Bangladesh is the most densely populated country
in the world, with 122 million people. In spite of many challenges
such as poverty, illiteracy, political instability, natural disasters,
the national population and health programmes have made significant
progress in the recent decades. In 1977, the annual incidence of
all TB was 246 / 100,000 population; death due to TB was 68,000
in the whole country. The annual risk of infection was estimated
to be 2.2% with an annual decline of 1%. In 1965, the TB services
were organized into 44 TB clinics and 12 TB hospitals situated in
different districts of the country.
In 1975, the health and population sector, with
the international assistance had been successfully implemented,
but the philosophy of fourth population and health project (FPHP)
was project oriented and had several weaknesses i.e., centralized
authority, delays in fund release, etc. In 1998 the GOB changed
its policy to sector wide management known as Health and Population
sector programme (HPSP). This involves strengthening the management
capacity of the Ministry by integrating the two wings of health
and population control. The reforms were made to address the inefficient,
fragmented and duplicated services provided by the project oriented
approach. The essential service package will receive 60% of the
total funds. The five areas identified are reproduction, child health
care, communicable disease control, curative care and behaviour
change communication. TB & leprosy services were identified
as important programmes within the communicable diseases.
The NTP organized within the FPHP provided effective
TB control services within the existing health care system in Bangladesh.
In 1992, Government of Bangladesh (GOB) adopted the WHO recommended
World Bank sponsored DOTS programme. Will the integrated approach
in fifth HPSP, the priority and commitment given to TB will be sustained?
Having reached high cure rates, the NTP needs to reach out to private
practitioners and other academic institutions. This needs monitoring
of the changed strategy and reformed sectoral approach through indicators
such as case detection and cure rates. Many challenges are foreseen
in the transition period of implementation of HPSP. The essential
programmes should be further integrated for their sustainability
and participation by the NGOs, community and the private practitioners
should be strengthened.