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Copenhagen Consensus Center

Bangladesh Priorities: Child and Maternal Health, Khan and Ahmed

Even though Bangladesh has greatly reduced child and maternal deaths, the progress has been uneven. According to the World Bank, the mortality rates are nearly twice as high for infants and young children in the poorest 20 percent of the population compared to those in the richest 20 percent.

Research by Jahangir A.M. Khan, senior lecturer in health economics at Liverpool School of Tropical Medicine, and Sayem Ahmed, research investigator at The International Centre for Diarrhoeal Disease Research, Bangladesh, looks first at making births safer. Getting more women to deliver in medical facilities, which only half do now, could help. 


Strategy Takas of benefits per taka spent
Facility births with skilled attendant 8
Newborn homecare by health workers 27
Immunize children in urban slums 15
Immunize children in remote areas 8

A more cost-effective way to help with pregnancies is to have community health workers visit mothers at home both before and after births. This option is very cheap—just 850 takas over the course of a pregnancy. Nearly 750,000 pregnant women could be targeted, and in all, homecare visits could save lives of more than 8,900 infants. Benefits for each taka of spending would be an impressive 27 takas.It would cost an estimated Tk 6,000 per delivery but is not practical for everyone, particularly in remote areas. The experts estimate that total spending of Tk 8.94 billion (Tk 894 crore) could move 80 percent of currently unattended births, or 1.5 million deliveries, into medical facilities. This would avert more than 37,500 deaths. Overall, each taka spent would do 8 takas of good.

While 85 percent of children ages 12-23 months are fully immunized, that figure is just 51 percent for children in remote rural areas and just 43 percent for those in urban slums. Vaccinations cost Tk 1,400-1,900 per child and could save more than 4,100 lives each year. Each taka spent immunizing children would do 10 takas of good.