Bangladesh - Health Care Facilities

The Ministry of Health and Family Planning was responsible for developing, coordinating, and implementing the national health and mother-and-child health care programs. Population control also was within the purview of the ministry. The government's policy objectives in the health care sector were to provide a minimum level of health care services for all, primarily through the construction of health facilities in rural areas and the training of health care workers. The strategy of universal health care by the year 2000 had become accepted, and government efforts toward infrastructure development included the widespread construction of rural hospitals, dispensaries, and clinics for outpatient care. Program implementation, however, was limited by severe financial constraints, insufficient program management and supervision, personnel shortages, inadequate staff performance, and insufficient numbers of buildings, equipment, and supplies.
In the late 1980s, government health care facilities in rural areas consisted of subdistrict health centers, union-level health and family welfare centers, and rural dispensaries. A subdistrict health center in the mid-1980s typically had a thirty-one-bed hospital, an outpatient service, and a home-service unit staffed with field workers. Some of the services, however, were largely nonoperative because of staffing problems and a lack of support services. Health services in urban areas also were inadequate, and their coverage seemed to be deteriorating. In many urban areas, nongovernment organizations provide the bulk of urban health care services. Programming and priorities of the nongovernment organizations were at best loosely coordinated.
A union-level health and family welfare center provided the first contact between the people and the health care system and was the nucleus of primary health care delivery. As of 1985 there were 341 functional subdistrict health centers, 1,275 rural dispensaries (to be converted to union-level health and family welfare centers), and 1,054 union-level health and family welfare centers. The total number of hospital beds at the subdistrict level and below was 8,100.
District hospitals and some infectious-disease and specialized hospitals constituted the second level of referral for health care. In the mid-1980s, there were 14 general hospitals (with capacities ranging from 100 to 150 beds), 43 general district hospitals (50 beds each), 12 tuberculosis hospitals (20 to 120 beds each), and 1 mental hospital (400 beds). Besides these, there were thirty-eight urban outpatient clinics, forty-four tuberculosis clinics, and twenty-three school health clinics. Ten medical college hospitals and eight postgraduate specialized institutes with attached hospitals constituted the third level of health care.
In the mid-1980s, of the country's 21,637 hospital beds, about 85 percent belonged to the government health services. There was only about one hospital bed for every 3,600 people. In spite of government plans, the gap between rural and urban areas in the availability of medical facilities and personnel remained wide. During the monsoon season and other recurrent natural disasters, the already meager services for the rural population were severely disrupted.

Bangladesh - Women's Role in Society

Available data on health, nutrition, education, and economic performance indicated that in the 1980s the status of women in Bangladesh remained considerably inferior to that of men. Women, in custom and practice, remained subordinate to men in almost all aspects of their lives; greater autonomy was the privilege of the rich or the necessity of the very poor. Most women's lives remained centered on their traditional roles, and they had limited access to markets, productive services, education, health care, and local government. This lack of opportunities contributed to high fertility patterns, which diminished family well-being, contributed to the malnourishment and generally poor health of children, and frustrated educational and other national development goals. In fact, acute poverty at the margin appeared to be hitting hardest at women. As long as women's access to health care, education, and training remained limited, prospects for improved productivity among the female population remained poor.
About 82 percent of women lived in rural areas in the late 1980s. The majority of rural women, perhaps 70 percent, were in small cultivator, tenant, and landless households; many worked as laborers part time or seasonally, usually in post-harvest activities, and received payment in kind or in meager cash wages. Another 20 percent, mostly in poor landless households, depended on casual labor, gleaning, begging, and other irregular sources of income; typically, their income was essential to household survival. The remaining 10 percent of women were in households mainly in the professional, trading, or large-scale landowning categories, and they usually did not work outside the home.
The economic contribution of women was substantial but largely unacknowledged. Women in rural areas were responsible for most of the post-harvest work, which was done in the chula, and for keeping livestock, poultry, and small gardens. Women in cities relied on domestic and traditional jobs, but in the 1980s they increasingly worked in manufacturing jobs, especially in the readymade garment industry. Those with more education worked in government, health care, and teaching, but their numbers remained very small. Continuing high rates of population growth and the declining availability of work based in the chula meant that more women sought employment outside the home. Accordingly, the female labor force participation rate doubled between 1974 and 1984, when it reached nearly 8 percent. Female wage rates in the 1980s were low, typically ranging between 20 and 30 percent of male wage rates.

SOCIAL SYSTEM IN BANGLADESH

Bangladesh did not exist as a distinct geographic and ethnic unity until independence. The region had been a part of successive Indian empires, and during the British period it formed the eastern part of a hinterland of Bengal, which was dominated by the British rulers and Hindu professional, commercial, and landed elites. After the establishment of Pakistan in 1947, present-day Bangladesh came under the hegemony of the non-Bengali Muslim elites of the West Wing of Pakistan. The establishment of Bangladesh, therefore, implied the formation of both a new nation and a new social order.
Until the partition of British India in 1947, Hindus controlled about 80 percent of all large rural holdings, urban real estate, and government jobs in East Bengal and dominated finance, commerce, and the professions. Following partition, a massive flight of East Bengali Hindus effectively removed the Hindu economic and political elite and cut the territory's ties to Calcutta. After the emigration of the Hindus, Muslims moved quickly into the vacated positions, creating for the first time in East Bengal an economy and government predominantly in Muslim hands. These vastly increased opportunities, especially in the civil service and the professions, however, soon came to be dominated by a West Pakistani-based elite whose members were favored by the government both directly and indirectly. Soon after independence in 1971, an ill-prepared Bangladeshi elite moved into the areas vacated by West Pakistanis. Except for members of small non-Bengali caste-like Muslim groups known as "trading communities," Bangladeshi Muslims almost immediately established control over all small- and medium-sized industrial and commercial enterprises. The 1972 nationalization of non-Bengali-owned large industries accelerated the establishment of control and influence by the indigenous community.
The sudden rise of a new managerial class and the expansion of the civil and military bureaucracy upset the balance in both the urban and the rural sectors. Party affiliation, political contacts, and documented revolutionary service became the main prerequisites for admission to the rapidly growing new elite of political and industrial functionaries; the established middle class and its values played lesser roles. In the countryside, new elites with links to the villages bought property to establish their sociopolitical control. Also taking advantage of the situation, the rural political elite amassed fortunes in land and rural-based enterprises. The result was the growth of a new, land-based, rural elite that replaced many formerly entrenched wealthy peasants (in Bangla, jotedars).Transition to a New Social Order-->

The Society and Its Environment(Bangladesh)

BANGLADESH IS NOTED for the remarkable ethnic and cultural homogeneity of its population. Over 98 percent of its people are Bengalis; the remainder are Biharis, or non-Bengali Muslims, and indigenous tribal peoples. Bangladeshis are particularly proud of their rich cultural and linguistic heritage because their independent nation is partially the result of a powerful movement to uphold and preserve their language and culture. Bangladeshis identify themselves closely with Bangla, their national language.
One of the world's most densely populated nations, Bangladesh in the 1980s was caught in the vicious cycle of population expansion and poverty. Although the rate of growth had declined marginally in recent years, the rapid expansion of the population continued to be a tremendous burden on the nation. With 82 percent of its people living in the countryside, Bangladesh was also one of the most rural nations in the Third World. The pace of urbanization in the late 1980s was slow, and urban areas lacked adequate amenities and services to absorb even those migrants who trekked from rural areas to the urban centers for food and employment. Frequent natural disasters, such as coastal cyclones and floods, killed thousands, and widespread malnutrition and poor sanitation resulted in high mortality rates from a variety of diseases.
In the late 1980s, poverty remained the most salient aspect of Bangladeshi society. Although the disparity in income between different segments of the society was not great, the incidence of poverty was widespread; the proportion of the population in extreme poverty--those unable to afford even enough food to live a reasonably active life--rose from 43 percent in 1974 to 50 percent in the mid-1980s. The emerging political elite, which constituted a very narrow social class compared with the mass of peasants and urban poor, held the key to political power, controlled all institutions, and enjoyed the greatest economic gains. Urban in residence, fluent in English, and comfortable with Western culture, they were perceived by many observers as socially and culturally alienated from the masses. At the end of the 1980s, Bangladeshi society continued to be in transition--not only from the early days of independence but also from the colonial and Pakistani periods as well--as new values gradually replaced traditional ones.
Nearly 83 percent Muslim, Bangladesh ranked third in Islamic population worldwide, following Indonesia and Pakistan. Sunni Islam was the dominant religion among Bangladeshis. Although loyalty to Islam was deeply rooted, in many cases beliefs and observances in rural areas tended to conflict with orthodox Islam. However, the country was remarkably free of sectarian strife. For most believers Islam was largely a matter of customary practice and mores. In the late twentieth century fundamentalists were showing some organizational strength, but in the late 1980s their numbers and influence were believed to be limited. Promulgated in June 1988, the Eighth Amendment to the Constitution recognizes Islam as the state religion, but the full implications of this measure were not apparent in the months following its adoption. Hindus constituted the largest religious minority at 16 percent; other minorities included Buddhists and Christians.
Since its birth in 1971, Bangladesh has suffered through both natural calamities and political upheavals. In July-September 1987, for example, the country experienced its worst floods in more than thirty years, and floods during the same period in 1988 were even more devastating. In 1987 more than US$250 million of the economic infrastructure was destroyed, the main rice crop was severely damaged, and an estimated 1,800 lives were lost. The 1988 floods covered more than two-thirds of the country, and more than 2,100 died from flooding and subsequent disease. The country also underwent a period of political unrest fomented by major opposition political parties. Enduring uncertainties as the 1990s approached were bound to have an impact on social development, especially in the areas of education, development of the labor force, nutrition, and the building of infrastructure for adequate health care and population control.

Poverty In Bangladesh

Living in a country like Bangladesh constantly forces me to redraw the lines around my mental conception of poverty. A factory worker seems hard done by until you meet the construction worker. The construction worker earns your sympathy until you see the child collecting trash. The child is then outdone by a disabled beggar... When I was not immersed in this reality it was easy to treat them all as poor, to condemn all of the conditions they faced as equally bad. But in reality the poverty here is extremely complex and it isn't realistic or meaningful to treat each person's poverty as if it were the same.Yes, poverty is really a complex thing. It all depends on where you set the standard. If you go to a village you will find the simplicity of a living. They may not have TV refrigerator or even electricity but they are surviving. They can still live an eventful life with their sorrows, joys, love and patriotism. A village family's monthly expense can be less than what a rich family dines in a restaurant in the capital in one night. Yet if you compare those riches with a rich people in a Western country they will be outclassed. In the West there are also poor people but you can barely notice them. Its not only that they are protected by social security, but there is hardly any difference of appearance between rich and poor. Except for the über rich people (who have their limos and jets) people do not show off their richness to others. They don't have maids at home, they are not more shiny in appearance than the less well-offs. Even you cannot distinguish between a day-labor and a rich lawyer in the streets as they are treated as equals.But the picture is different in Bangladesh. There is a pseudo class notion among the people. Ask anyone from a village, their goal is to be rich one day to have maids and cars to show off. From lower income class to middle class, upper middle class to rich every body dreams to oppress the lower class; there is no sense of equality. And that is why the poverty is so complex and ugly. Because there is a competition to be richer and show off your shiny cloth, assets in every strata of society. So you get a hierarchy of poors, a million dollar mansion overshadowed by slums beside it. And nobody seem to care about others.Shawn, who came to Bangladesh to do something about poverty finds out this reality:
"With an estimated 80% of the country surviving on less than $2 a day, Bangladesh is sharply divided between those struggling to survive and those living it up. Being rich, in Bangladesh typically means being insulated and detached from the tragedies that fall upon the country.The rich tend to congregate in Dhaka City where they live in up-scale apartment complexes and homes. These are strategically built on higher ground, in gated communities, with their own backup generators and reserve water tanks. Most of the urban rich do not have to worry about driving, cooking, or cleaning as it is relatively inexpensive for them to hire chauffeurs, cooks, and maids. Having lived in this country for the past six months, I have observed that the typical routine for rich Bangladeshis is to stay sheltered at home during floods, riots, and curfews and then - when it is all over - resume daily activities as if nothing has happened