Md. Ismail Tareque
Lecturer, Dept. of Population Science and Human Resource Development
University of Rajshahi, Rajshahi-6205, Bangladesh
E-mail: tareque_pshd@yahoo.com

 

ABSTRACT Attempts have been made in this study to rank almost all countries of the world according to constructed index of health facilities. USA was at the top ranking position in 1990 but in 2000 it came down to 2nd position. The study reveals that Bangladesh was at 36th position in 1990 and increased their facilities for health during 1990 to 2000 but it did not come out from the low ranking group. Bangladesh should follow the top ranking country's policies regarding the health sector. Keywords: Index of health facilities, country's rank and Bangladesh.

Born in 1971 after a devastating war, Bangladesh is a land of immense beauty and potential. In its short history, Bangladesh has faced a daunting challenge of improving the health of its people and has made remarkable progress. Over the last two decades, Bangladesh has witnessed a large decline in mortality despite economic backwardness and inadequate health services. During the period 1990 - 2000, the crude death rate dropped from approximately 11.1 to 9.2 per 1,000 population. In the same period the infant mortality rate also dropped from approximately 89 to 73 per 1,000 population (World Population Prospectus, 2006). Bangladesh ranks among the extreme poor and most densely populated countries in the developing world, with less than 45 percent of its population having access to primary health care services beyond childhood immunization and family planning (UNDP 1997).

Equity in health is defined as "the absence of systematic and potentially remediable differences in one or more aspect of health across populations or population subgroups defined socially, economically, demographically, or geographically" (ISEqH 2001). More simply, these are health inequalities which are deemed unfair or unjust. Its principles are derived from the fields of philosophy, ethics, economics, medicine, public health, and others. The subsets of health inequalities that are judged unjust or unfair constitute health inequities. A recent examination of data from Matlab indicated that the gain in mortality reduction for children during the last twenty years was much greater for females and in children from the extreme poor households (Bhuiya et al., 2001).

While the decline in mortality is impressive, it is not known whether the decline is due yoincreased health facilities. Especially, were health facilities improved in all countries of the world as well as in Bangladesh during the period 1990 - 2000? The study attempts to address the above question along with the determination of the index of health facilities (IHF) for different countries of the world and their corresponding ranking position.

The study is based on the data of WHO. We have mainly used World Health Statistics 2006 (WHO, 2006) data prepared by WHO.

The present study considers only a few sets of variables related to health facilities. Many are left partly owing to unavailability of data at the country levels. The index of health facilities (IHF) has been constructed using the variables such as number of physicians, number of nurses, number of midwives, number of dentists, number of pharmacists, number of public and environmental health workers, number of community health workers, number of other health workers, number of lab technicians, number of health management and support workers and number of hospital beds. Calculation of single variable index is made as follows:

Let Xij denotes value of i^th variable for j^th country. We may get an index called the single variable index at the country level by using the following formula:

IVij =

Where, (Xij), Min (Xij), Max (Xij) and IVij are, respectively, the actual, minimum, maximum and index value of X over the countries.

Wij =

Where, Var.(IVij) denotes the variance of index value of i^th variable for j^th country and k is the number of variables. The choice of weights in this manner ensures that large variations in any one of the indicators will not unduly dominate over the contribution of the indicators and distort inter country comparisons.

Thus using the weight and index value, a weighted combined index is obtained using the following formula:

Cij =

The above index is computed in the same fashion as Gupta (1989) and Rahman (1999).

Country Variation: Index of Health Facilities

We would like to identify the ranking position of each country of the world on the basis of IHF in 1990 and 2000. Due to lack of the relevant indicators of the IHF, only 172 countries for 1990 and 173 countries for 2000 have been included in our study. For 1990, 172 counties are divided into three groups where first 57 countries, scored 0.01 to 0.48, are categorized as low ranking and next 57 countries, scored 0.49 to 1.43 are categorized as medium ranking countries. And last 58 counties are categorized as high ranking countries whose score are 1.44 to 5.1. Table 1 shows the country’s ranking position in 1990 by IHF.

Here we observed that USA (score 5.1) was at the top ranking position and Somalia (score 0.01) at the lowest ranking position. That means the health facilities were more available in USA than the other countries. Bangladesh ranked 36^th position whose score were 0.24 and at the lower group according to IHF in 1990.

Note: parentheses indicate the corresponding ranking position in second column

Table 2 provides the country’s ranking according to IHF in 2000 where the IHF groups are same as the group of 1990 except the high (1.44 – 10.14). We observed that USA (score 6.97) came down to the 2^nd position and Romania (score 10.14) came at the top ranking position in 2000. We may conclude that Romania (77^th position in 1990) improved very much in their health sector than the other countries and came out from the medium group within only ten years. Bangladesh (score 0.29) came at 37^th position in 2000 which was 36^th position in 1990. It is an indication that population health was better in 2000 by getting more health facilities though it didn’t come out from the low ranking group. We also observed in our calculation that all countries scored more in 2000 than their corresponding 1990’s score. That means in all countries health facilities were increasing with the passing of time.

Study of health facilities by country is a complex one. A sound conclusion on this phenomenon is difficult if significant data are not available. The performance of the health care sector obviously remains an important factor (UN, 1988). It is true that universal attainment of an acceptable level of health and welfare services should be the main purpose of health development. Health and welfare systems development should be advocated by all as a social movement for human development.

1. More studies are needed and the policy makers should have to delineate necessary laws, regulations, funds and personnel regarding health facilities to achieve a high standard of living and highest life expectancy;
2. Timely, accurate and sufficient data should be published to demonstrate the situation of health facilities which helps the policy makers and experts to make their policy and decisions for a country’s development;
3. Also the top ranking country’s policies should be followed by other countries to improve their health sector.

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