2018, Frere, Jean-Jacques, Govindaraj, Ramesh, Raju, Dhushyanth, Secci, Federica, Chowdhury, Sadia

Urbanization is occurring at a rapid pace in Bangladesh, accompanied by the proliferation of slum settlements, whose residents have special health needs given the adverse social, economic, and public environmental conditions they face. Over the past 45 years, the country’s health and nutrition policies and programs have focused largely on rural health services. Consequently, equitable access of urban populations—particularly the urban poor—to quality health and nutrition services has emerged as a major development issue. However, the knowledge base on urban health and nutrition in Bangladesh remains weak. To address the knowledge gap, Health and Nutrition in Urban Bangladesh: Social Determinants and Health Sector Governance examines the health and nutrition challenges in urban Bangladesh—looking at socioeconomic determinants in general and at health sector governance in particular. Using a mixed methods approach, the study identifies critical areas such as financing, regulation, service delivery, and public environmental health, among others that require policy attention. The study also proposes specific actions within and outside the health sector to address the issues, providing guidance on their sequencing and the specific responsibilities of government agencies and other actors. This study should be useful to policy makers and practitioners working on urban health and nutrition issues in Bangladesh and in other low- and middle-income countries.

2014-05, Cortez, Rafael, Saadat, Seemeen, Chowdhury, Sadia, Sarker, Intissar

Considerable progress has been made towards the achievement of the Millennium Development Goals (MDGs) since 1990. Although advances in improving MDG 4 and MDG 5a (reducing child and maternal mortality, respectively) have been made, progress is some countries have been insufficient. While some countries have made substantial gains, others have not. This paper is part of a larger study that aims to address this gap in knowledge. The paper discusses the findings from qualitative case studies of five countries that are either on track to meet MDGs 4 and 5a by 2015 or have made significant progress to this end (Bolivia, China, Egypt, Malawi and Nepal). Although they have different socio-economic characteristics, all have made significant advancements due to a strong commitment to improving maternal and child health. To do this, strong political commitment, through policies backed by financial and programmatic support, was critical. In addition, focusing on the most vulnerable populations helped increase access to and use of services. Empowering women and families through education, employment, and poverty reduction programs have led to better health outcomes. These countries still face challenges, however, in terms of the evolving health system, and changes at the economic, social and political levels. Future qualitative and quantitative analyses on the returns of health investments, the political context and institutional arrangements at the country level could help deepen the understanding of the ways in which various countries, with their unique conditions, can improve MCH.

2007-12, Lule, Elizabeth, Singh, Susheela, Chowdhury, Sadia Afroze

The report consists of three parts: global trends in fertility, contraceptive use and unintended pregnancies; studies of two regions (Africa and Eastern Europe/Central Asia) and two countries (Nigeria and Kazakhstan) on the costs of fertility regulation behaviors and provider attitudes towards contraceptive use. Fertility levels have declined steadily over the last three decades but the pace of decline varies among regions. Countries that have achieved a high level of contraceptive use have reached a lower fertility level. A gap continues to exist between actual and desired family size, resulting in unintended pregnancies. More than one-third of the pregnancies that occur are unintended and one in five pregnancies ends in induced abortion. Almost half of all induced abortions are unsafe, and the proportion of all abortions that are unsafe have increased during the last decade. Sixty-six percent of unintended pregnancies occur among women who are not using any method of contraception. Investing in quality family planning programs is a cost-effective way to address unmet need for contraception and reduce the risks of unsafe abortion, thereby improving maternal health. If contraception were provided to the 137 million women who lack access, maternal mortality will decline by 25-35 percent.

2016-11-17, Ohno, Naoko, El-Saharty, Sameh, Sarker, Intissar, Chowdhury, Sadia

South Asia Region (SAR) has decreased maternal mortality ratio (MMR) by 65 percent between 1990 and 2013, which was the greatest progress among all world regions. Such achievement implores the question, What made SAR stand out against what is predicted by standard socioeconomic outcomes? Improving Maternal and Reproductive Health in South Asia: Drivers and Enablers identifies the interventions and factors that contributed to reducing MMR and improving maternal and reproductive health (MRH) outcomes in SAR. In this study, the analytical framework assumes that improving MRH outcomes is influenced by a multitude of forces from within and outside the health system and considers factors at the household and community levels, as well as interventions in other sectors and factors in the enabling environment. The analysis is based on a structured literature review of the interventions in SAR countries, relevant international experience, and review of the best available evidence from systematic reviews. The focus of the analysis is mainly on assessing the effectiveness of interventions. The findings from this study indicate that the most effective interventions that prevent maternal mortality are those that address the intra-partum stage - the point where most maternal deaths occur - and include improving skilled birth attendance coverage, increasing institutional delivery rates, and scaling up access to emergency obstetric care. There is also adequate evidence that investing in family planning to increase contraceptive use also played a key role during the inter-partum phase by preventing unwanted pregnancies and thus averting the risk of maternal mortality in SAR countries. Outside the programmatic interventions, the levels of household income, women’s education, and completion of secondary education of girls were also strongly correlated with improved MRH outcomes. Also, there is strong evidence that health financing schemes - both demand and supply side - and conditional cash transfer programs were effective in increasing the uptake of MRH services. The study points out to many other interventions with different degrees of effectiveness. The study also identified four major reasons for why SAR achieved this progress in MMR reduction. The best practices and evidence of what works synthesized in this study provide an important way forward for low- and middle-income countries toward achieving the health-related Sustainable Development Goals.

2013-12, Vergeer, Petra, Chowdhury, Sadia, Schmidt, Harald, Barroy, Helene, Bishai, David, Halpern, Scott

This paper was developed for World Bank task team leaders (TTLs) and teams designing results-based financing (RBF) programs in family planning (FP). It explores the rationale for introducing such incentives based on insights from classical and behavioral economics, to respond to supply- and demand-side barriers to using FP services. To help the reader understand why incentivizing FP requires specific attention in RBF, the evolution of incentives in vertical FP programs introduced from the 1950s to the early 1990s and the ethical concerns raised in these programs are described. RBF programs after the 1990s were also studied to understand the ways FP is currently incentivized. The paper also touches on the effects of the incentive programs for FP as described in the literature. Finally, it examines ethical concerns related to FP incentives that should be considered during the design, implementation, and evaluation of programs and provides a conceptual framework that can be of use for task teams in the decision making process for FP in RBF programs. It should be noted that the paper is concerned exclusively with developing a framework that can help design ethical programs to address the unmet need for FP.

2001-08, Chowdhury, Sadia

In Bangladesh an education program aimed at teaching mothers how to prepare and use oral rehydration solution to treat diarrhea relied on output-based incentives to ensure that the teaching was effective. The program tied field workers' pay to fast-cycle feedback on performance against output indicators. Monitoring results show that the approach worked: the mothers learned effectively. Over 10 years the program reached 12 million households.

2014-07, Kuruvilla, Shyama, Schweitzer, Julian, Bishai, David, Chowdhury, Sadia, Caramani, Daniele

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women’s and Children’s Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula – fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women’s and children’s health towards 2015 and beyond.