title: Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh.
abstract: In Bangladesh, rapid advancements in coverage of many health interventions have coincided with impressive reductions in fertility and rates of maternal, infant, and childhood mortality. These advances, which have taken place despite such challenges as widespread poverty, political instability, and frequent natural disasters, warrant careful analysis of Bangladesh's approach to health-service delivery in the past four decades. With reference to success stories, we explore strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms. Continued development of innovative, community-based strategies of health-service delivery, and adaptation of new technologies, are needed to address neglected and emerging health challenges, such as increasing access to skilled birth attendance, improvement of coverage of antenatal care and of nutritional status, the effects of climate change, and chronic disease. Past experience should guide future efforts to address rising public health concerns for Bangladesh and other underdeveloped countries.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Aliki
authors.initials: A
authors.lastname: Christou
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. Electronic address: laura.reichenbach@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Reichenbach
authors.affiliation: University of Dhaka, Dhaka, Bangladesh.
authors.forename: Ferdous Arfina
authors.initials: FA
authors.lastname: Osman
authors.affiliation: Diabetic Association of Bangladesh, Dhaka, Bangladesh.
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
authors.affiliation: Ministry of Health and Family Welfare, Dhaka, Bangladesh.
authors.forename: Khaled Shamsul
authors.initials: KS
authors.lastname: Islam
authors.affiliation: BRAC, Dhaka, Bangladesh.
authors.forename: Faruque
authors.initials: F
authors.lastname: Ahmed
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Henry B
authors.initials: HB
authors.lastname: Perry
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Peters
mesh_terms: D001459:Bangladesh; D003140:Communicable Disease Control / Q000458:organization & administration / Q000639:trends; D003153:Community Health Services / Q000458:organization & administration* / Q000639:trends; D003150:Community Health Workers / Q000600:supply & distribution; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000639:trends; D003920:Diabetes Mellitus / Q000628:therapy; D004059:Diffusion of Innovation; D005193:Family Planning Services / Q000458:organization & administration / Q000639:trends; D005440:Fluid Therapy / Q000639:trends; D005544:Forecasting; D006077:Government Agencies; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration / Q000639:trends; D007400:Interprofessional Relations; D009938:Organizations; D017063:Outcome Assessment, Health Care; D017149:Private Sector; D014376:Tuberculosis / Q000517:prevention & control; D019472:Universal Health Insurance / Q000458:organization & administration / Q000592:standards