In 2021, Bangladesh celebrates its 50 years of independence. Bangladesh emerged as an independent country on the world map following decades long struggles, and finally a nine month long blood-stained war of independence in 1971. The Golden Jubilee is coincided with the birth centenary (Mujib Borsho) of the Father of the Nation, Bangabandhu Sheikh Mujibur Rahman.

In 1971, Bangladesh, a densely populated country was desperately facing the challenges in health care system. The country was in high economic crisis. The economy was mostly depended on agriculture, and was disrupted with frequent natural disasters.¹

Over the last five decades, Bangladesh has achieved remarkable progress in social, economic and health sectors. The country has significant health achievements including reduction of childhood mortality, maternal mortality ratio, immunization coverage, reducing communicable diseases etc. and on the other hand, increase life expectancy and per capita income. Bangladesh is scheduled to graduate to a developing country from least developed country (LDC) category in 2026.

Bangladesh is the 8th populous country of the world with more than 160 million people. The population of the country in 1971 was 70 million with growth rate of more than 3.0%. With effective population control programme, the annual population growth has been declined to 1.2% in 2020. The life expectancy at birth was 46 years in 1970, which has been increased to 73 years in 2020. 2 Per capita income is US$ is 2,591 in 2020-2021, which was US$ 134 only in 1971.³ Bangladesh has maintained an impressive track record of 7.9 percent economic growth rate during the past decade, coupled with remarkable improvements in human development.3 With the fast- economic growth, technological change, and rapid urbanisation, the country has been passing health transition from communicable diseases to a combination of communicable and non-communicable diseases.⁴

Over the last five decades, the neonatal mortality was reduced to 17.49 from 96.34 per 1000 livebirths, infant mortality rate has been declined to 24.32/1000 livebirths in 2020 from 137.2 in 1971; and the under 5 mortalities have also been declined to 29.1 in 2020 from 215.2 in 1971.³ Maternal mortality ratio has also been decreased to 173/100000 livebirths in 2020 from 574 in 1991. In 2010, Bangladesh received a United Nations award for its remarkable achievements in attaining the Millennium Development Goals (MDGs) for reducing child mortality rate nearly by two-thirds well ahead of the targeted time- frame.⁵

In 1985-86, among the under five children, the prevalence of underweight, stunting and wasting were 71.5%, 68.7% and 14.7% respectively; which now comes down to 66.0%, 52.0 % and 44.0% over the last four decades.⁶ In 2013, Bangladesh received FAO of UN award for reducing hunger by half, well ahead of the target year 2015, set by Millennium Development Goal 1 (MDG1).⁷ The country has also achieved marked progress in prevention and control of micronutrient deficiencies including iodine, vitamin A and others.

Government of Bangladesh is well committed to improve the safety and quality of the food and food products. Government has further strengthened the food safety and quality control activities along the food chain. Govt. has enacted the Bangladesh Food Safety Act 2013, including establishment of the Bangladesh Food Safety Authority.

Bangladesh officially initiated EPI activities in 1979. Immunisation in Bangladesh progressed through several stages of development from its early beginnings in the 1980s, to consolidation of the programme in the 1990s, and through introduction of new vaccines and medical technologies in the 2000s.⁸ EPI has achieved 83.9% valid full vaccination coverage in 2019 among the under one-year old children, which was only 2% in 1985.^9,10 The country has made tremendous strides in immunisation, which has been recognised by the GAVI, the Vaccine Alliance.; and awarded Her Excellency Sheikh Hasina, the Prime Minister of Bangladesh, the Vaccine Hero Award in 2019.¹¹ Bangladesh was also honoured with GAVI Alliance Award in 2009 and 2012 for its outstanding performance in improving the child immunisation status.¹² The World Health Organization has certified Bangladesh as a Polio-free country on 27 March 2014.⁵

Bangladesh has also achieved significant success in prevention and control of neglected tropical diseases including Filaria, Kala-azar, Leprosy and others. Through National Malaria Elimination Programme, a significant reduction in case identification and death has achieved in the endemic districts of Bangladesh. Bangladesh has also efficiently managed the COVID-19 pandemic, with its limited resources. Furthermore, initiatives for COVID-19 vaccination is highly commendable.

With the improvement of socio-economic status and changing of lifestyle of the people, non-communicable diseases (NCDs) are emerging as major cause of morbidity and mortality. The Government has been implementing multisectoral action plan for prevention and control of non-communicable diseases.¹³

Bangladesh is well committed to welfare of mental health, autism and disability. Bangladesh has enacted -the Disability Rights Law, 2013 and Neuro Developmental Disability Protection Trust Act, 2013, to protect the rights and ensure safety of the differently able persons. With the leadership of Bangladesh, the United Nations and the World Health Organization have adopted two separate resolutions on Autism. In 2016, WHO South-East Asia Regional Office, nominated Saima Wazed, the daughter of the Hon’ble Prime Minister of Bangladesh, as ‘WHO Goodwill Ambassador for Autism’ and ‘WHO Regional Champion for Autism’ for her extraordinary role in raising the issue globally. She also awarded ‘WHO Excellence in Public Health in South-East Asia Award’ by WHO for her extraordinary contribution in the areas of Autism.⁵

With the aimed to build ‘Digital Bangladesh’, the health sector has also introduced telemedicine, to provide specialised services for the rural people. In addition, “Sasthya Batayan 16263” round the clock call centre has been established. Through this call centre, any body from any corner of the country can avail the health information, talk to doctor for health services etc. Voice message, SMS and health information are also being sent through mobile phone services. In 2011, in recognition, the Hon’ble Prime Minister of Bangladesh received the ‘Digital Health for Digital Development’-Global Health and Children’s Award for her contribution to develop Bangladesh’s health sector by using the Information Communication Technology (ICT).⁵

Community Clinic (CC) is a people-oriented health service system, an innovation of Bangladesh Government. It is aimed to extend primary health care to the doorsteps of rural people across the country. It becomes an integral part of national health system.^5.14

In recognition of the achievements in health, several other awards also received by Bangladesh including WHO award for eradication of tetanus of mothers and newborn; WHO award for control of Rubella and congenital rubella syndrome etc.

The progress in the health sector over the last five decades are due to commitments of the government, introduction or enactment of policies, strategies, acts rules and regulations and their effective and timely implementation, well established and well-functioning organisational networks, manned by technical and non- technical health manpower, concerted efforts of the public, private and non-government organizations, and support from the development partners; and overall active community engagement in different programmes including family planning, immunisation, oral rehydration therapy, tuberculosis, vitamin A supplementation and others.However, there are number of challenges ahead to ensure universal health coverage including increase allocation of the budget for health, adequate human resources for health along with their appropriate carrier plan, more concerted effort from public and private sectors, and further reinforcing engagement of the community in all tiers of the health system.

Further strengthening of health system for ensuring universal health coverage and ensure good governess by reforming the present health management structure thus suggested.