H E A LT H , N U T R I T I O N A N D P O P U L AT I O N Health Sector Support Project BASIC APPROVAL END TOTAL IMPLEMENTING INFORMATION DATE: DATE: COMMITMENT: AGENCIES: July 28 June 30 $500 million Ministry of Health and 2017 2024 Family Welfare BUILDING A HEALTHY NATION OVERVIEW Bangladesh has made remarkable progress in improving key health indicators, including significantly reducing maternal mortality and under-5 child mortality. The progress is not uniform throughout the country and divisions like Sylhet and Chattogram lag behind in key health outcomes. Through the Health Sector Support Project (HSSP), the World Bank supported the Government’s Fourth Health, Population and Nutrition Sector Program. On the onset of the COVID 19 pandemic, the World Bank adjusted the project to help maintain critical levels of child immunization in vulnerable eastern border areas. This ensured that at least 85 percent immunization coverage was maintained among children in the Sylhet and Chattogram divisions. 16 HEALTH SECTOR SUPPORT PROJECT CHALLENGE RESULTS Bangladesh’s Health, Nutrition, and Population (HNP) 382 Upazila Health Complexes with at least 2 sector faces numerous challenges, including continuing accredited diploma midwives. immunization coverage and improving child nutrition as well as further enhancing the quality and coverage and reducing socio-economic and regional disparities, addressing 5,843,469 children immunized. emerging health challenges; and improving financial management of health sector. 588,032 women and children have received basic nutrition services. The COVID-19 pandemic and the movement restrictions exacerbated the health sector challenges. In 2020, due to the movement restrictions, the outreach sessions of the 722,462 deliveries attended by skilled health personnel. Expanded Program of Immunization (EPI) were suspended. Even after lockdowns were lifted, households were unwilling to allow field health workers tasked with child immunization During the movement restriction for COVID to enter their homes for fear of spreading infection. At the 19, in the Sylhet and Chattogram divisions same time, Community Clinics and Union Health and Family 1,136,888 children (0-11) months were Welfare Centers shifted their focus onto COVID-19-related vaccinated in 2020, 1,212,206 in 2021 services. These developments seriously impacted child and 1,251,086 in 2022. immunization services. The project is expanding the essential maternal and child health services, including EPI, to benefit the poor in Barisal division in 2022. APPROACH Initially the project focused on strengthening the country’s health sector and improve quality and coverage of essential health service delivery, with a particular focus to the Sylhet and Chattogram divisions, where key health outcomes are below national average. As the pandemic started, the Ministry of Health and Family Welfare (MOHFW) and the districts worked out different approaches to quickly restore EPI coverage. These included: (i) maintaining the supply chain line followed by rigorous monitoring (ii) developing district-specific vaccination plans to reach defaulters; (iii) creating awareness through intensive communication campaigns and (iv) dispatching outreach teams to remote areas. The ministry identified locations with low coverage. Field health workers carried out active child immunization defaulter tracing by going house-to-house to address misinformation and stigma attached to COVID-19 that affected routine child immunization services. Reminders were sent by text and telephone to attend immunization sessions. Communication for development volunteers were engaged to escort mothers to vaccination sites to ensure their children were vaccinated against common childhood infectious diseases. The government provided special passes to allow EPI staff to move about during lockdowns. THE WORLD BANK IN BANGLADESH 2024 | 17