2005年-世界发展银行全球_Maintaining_Momentum_to_2015___An_Impact_Evaluation_of_Interventions_to_Improve_Maternal_and_Child_Health_and_Nutrition_in_Bangladesh_252页_3mb

Summary of "Maintaining Momentum to 2015?"

An Impact Evaluation of Interventions to Improve Maternal and Child Health and Nutrition in Bangladesh

Core Content

This report evaluates the impact of interventions aimed at improving maternal and child health (MCH) and nutrition in Bangladesh, with a focus on whether these efforts have helped maintain momentum toward achieving national and international development goals such as the Millennium Development Goals (MDGs). It is the second in a series of three impact studies conducted by the World Bank's Operations Evaluation Department (OED), in partnership with the U.K. Department for International Development (DFID), and draws on a range of data sets to assess outcomes and program effectiveness.

Main Goals and Objectives

The report seeks to answer four key questions:

1. How have child health, nutrition, and fertility outcomes evolved in Bangladesh since 1990? Have the poor benefited from these improvements?
2. What have been the main determinants of MCH outcomes over this period?
3. What has been the impact of publicly and externally supported programs on improving health and nutrition?
4. Have these interventions been cost-effective?

Key Findings

1. Progress in Child Health and Fertility

• Bangladesh has made significant progress in reducing under-five mortality and fertility rates over the past two decades.
• Under-five mortality has declined substantially, with the country on track to meet the MDG target of a two-thirds reduction by 2015.
• Fertility has also declined rapidly, particularly due to the expansion of family planning services.
• The poor have seen faster declines in mortality than the non-poor, and are more likely to use contraception and have lower fertility rates.

2. Determinants of Improvement

• Economic growth has played a major role in improving child health outcomes.
• Social sector interventions, especially in health and education, have had a significant impact on mortality reduction.
• Expanded immunization coverage, increased female education, and improved health services have all contributed to better outcomes.
• A pronounced sex bias in mortality exists, with girls disproportionately affected in Sylhet and Chittagong.

3. Impact of Specific Interventions

• Immunization: Coverage increased from less than 2% in the early 1980s to nearly 50% by 1990. Immunization has saved over two million lives, with a cost of $100–$300 per life saved.
• Training of Traditional Birth Attendants (TBAs): The World Bank funded the training of around 14,000 TBAs until the late 1990s. Despite the shift toward skilled birth attendants, TBAs contributed to reducing infant mortality at a cost of $220–$800 per life saved.
• Female Secondary Education: Rapid expansion in the 1990s, especially in rural areas, was supported by multiple donors, including the World Bank. It has contributed to lower mortality at a cost of $1,080–$5,400 per life saved.
• Rural Electrification: Supported by three World Bank programs, electrification reduced under-five mortality by 25 per 1,000, with a cost of $20,000–$40,000 per life saved.

4. Nutrition: Progress and Challenges

• Nutrition has lagged behind other health indicators, with malnutrition remaining high despite some improvements in the 1990s.
• The Bangladesh Integrated Nutrition Project (BINP) was launched to address this, focusing on community-based nutrition counseling and supplementary feeding.
• However, the project's impact on nutritional status has been limited, and it has not been cost-effective compared to other interventions.

5. Fertility Reduction

• Fertility decline in Bangladesh is more rapid than expected from socioeconomic changes alone.
• The family planning program, supported by external partners, has been a major driver of this decline.
• Raising the age of marriage has had a limited effect on fertility due to traditional practices and the fact that many women plan to have only 3–4 children.
• Targeting high-fertility households and addressing son preference are more effective strategies.

Key Lessons

• Externally supported interventions have had a significant impact on MCH outcomes.
• Immunization has been particularly cost-effective, saving millions of lives.
• Social sector interventions, such as education and health services, are important for reducing child mortality.
• The knowledge-practice gap remains a challenge, with women often not translating nutritional advice into action.
• The BINP has improved nutritional status, but not as much as planned, and may not be the most cost-effective way to scale up nutrition programs.
• Gender issues are central to health strategies, and addressing biases is essential for sustaining progress.
• National surveys can be used for evaluation, but more detailed community questionnaires would enhance their effectiveness.

Conclusion

Bangladesh has made remarkable progress in maternal and child health and fertility reduction, but nutrition remains a challenge. The study highlights the importance of targeted and cost-effective interventions, the role of gender in shaping health outcomes, and the need for more rigorous impact evaluation to guide future programming.