Noncommunicable diseases (NCDs) are the leading cause of death in Bangladesh. In 2019, NCDs, including cancers, diabetes, cardiovascular and chronic respiratory diseases, accounted for 70% of mortality in the country. NCDs derive from genetic, environmental and behavioral factors, meaning a person’s lifestyle impacts their likelihood of diagnosis.

Air pollution in Bangladesh contributes to the rise of cardiovascular illnesses and chronic respiratory diseases, where heart disease, strokes and asthma impact individuals’ physical health. Unhealthy lifestyles, diet and physical inactivity are also causes of NCDs like cancer and diabetes. These ongoing causes and burdens have mobilized the government to work toward controlling NCDs in Bangladesh.

Health Discrimination

Health surveys from 2011 to 2018 have shown that socioeconomic disparities are connected to the prevalence of hypertension, diabetes and overweight and obesity. For example, those who work in manual labor in Bangladesh are more exposed to air pollution, increasing the incidence of hypertension and obesity. Conversely, economic growth has led to more processed, readily available and low-cost foods available to poor people. Unhealthy diets also contribute to high NCD prevalence in poorer communities in the country.

Moreover, NCD services are costly and access to proper care is far less attainable for people experiencing poverty. These chronic conditions require long-term care and jeopardize patients’ financial stability with medical expenditures. In 2021, the country allocated 2.36% of its gross domestic product to health expenditure. Out-of-pocket spending accounts for a 68.5% share of health expenditure. Dependence on out-of-pocket spending causes financial distress, especially among vulnerable families.

The Plan

Bangladesh’s Multisectoral Action Plan for the Prevention and Control of NCDs 2018-2025 commits to address these diseases and improve the health care system. The operation plan’s success requires four courses of action that are conducive to controlling noncommunicable diseases in Bangladesh.

• Action area 1: Advocacy, leadership and partnerships.
• Action area 2: Promotion and risk reduction.
• Action area 3: Health systems strengthening for early detection and management of NCDs and their risk factors.
• Action Area 4: Surveillance, monitoring and research.

Successes since 2018

Through partnerships, the country has made significant progress in creating a strong foundation for NCD prevention and control. The collaboration between 30 ministries and agencies was one notable success. In the 2022 first National NCDs Conference in Bangladesh, national and international stakeholders assembled to discuss NCD prevention and control strategies and established the Dhaka Declaration, 32 steps to combat NCDs. This declaration furthered the Multisectoral plan’s goal of controlling tobacco, alcohol and indoor air pollution and promoting physical activity and healthy diets.

NCD Corners in health complexes have also been developed across the country, increasing access to care. These corners facilitate early detection and management of common NCDs, even in rural areas. By October 2022, 6,231 patients were treated for high blood pressure and 1,386 for diabetes through these corners. The National Heart Foundation Bangladesh has also reported an increase in hypertension control across the country’s administrative districts. For instance, in Kualara, from May 2022 to October 2022, the number of patients with controlled hypertension rose by 15%, from 55%,  with the assistance of NCD corners. These corners are located in community health centers and primary health care facilities, providing easy access for all population groups.

Furthermore, progress has been made in developing policies to control shared risk factors of NCDs. To promote healthy diets, the country has imposed taxation on domestically produced sugar-sweetened beverages. First, there is a 15% value-added tax and then a 25% supplementary duty for carbonated drinks and 35% for energy drinks. Taxes on unhealthy items help reduce consumption and the prevalence of obesity and other NCDs can decrease.

Ongoing Efforts

There is still more to be done. Taxation is effective in controlling Bangladesh’s tobacco problem. In the fiscal years 2024 and 2025, the government strives for a 66% increase in the tax rate on cigarettes and tobacco products. This change factors in indoor pollution control as tobacco smoke inside homes exposes nonsmokers to smoking and poor air quality.

The plan further addresses health financing and expenditure. In the fiscal year 2024, the country increased its federal budget allocation for health by 9%. However, this improvement had little effect on the country’s health care quality. Bangladesh’s Multisectoral plan proposes financial risk protection through:

• Accessing NCD services without upfront costs.
• Integrating essential services at district and lower levels, including an annual NCD voucher system with minimal costs.
• Adjusting the fee structure if other strategies cannot be implemented.

By prioritizing these strategies, Bangladesh can look toward a healthier future for all its citizens, ensuring equitable access to quality health care.

Conclusion

Noncommunicable diseases continue to impact mortality and quality of life in Bangladesh. However, Bangladesh’s Multisectoral plan has successfully coordinated efforts across various sectors to control NCDs. Collaboration, policies, regulations and initiatives for enhancing accessibility remain conducive to these goals.

– Caroline Albright

Caroline is based in Milton, MA, USA and focuses on Good News and Global Health for The Borgen Project.

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