Experience Using Data from DHS to Shape Policy and Planning at National Level in Bangladesh

SESSION 3D-1 17 April 2013

Bangladesh
Population (2011) 150 million Density 1015 per sq KM Per capita income US$848 Births per year 3.4 million Newborn deaths per year 105 thousand Maternal deaths per year 7,300
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Bangladesh Demographic and Health Survey (BDHS)

A nationally representative survey provides estimates for The whole country Urban and rural areas Administrative divisions 6 rounds of BDHS since 1993 with an interval of 3-4 years, last one in 2011 All surveys collected information on newborn survival Data on causes of deaths were collected in 2004 and 2011 Last 2 surveys (2007 & 2011) collected data on newborn health
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Reducing neonatal mortality is key to future progress

133 116
Deaths per 1,000 live-births

46 34

12-59 Month Deaths/1,000 LB 1-11 Month Deaths/1,000 LB Neonatal Deaths/1,000 LB 94

28

88
23 24

35

34 24

65
13 15

53
11 10

52

39% 48

42
1995-9

41
1999-2003

37
2002-6

60%

32
2007-11

1989-93

1992-6

Source: BDHS 2011 policy briefs

Causes of neonatal deaths

Neonatal Deaths
Birth Injury Other 7% 4%

Prematurity 0-28 d /LBW 11% Birth Asphyxia 21% Pneumonia 13%

Annual number of deaths:

Undefined 20%

Infection and
pneumonia

38,000 12,000

Birth asphyxia 21,500

Possible serious infection 24%

Preterm birth

Source: BDHS 2011 policy briefs

Use of BDHS data for decision making

Monitoring of health sector program
Neonatal mortality:
Baseline 2011 Target 2016 32/1,000 LB 21/1,000 LB

Plan and implement interventions

piloting of kangaroo mother care prevention and treatment of newborn sepsis helping baby breath designing community-based programs
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Percent non-institutional births in the three years preceding the survey

Monitoring implementation of national neonatal health strategy

2007 BDHS 2011 BDHS 47 51 43 33 17 6 Dried within 5 minutes of birth 2 Wrapped within 5 minutes of birth Bathed 72+ hours after birth Breastfed wthin 1 hour of birth
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Source: BDHS 2011 final report

Forum or venue of data use

National dissemination of survey results Policy presentation at national level Regional dissemination Targeted audience

Policy discussion with policy makers, program managers and development partners Sharing results with:
Health sector program review team Professional bodies Media: Health reporter Medical students and private practitioners

Discussion with program personnel and opinion leaders in low performing areas
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Outcome of data use

Data showed that to reach MDG 4, Bangladesh needed to reduce neonatal mortality This led to: advocacy for development of the Bangladesh Neonatal Health Strategy 2009

introduction of programs
to improve newborn care

Outcome of data use

Causes of death data helped scale up of interventions at national level
Promote facility deliveries and home deliveries with skilled assistance to reduce asphyxia deaths Rolled out the Helping Babies Breathe initiative nationally Strengthen community mobilization for management of neonatal sepsis
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High level response

BUDGET SPEECH 2012: According to BDHS 2011, under-5 mortality rate has been reduced

to 53 from 65 per thousand over the past four years. Currently, one third of women receive the assistance of the trained health workers during child birth. To increase this number further, taking initiative to train 40,000 health workers of various tiers Maternal Health Voucher Scheme will be expand to another 27 sub-districts 24-hour emergency maternal care service will be provided in 96 sub-district health complexes.

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Lessons learned
Highly acceptable: BDHS addresses country specific need of health sector program and national strategies Quality: Survey design and implementation is a collective responsibility of technical working group and data users Useful: Policy discussion by program experts Easily accessible: Reach various stakeholders for ensuring wide utilization of data Challenging: Advocacy for shaping evidence-based policy and programs
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