Photo: Courtesy of Christian Erni/IWGIAA Jumma woman and her child
Bangladesh's remote Chittagong Hill Tracts (CHT) has the worst health record, say health workers and aid agencies.
Infant and child mortality and maternal health are among the most crucial figures lagging well behind the already struggling national averages. The mostly Buddhist population of 1.3 million is spread across three districts, Bandarban, Rangamati and Khagrachari, and 90 percent are located deep in rugged, rural terrain where healthcare is difficult to access.
According to the Civil Surgeon's Office, which manages government hospitals regionally, 50 percent of the positions in the government healthcare facilities in the CHT are vacant. Only a limited number of ambulances exist at the district level and none exists at the sub-district level.
A shortage of skilled people willing to work in such a remote and dangerous area is an ongoing challenge for this conflict-prone region comprising 11 indigenous groups known collectively as the Jumma, said Moumita Chakma, general secretary of the Family Planning Association of Bangladesh (FPAB) in Rangamati. FPAB is one of the leading NGOs in the region, providing mothers and infants with healthcare support.
"We try our best to provide necessary healthcare services through paramedics and volunteers, but qualified doctors are hard to recruit," she told IRIN.
Lack of birth attendants
Compared with a national average of nearly a quarter of births attended by a skilled health worker, Bandarban District has the country's lowest average: 7.6 percent, according to the 2009 Multiple Indicator Cluster Survey (MICS) by the Bangladesh Bureau of Statistics (BBS) and UN Children's Fund (UNICEF).
Rangamati and Khagrachari are well below average as well at 11.5 and 9.1 percent, respectively.
Partly due to this absence of skilled workers, Bandarban has one of the highest infant mortality rates in the country, standing at 63 deaths per 1,000 live births, against the national average of 49 deaths per 1,000 births. Under-five mortality rates are 85 deaths per 1,000 in the CHT, compared with a rate of 64 deaths per 1,000 nationally.
Malaria
Malaria is another constant menace in the region and a leading cause of child mortality. In 2009, there were more cases of malarial infection and death in the three CHT districts than the rest of the nation combined, according to the Directorate General of Health Services.
Photo: Ahmed Orko Nur/IRIN Access is a key factor in reaching health facilities
Health workers warn that after a decline in cases since 2007, malaria is likely to make a comeback in the CHT in 2011.
"This year, in this month [end of June], we have almost four times more malaria cases than the previous year," said Paul Swoboda, field coordinator at the Malaria Research Initiative in Bandarban (MARIB), a research organization that is a joint effort of the Medical University of Vienna and Bandarban Sadar Hospital.
But research fellows such as Swoboda and programmes like MARIB are scarce for the people living in CHT, where a health facility can be days away.
"In the remote regions, if someone falls sick, it is very difficult to take them to any healthcare facilities. The transportation cost is very high. Once, my father fell ill and it took me two whole days to bring him to the district hospital," said Mong Khya Marma, a patient seeking treatment in the Bandarban District. "We had to carry him on our shoulders for a whole night."
To combat the low health indicators across the region, the Ministry of Health and Family Welfare launched the Tribal Health Nutrition and Population Plan in 2004, an ongoing and developing project created by the government to marry health outreach with a cultural knowledge of ethnic minorities.
As nutrition continues to be problematic as well, the government has taken steps to safeguard the tenuous food supply, Abdur Razzak, Minister of the Food and Disaster Management, said. The UN World Food Programme recently reported that Sajeck Union, part of Rangamati District, had undergone repeated food security crises in the past several years attributed to a rat infestation, restrictions on cultivation, rising prices and a seed shortage.
And while health workers acknowledge some improvements in the past decade, the three districts still rank among the five least performing in the country in terms of the Millennium Development Goals, according to the Bangladesh Bureau of Statistics and UNICEF
http://www.irinnews.org/report.aspx?reportid=93224
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