Seminar 10: Good health at low cost

The latest in C3’s series of International Breakfast Seminars was given by Dr Tracey Koehlmoos on 18 October 2011, on Good health at low cost: can Britain learn from Bangladesh’s low-cost, low-tech solutions to the chronic disease crisis?

Dr Koehlmoos is a health systems scientist with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).

  • Slides from the event are available here >>
  • A full report of the event is available here >>

Dr Koehlmoos was in London for the launch of a new book, which outlines a large study exploring the development of the health system in Bangladesh, Good Health at Low Cost (click here >>), undertaken by the ICDDR,B. She gave insights into the health system in Bangladesh, and the strides being taken to focus attention on the emerging NCD challenge in the country.

At its founding in 1971, following the War of Liberation, Bangladesh was the poorest country in the world. Today, life expectancy has increased from 45 (in 1960) to 66, child mortality has decreased from 240 per 1,000 to 45 per 1,000, and there is no longer seasonal famine – the challenges are food security and affordability.

There have been three key factors in shaping and strengthening the health system:

Political commitment to health: This transcends party politics, so major reforms continue during government change, resulting in ongoing development – for example, the country is on track to achieve the MDG on child mortality, fertility has declined from 6.2 to 2.7 children per woman, there is a policy of developing indigenous pharmaceuticals, and a sector-wide approaches are encouraged rather than vertically funded programmes.

Community health workers: They are the backbone of the public and non-state sectors, providing low-tech, low-cost solutions.

Role of the non-state sector: 2,000 NGOs extend government capacity, and 400,000 people have been partially trained as informal care providers.

The country is facing a serious NCD challenge, as 26 per cent of the population is already over 60 – and the number will increase 10-fold by the end of the century. Tobacco use is increasing (especially among women), cardiovascular events are happening at younger ages, and women have more diabetes complications than men. NCDs account for 54 per cent of deaths – an apparently dramatic increase, although this may also partially be explained by better data collection. There is also a lack of good evidence of effectiveness of interventions.

The discussion that followed covered topics including:

  • using lay workers to promote health, both in the United Kingdom (pharmacy workers) and Bangladesh. It is challenging to encourage professionals to relinquish control. In Bangladesh, physicians are orientated towards particular projects, but the lay workers are trained to implement them;
  • how to achieve continuity and coherence of development of the health system over time and between governments;
  • using social media; and
  • the role of the pharmaceutical companies.