Evaluation of Healthcare Development in Bangladesh

Muntasir Murshed

DSCF8979 01The conceptual framework of ‘a healthy nation being a wealthy one’ has received global recognition. In the past, economies strived in achieving development without much emphasis on improving its social indicators. However, as time progressed the concept of development had undergone multidimensional transitions whereby development was gradually perceived to be a socioeconomic variable with utmost preference to both economic and social improvements within the economy. The paramount significance of improving health indicators has also been acknowledged in SDG3 (Good health and well-being). Bangladesh, adhering to its remarkable performances in achieving the Millennium Development Goals (MDGs) way ahead of neighbouring countries, has also expressed its willingness to do the same with regard to achieving the SDGs as well. As part of the nation’s commitment in achieving the SDGs, the current government took the agenda of healthcare development with utmost importance and has adopted relevant policies to improve the national health indicators. Although the fiscal allocations to health have shrunk in recent times, the health sector indicators of Bangladesh have portrayed significant improvements as compared to its post-independence phase.

Bangladesh over the course of its post-independence period has come a long way in stimulating healthcare development within its economy. A country which once had a huge portion of its population being malnourished has somewhat reversed the scenario at present. The life expectancy at birth has surged by more than 53% over the last 45 years revealing remarkable development in healthcare facilities over time. According to the World Health Organization (WHO), Bangladesh is ahead of most of its neighbouring nations when it comes to its national life expectancy at birth. For instance, the life expectancy at birth in the country is 72 years on average where India and Pakistan have a life expectancy at birth figures of 68.5 years and 67 years respectively. Moreover, the country displayed impressive performance in safeguarding and improving maternal and infant lives. The maternal mortality rate in Bangladesh has also experienced a declining trend as the rate was curbed by more than 70% over the last 30 years. At present, maternal mortality rate in the country is estimated to be around 176 per 100,000 live births. According to the WHO, the maternal mortality ratio between 2000 and 2015 in Bangladesh dropped from 339 to 176 maternal deaths per 100,000 live births while the corresponding lifetime risk of maternal death declined from 1.49% to 0.421%. The country has also taken effective initiatives in ensuring praiseworthy infant and neonatal heath protection as reflected by sharp declines in the associated death rates. Infant mortality rate in the country has gone down by almost 75% over the last three decades or so. At present, infant mortality rate in Bangladesh hover around 31 deaths per 1000 live births as compared to India and Pakistan having corresponding rates of 38 and 66 per 1000 live births respectively. The current neonatal death rate in Bangladesh, according to UNICEF, is around 23 deaths per 1000 live births which is 50% and 17.86% less compared to that in Pakistan and India respectively. Furthermore, loss of lives due to communicable diseases and maternal, prenatal and nutrition conditions has also reduced in the country by more than 33% in between 2000 and 2012.

Despite such progresses made in the fields of health and nutrition in Bangladesh, the country is yet to match global standards which would have potentially aided the nation in leapfrogging into the elite list of upper middle income countries in near future. This can partly be attributed to the inefficiencies attached to the heal sector of the country and also to the reduction in fiscal allocations aimed at development of this sector.

Thus, in order to achieve the SDG3 and also to comply with the commitments of the current government for ensuring improved quality and access to healthcare facilities in the country, it is high time to get over the existing inefficiencies and irregularities engulfing the health care sector of Bangladesh. It is ideal for the government in leaving no stones unturned in ensuring greater access to safe drinking water, sanitation and nutritional commodities for betterment of public health in the country. Moreover, the disparity in the urban and rural health services on offer should also be mitigated in order to enhance the overall health standards.

Muntasir Murshed, MS in Economics, School of Business and Economics, North South University

Email: muntasir.murshed@northsouth.edu





Revisiting Active Labor Market Policies for Skills Development Programs in Bangladesh

Mohammad Nazmul Avi Hossain

edited - 26112408_1582568295122875_4002223214601812262_nHow often has human capital development been strongly termed as the driving factor of a nation? Surely, we cannot disapprove the evidences of human capital’s supremacy in making an economy robust. The macroeconomic confounding factors of a nation are “defacto” whereas human capital development acts as “dejure” to disentangle the differences in country’s prosperous transformation from developing to developed nation. The journey of Bangladesh towards a developing country will unsurprisingly rely on the utilization of its human capital optimally. Hence, labor market context is pivotal in terms of policy formulation and growth generation. In addition, the success of the nation in achieving SDGs will heavily rely on its status of the workforce, especially the youth in the labor force.

As per the latest labor force survey, the youth (aged 15-29 years) participation has reached to 20.1 million from 17.8 million recorded in 2005/06, where increased participation of female youth (7.0 million) played a crucial role. These stats are promising for a country that is riding on the airbus of consistent 6 plus GDP growth rate and entering into Rostow’s take off stage of economic development. However, the road to glory is illusive with only around 4.8 percent of youths obtaining university degrees, poor quality of education and disregarded Technical and Vocational Training and Education (TVET).

In the latest LFS, unemployment was recorded highest, 14.9 percent, among the population who completed higher secondary level of education followed by 11.2 percent who completed tertiary level. This is highly alarming in understanding the signals of education as a proxy of capabilities in the job market. Moreover, the skills development training programs led by Government, private and donor organizations are suffering from lack of vision in addressing the macroeconomic constraints such as “jobless growth” and “youth unemployment/underemployment”.

Active Labor Market Policies (ALMPs) are the universal sets consisting of the skills development training programs as sub-sets. In Bangladesh, several donors are working under bilateral and multilateral approaches in providing skills development training to poor and disadvantageous groups. Most of these skills development programs are focusing on capacity building of public-private partners and facilitating the poor to participate as trainees in training centers. Results are being obtained in generating increased employment among the target groups and enabling them to earn close to minimum wages. However, these results are far away from the asymptotical convergence towards employment generation and access to labor market in ensuring skilled jobs for a large population. Mostly, supply side factors are driving the existing training programs where private training service providers get support from a project/program to train poor with the help of aid. Two-fold question arises regarding the effectiveness of these kinds of typical TVET programs. First, how do these programs ensure the sustainability? Second, without involving employers and the demand side actors, to what extent these training programs are generating decent jobs for the trainees?  These questions do not have any straight forward answers though.

However, as per Brown, A. J., & Koettl, J. (2015) skills development programs should consider few major aspects in tuning the labor market’s functionality through training programs in order to improve the macroeconomic impacts of ALMPs. First, programs must bear in mind that “the indirect deadweight effect” lowers the cost-effectiveness of ALMPs. It refers to the resources of the policy that go to beneficiaries who would have achieved the objective of the policy even in its absence. Second, the effectiveness of ALMPs can be further undermined by the cream-skimming effect, by which only workers with high employment probabilities are selected into the program which may end up providing biased results. Third, the so-called locking-in effect (also called retention effect) refers to the lower probability of finding a job of ALMP participants compared to the unemployed who are not in ALMPs. Fourth, bringing unemployed workers back into work via ALMPs will increase their employment probabilities by the transition effect. This effect is the strongest for long-term unemployed workers, who during their unemployment suffer from skill attrition and loss of work routine. Fifth, the so-called competition effects highlight ALMPs’ role in strengthening outsiders’ position in the job market relative to insiders. According to the insider-outsider theory, labor turnover costs, firing costs as well as hiring and training costs for new employees give insiders market power, which they use to their own advantage, for example, to push up their own wages. Finally, it is the country context and overall macroeconomic enduring environment that discrepant the success of a skills development program. Need based industry driven training programs will benefit the labor market more. In addition, engagement of the private sector, employers and money generating business models of training service providers can comprehensively enhance the sustainable impact of skills development program. Integration of technology and digitization in skill development programs will open the new avenues for labor market.

More specifically, government policies intended to affect publicly-provided education and training will, in effect, determine the process of growth of the whole economy, promoting increasing returns to scale for Bangladesh.

Mohammad Nazmul Avi Hossain, Manager – Private Sector Engagement (Training and Employment), B-SkillFUL, Swisscontact 

Email: nazmulavi@gmail.com 


Political Economy of Special Economic Zones: China vs India

Towhid Iqram Mahmood

IMG-3084According to the World Bank in 2008, a modern day Special Economic Zone (SEZ) typically includes a “geographically limited area, usually physically secured (fenced-in); single management/administration; eligibility for benefits based upon physical location within the zone; separate customs area (duty-free benefits) and streamlined procedures”. For that, practices related to business and trade differ from rest of the country and therefore, all units therein get special privileges. SEZs can generate both static and dynamic benefits. Static benefits include employment creation, export growth and rise in government revenues; whereas dynamic benefits include economic diversification, innovation and transfer of technology through Foreign Direct Investment (FDI) and skills upgrading. However, good governance, proper political and investment conditions for business and timely order of work is quintessential for a successful SEZ. The successes of SEZs in China made other South Asian countries like India to succumb to the Chinese SEZ model. The notwithstanding principles of this model resulted in a poor performance of India’s SEZs though.

In 2016, Chinese SEZs have contributed 22% of China’s GDP, 45% of total national FDI and 60% of exports. These SEZs have also increased the income of participating farmers by 30% and accelerated industrialization, agricultural modernization and urbanization. Whereas for India, SEZs contributed only 3.72% of GDP and 20% of exports. The most astounding fact is that only 223 are operational out of 420 approved SEZs. Furthermore, only 40% of the total lands acquired for SEZs are in use. Most of these lands were deliberately taken out from agricultural production to apt with quicker economic growth.

Chinese experience with SEZs has indicated a number of factors that contribute to their success and effective operation. For example, SEZs need to be linked to economic opening and capitalize on innovation, political stability, promote industrial expansion, building brands, incubating local ideas by integrating learning, bringing together resources and expertise from government, industry and research institutions to move into more advanced value chains etc.

The ease of doing business index by the World Bank shows fundamental differences in incubating businesses between China and India. One can argue that India started economic reforms and initiated SEZs much later than China. Although that is a very small fraction of caveat that India faces if not minimal. A few of the major reasons for slow growth of Indian SEZs are lack of diversification of products, unstable fiscal incentives due to changing regimes and their belligerence towards policies from previous regime, poor infrastructure, political patronage and delay in environmental clearance and approval by state governments.

However, the low performance of Indian SEZs can be looked at from a political economy perspective.  With better than ever infrastructure and geographically ideal position, China offers something more than that India could offer to the international market. We know that China is a one-party political system whereas India is a multiparty democracy. From the viewpoint of an investor, Chinese market is way more lucrative than India in terms of political stability and investment environment. Of course, it is not always true that an authoritarian system can incubate better economic system (take Idi Amin’s Uganda for example). However, China’s performance has assured investors to rely on its economic system ever since it has opened its door to a market economy. Thus, political stability along with better business environment helped China to attract the flood of foreign investment unanimously. In case of India, SEZ rules have been amended at least seven times since its initiation in 2010. These changes are concomitant with the caveats of regime changes that, in turn, changes most of the policies and acts because of internal rivalries between political parties. On top of it, as mentioned, bureaucratic complexity has made it more difficult for investors to easily start a business in India. Unjust land acquisition without feasibility studies raises questions. Perhaps, some of these are answered when some lands acquired for SEZs are sold at a higher-than-market rate by political activists.

Drawing from the discussion, it can be stated that undoubtedly political stability and understanding between political parties to ensure economic success for a country is the primary incentive for an SEZ’s success. Learning from SEZs in India, a lineation of rivalry between political parties in a multiparty democratic system is a must if we want to parallelly increase economic stability with the help of SEZs. To bolster effective SEZs, well monitoring of the mechanisms with inclusive functioning cannot be negated.

Towhid Iqram Mahmood, Senior Research Associate, SANEM

E-mail: towhid.iqram@gmail.com

First published in the Thinking Aloud, 1 November 2018