Bangladesh *

Example of a country which has advanced through the epidemiological transition due to the actions of international agencies / NGOs

Background

• in the 1970s, Bangladesh had high mortality from infectious diseases (e.g. cholera, diarrhoea, malaria)

• it was stuck in Stage 2 of the epidemiological transition (receding pandemics)

role of IAs / NGOs

• UNICEF and WHO supported mass oral rehydration therapy (ORT) programs to combat diarrhoeal disease

• BRAC (a major Bandladeshi NGO) trained millions of mothers in rural areas to use home-made ORT using salt, sugar and water

• GAVI and Global Fund helped roll out vaccination programmes for diseases like measles and TB

• World Bank and others funded maternal and child health programes, improving nutrition and access to clean water

impacts

• huge drop in child mortality and deaths from infectious disease

• life expectancy increased dramatically (from 45 to 72+ today)

• Bangladesh is now entering Stage ¾ of the ET - more deaths now come from NCDs (heart disease, diabetes)

negative impacts

1. dependency on external aid

   • bangladesh became reliant on foreign funding and expertise

   • long-term health solutions can falter if international support is withdrawn or funding is cut

2. lack of sustainability

   • some health campaigns were short-term or project-based with limited local integration

   • without strong local systems, progress can stall once NGOs leave

3. parallel systems

   • NGOs sometimes set up their own health systems that bypass gov structures, which can undermine national health services and cause duplication or confusion in service delivery

4. top-down approaches

   • some interventions were designed without full understanding of local culture or needs

   • e.g. introducing health programmes without involving communities can reduce effectiveness or trust

5. unequal coverage

   • NGO efforts can focus on ‘target areas’ or urban centres

   • this can widen rural-urban inequalities and leave vulnerable populations behind

summary

Bangladesh is a clear example of a country that advanced through the epidemiological transition thanks to international NGO and agency support, especially in public health education, vaccination, and disease prevention.