Multi Donor Trust Fund Grant Agreement signing ceremony of the Health, Nutrition and Population Sector Program (HNPSP)

 
Speech delivered by Christine Wallich , Country Director of World Bank
at the Sonargaon Hotel on the 15th October 2006

Honorable Ministers, distinguished guests, ladies and gentlemen. I am delighted to be here to sign the Multi-Donor Trust Grant Agreement on behalf of the World Bank. I thank both the Government of Bangladesh and the development partners, the UK’s Department for International Development, the European Commission, the Embassy of the Kingdom of the Netherlands, the Swedish International Development Cooperation Agency and UNFPA. The World Bank is honored to have been entrusted by these development partners with the task of administering the fund based on their contributions. We also acknowledge the Canadian International Development Agency and the KFW of Germany, whose possible contribution to the Trust Fund are under consideration.

In recent years, Bangladesh has made great strides in improving the health of its citizens. As we have already heard, the country has a good probability of meeting several of the health-related Millennium Development Goals, most notably those linked to child mortality rates. Here it is interesting to note that infant mortality in Bangladesh is now lower than in India, even though Bangladesh’s per capita income level is well below that of its neighbor. Bangladesh also outperforms India on child malnutrition.

And there are many other successes, be it in immunization levels, polio eradication, TB detection rates or the Government’s involvement in combating the spread of HIV/AIDS.

It would be unfair to say that these were easy achievements; however in a certain sense they do represent first generation achievements – low-hanging fruit – that the system with its current capabilities and in its current state of organization could deliver through the combined efforts of Government and NGOs.   Looking forward, our message is that it will take fresh initiatives and substantial efforts to move Bangladesh to the next level in the battle against ill health and disease.

For example, while reducing child mortality has been one of Bangladesh’s greatest achievements, the country still has one of the highest rates of maternal mortality in the world.    A major reason for this is the current state of public health services.   Women facing complications during child birth need good hospital facilities, skilled medical attention, blood transfusions.   We know, if we are frank with each other, that in most parts of Bangladesh these facilities simply aren’t available.   And, it is this same poor state of public health facilities that make road accidents the 9th leading cause of death and disability in Bangladesh, their victims languishing for lack of care.

Another challenge is posed by non-communicable diseases. We firmly believe in prevention, but patients suffering from heart disease, diabetes, or cancer all require treatment, and even in its most unsophisticated form, this treatment is beyond what is typically provided in Government health facilities.   In other words, the present health system just isn’t keeping pace.

Bangladesh is a world beater when it comes to organizing public preventive health campaigns. Look at the stunning results achieved by last year’s measles immunization campaign which reached 17 million children… how people were mobilized at all levels. But campaigns by themselves are not enough; this country needs a functioning and accountable health care system that is accessible to those in need.

The Health, Nutrition and Population Sector Program, HNPSP, is a bold attempt to create this functioning and accountable health system, to take Bangladesh to the next level in health care. It targets resources on the poor, and aims to create a health care system that can provide reliable and sustained levels of services,…… services that reach users and respond to their needs.

Financial resources are vital in achieving this, but there is much more to it. Not surprisingly, many people have turned away from public health provision, deterred by staff absenteeism, inconsistent quality and demands for illegal payments. Bringing health services closer to people and making them accountable, is a major aim of HNPSP.

A functioning health sector demands increased accountability, not just of medical staff to their masters in Dhaka, but to the local community where services are delivered. We know this can be done. Look at the examples from the NGO sector where village development committees or similar structures are used to oversee health care delivery, often producing better levels of care at considerably lower costs.

An important aspect of HNPSP commitment to tap into this wide network of health service providers. NGOs, the private sector and civil society organizations are partnered with the public health care system so that jointly, more services can be delivered to people currently outside the reach of the Government system.   At the same time, greater local planning and hospital autonomy will attempt to break the financial and leadership dependence on Dhaka

Such partnerships between NGOs/civil society and government have born tremendous fruit for Bangladesh across a range of sectors – in education, in future, in health, and of course in microfinance.  I would like to take this opportunity to pay tribute to Dr Mohamed Yunus for receiving the Nobel Peace Prize just 2 days ago. His contribution, and that of Grameen Bank, have been recognized through this prize as a world-class partnership for poverty reduction via micro-finance.  With Government providing an enabling environment, his organization has had a profound impact on the well-being of 6 million Grameen members -- 30 million people if we include their families (over one fifth the population of Bangladesh). Peace and prosperity do go hand in hand, and the Nobel Prize committee recognized this in awarding the peace Prize to Dr Yunus.

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I would like to conclude by briefly focusing on the Trust Fund Agreement we are signing here today. By coming together and pooling their funds, development partners have made a clear, determined effort to harmonize their approaches under a single disbursement procedure, to avoid duplication of donor oversight, and also of government reporting requirements.    The aim is to cut down the transaction costs for Government and to make the overall aid process more efficient. Once again I thank the donors for taking this initiative.

HNPSP is a Government initiative and it is the Government who is implementing it. We share your goals, and we are with you each step of the way.

Thank you.