HEALTH SECTOR SUPPORT PROJECT BUILDING A HEALTHY NATION APPROVAL DATE: END DATE: TOTAL COMMITMENT: IMPLEMENTING AGENCIES: BASIC INFORMATION July 28 December 31 IDA: $500 million Ministry of Health and Family 2017 2022 $15 GFF grant: million Welfare (MOHFW) Multi-Donor Trust Fund: $40 million OVERVIEW Bangladesh has made remarket progress in the health, nutrition and population (HNP) outcomes and has surpassed many neighbouring countries in South Asia in terms of achieving the health-related Millennium Development Goals (MDGs). Over the last few decades, key health indicators such as child and maternal mortality, as well as fertility rates, have dropped significantly while slow progress has been made on child undernutrition. Despite the progress, Bangladesh continues to face challenges with health system governance and equitable access to HNP services, including across regions and socio-economic groups. The World Bank is supporting the government’s Fourth Health, Population and Nutrition Sector Program (Fourth HNP Sector Program) covering the period 2017-2022. The HSSP’s objective is to strengthen HNP sector’s core management systems and delivery of essential HNP services with a focus on Chittagong and Sylhet divisions. The HSSP supports the Ministry of Health and Family Welfare’s (MOHFW) program through three main components: (a) governance and stewardship; (b) HNP systems strengthening; and (c) provision of quality HNP services. 68 CHALLENGE TOWARDS THE The HNP sector faces three major challenges: FUTURE The HSSP is mobilizing i) Foundational financing and system development priorities: Health care expenditure as a percentage of gross domestic product additional resources to support in Bangladesh is under one percent, far below the required level of the World Health Organization. While there are high levels of to the government for providing coverage of basic high-impact interventions, such as immunization, utilization of government services is low for some key services, HNP services in Cox’s Bazar such as delivery care. district to about one million (ii) Unfinished MDG agenda: It is important to maintain the gains achieved in many areas—such as immunization coverage—and displaced Rohingya population. further improve quality and coverage and reduce socio-economic and regional disparities. In some regions, including Sylhet and Chittagong division, key health indicators are below national average. Improvement in child undernutrition has been slow. More needs to be done to control of communicable diseases, particularly tuberculosis. (iii) Emerging challenges: As the country experiences demographic changes, emerging health challenges include non-communicable diseases (NCDs), adolescence health care and low HNP outcome among urban poor and high dependence on private sector services requiring high out-of-pocket health spending. APPROACH The government of Bangladesh has pursued a sector-wide approach (SWAp) since 1998, adopting a series of multi-year strategies, programs and budgets for management and development of the sector, with support from both domestic and international financing. The current Fourth HNP Sector Program covers 5.5 years (2017-22) with a planned cost of US$14.7 billion. The HSSP provides a platform for co-financing of the government’s sector program with a credit of US$500 million from IDA, a grant of US$15 million from the Global Financing Facility (GFF), and a multi- donor trust fund of US$40 million by Development Partners (Netherlands, Sweden, United Kingdom and Canada). RESULTS 50 million people benefitted in Improved capacity of MOHFW Sylhet and Chittagong divisions to deliver HNP services THE WORLD BANK IN BANGLADESH | 69