In health, the cliché is to get rich for countries before they get old. This is mostly in the context of reaping the demographic dividend that some of the developing countries through their young and growing population. But a young and a growing population can only be a ‘dividend’ for a country if it is healthy, well-nourished, and educated – a fact quite obvious to everyone. Despite this, the challenge for developing countries is to reduce the geographic variation in inequities in child health and development.
Take for instance, Bangladesh. It’s population demographic can be very favorable to its economic growth considering that the population, which is less than 15 years of age in Bangladesh, is almost 35 percent, another 56.5 percent constitutes between 15-60 years of age and only 8.2 percent of population is above 60 years of age based on the latest estimates from demographic and health survey . But for a developing country, which has a large proportion of population that constitutes children, the challenge of improving basic services delivery in terms of health and education also remains enormous.
One such attempt to improve child health was last month when the country launched one of the largest child immunization campaign for measles vaccine Rubella. According to the WHO South East Asia Regional Office website about 52 million children are targeted to get vaccination between January 25 and Feb 13 and marks one of the biggest campaign in the country’s history since 1979.
While this is a welcome initiative for policy-makers, public health scholars among others, a concern that continues to daunt involved in reaching out is to improve coverage in some of the geographic regions which are difficult to reach. There is well known evidence (Mushtaque Chowdhury et al) that there continues to be deprivation in certain geographic regions which are located in the hilly regions or in the low-lying planes. Furthermore, for those children that work in tea-estates and do not go to school might pose another challenge for policy-makers and planners in designing interventions that can help in reaching out to this unreached population.
For example, vaccination coverage is highest in Khulna over 94 percent and lowest in Sylhet at around 80 percent, and if one may peek within districts, then one may find more variation in equities.
One such attempt to map geographic inequities was by UNICEF to construct a child deprivation index at the lower administrative levels. The deprivation index that was created out of composite set of indicators was an attempt to map the geographic variation in social indicators at the zilla and upzilla level, and provide information to policy-makers and planners as to which are the worst districts and upazillas and which ones are faring better. Similarly, UNICEF also released the Child Equity Report for Bangladesh which maps district-level variation as well as variation within the districts on several indicators. In addition, organizations like ICDDRL-B also integrated the use of GIS in health and demographic surveillance system at its field site in Matlab since 1990’s to produce geo-referenced maps at the village level and Bari, which is cluster of group of households which share a comman yard, according to the Health and Demographic Surveillance System, Matlab 2012 report. However, the extent to which these geo-referenced maps are actually used in government decision-making is not much known, in my opinion.
With the plethora of tools for information at the disposal of policy-makers across countries, it seems that state failure in improving the quality of public provision of services can no longer be an option but should be the norm.