Lessons from Bangladesh in Reducing Child Mortality

Bangladesh — the world’s eighth most populous country with 162 million inhabitants — has made tremendous and inspiring strides in reducing child mortality. This is despite the fact that it is a very poor country, with half the GDP per capita of not-particularly-rich neighbors India and Pakistan.

Less than two decades ago, the rate of death for children under five was 54% higher than the global average — now, it is 16% lower than the world average, and less than even its comparatively wealthier neighbors. Child deaths from diarrhea and other enteric diseases (e.g. those from bacterial contamination of food and drink) have declined a whopping 90%; whereas in 1994, 14% of Bangladesh children in surveyed households had suffered some sort of serious enteric illness, by 2014 that number halved to 7%.

The progress is incredible to behold visually:

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How has such a poor country pulled off such a feat? According to a report in The Economist states, the solutions were fairly simple:

The most obvious explanation for Bangladesh’s success is the proliferation of outhouses in Trishal and other villages. Made of tin or palm fronds, these conceal simple pit latrines—concrete rings sunk into holes in the ground, with toilets on top. Between 2006 and 2015 a sanitation programme run by BRAC, a charity that is ubiquitous in Bangladesh, helped more than 5m households build a toilet.

What charity started, village one-upmanship has accelerated. A group of women in Trishal explain that a household toilet is now a symbol of respectability, to the extent that marriages have been called off when a groom’s family is discovered not to have one. Even in the districts where BRAC operates, two-thirds of the latrines built between 2006 and 2015 were constructed not by charities or the government, but by ordinary people.

More important, people use the latrines. According to the World Health Organisation (WHO), the proportion of Bangladeshi households that defecate in the open has fallen to zero. That is probably overstating things. Other studies suggest that about 5% of households still resort to woods or roadsides, or use toilets overhanging rivers. But Bangladesh has certainly done better than other poor countries. According to the WHO, 40% of Indians defecate outdoors. The Indian government, which is in the midst of a fierce campaign against open defecation, disputes that, and claims to have cut the number of rural people relieving themselves outside from 550m to 250m since 2014. Either way, that is still far behind Bangladesh.

In addition to the survey data, there are many personal anecdotes confirming the change: a school headmaster noted that in nearly thirty decades of his work, he has never seen attendance so high, since fewer children are missing school due to illness. Outbreaks of cholera, once fairly common, have not occured in his area in a decade. His pupils are even taller than previous generations, since disease has not stunted their growth during their formative years.

It goes to show that even poor and badly governed countries have the potential to make tremendously positive changes, albeit with a little bit of help and political and public will.

To learn more about the charity that played a central role in this feat, click here.

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