<strong>in</strong> turn, leads to <strong>in</strong>effective use of FP methods, unwantedpregnancies <strong>and</strong> <strong>in</strong>creased use of menstrual regulation <strong>and</strong>abortion (see also Alaudd<strong>in</strong> et al., 2010).Limited fund<strong>in</strong>g <strong>and</strong> actualexpenditureTotal health expenditure (THE) was estimated at Tk.159.91 billion (US$ 2.32 billion) <strong>in</strong> 2007, up from Tk.73.8 billion (US$ 1.4 billion) <strong>in</strong> 2001 <strong>and</strong> Tk. 48.47billion (US$ 1.1 billion) <strong>in</strong> 1997. THE as a percentageof GDP was 2.7 per cent dur<strong>in</strong>g <strong>the</strong> period 1997-2000;it <strong>in</strong>creased to 3.4 per cent <strong>in</strong> 2007. Per capita spend<strong>in</strong>gon health <strong>in</strong>creased from Tk. 391 (US$ 9) <strong>in</strong> 1997 toTk. 1,111 (US$ 16) <strong>in</strong> 2007, one of <strong>the</strong> lowest levels <strong>in</strong><strong>the</strong> world. Bangladesh’s public expenditure constitutes 26per cent of THE, which is similar to that of India (25%).Private expenditure as a percentage of THE account for 74per cent <strong>in</strong> Bangladesh, 83 per cent <strong>in</strong> Pakistan <strong>and</strong> 52 percent <strong>in</strong> Sri Lanka (GOB, 2010d).116