While Bangladesh's development puzzle has attracted attention of Amartya Sen and Jean Drez long ago, a group of researchers came up this time with some findings relating to health and nutrition to posit the country's positive posture. Arabinda Ghosh, Daniel J. Corsi, and S. V. Subramanian call it a 'Tale of Two Bengals', in the Journal of Development Policy and Practice (2016). The authors take stock of a comparative performance of health and nutrition services in two Bengals: Bangladesh and the Indian state of West Bengal. Perhaps needless to mention, both Bengals are bounded by an intricately woven topography, demography and culture. Nevertheless, they are differentiated in political climate and administrative structure. The findings from the aforementioned researchers, occasionally paraphrased, duly deserve academic and policy level attention. A priori reasoning might suggest that West Bengal should lie ahead of Bangladesh but the empirics of the abovementioned authors seem to say otherwise. "The broad similarity of the indicators considered here demonstrates clearly that in spite of lower per capita income and female literacy in Bangladesh, the levels of access to improved sources of drinking water, sanitation and child nutrition both in terms of coverage and equity are remarkable."
This study revealed that in issues related to maternal health, contraception and family planning, West Bengal had better indicators compared to Bangladesh which can be adduced to the status of women in the respective societies. Surprisingly, as the paper shows, although both regions demonstrated over 90 per cent coverage of 'improved water sources', a few places have continuous supply of drinking water. For example, a recent Indian study shows that 42 per cent of urban and 60 per cent of rural samples of water were found to be contaminated. It may be so in the case of Bangladesh too. Therefore, unsafe water continues to be a vector for child diseases in the Bengal region. In fact, several studies demonstrated that the root cause of child mortality springs from unsafe water. It needs no mention that water and sanitation-related diseases, despite being preventable, remain one of the most significant child health problems. In both Bengals, sanitation witnessed improvement in physical facilities but how far in practice and awareness remains a question. "Sanitation has a strong connection not only with personal hygiene but also with human dignity and well-being, public health, nutrition and even education. The global impact of poor sanitation on infant and child death and health is profound. It is estimated that 10 million children under the age of 5 die every year-2.4 million of them in India-and that a fifth to a quarter of these deaths are due to diarrhoea. Being affected by diseases early in life also has lasting effects on the health and human capital of children who survive".
In this study, the researchers observed relatively similar rates of improved sanitation facilities usage between Hindus and Muslims in Bangladesh and slightly higher rates of improved facilities among Hindus in West Bengal compared to Muslims. While mortality was somewhat higher among Muslims in both regions, these differences were not statistically significant and the Hindu-Muslim comparisons on child under-nutrition were similar with the major exception being higher rates of stunting among Muslims in West Bengal. The differences in mortality appear unlikely to be explained by the small differences in the use of improved sanitation facilities.
Appropriate sanitation facilities have their own dividends that can be illustrated with examples. Among the world's poor countries, those with access to improved water and sanitation services experience greater economic growth. Poor countries with improved water and sanitation services enjoyed annual average growth of 3.7 per cent. Poor countries with the same per capita income but without improved access have an average per capita GDP (gross domestic product) growth of only 1.0 per cent (Stockholm International Water Institute). The cost-benefit ratio of water and sanitation interventions is high when all benefits are included, standing at around between US$5.0 and US$11 economic benefit per US$1.0 invested for most developing world sub-regions and for most interventions.
One of the potential drivers of the remarkable progress made in health in Bangladesh, as the researchers argue, is the pluralistic nature of the health sector. Bangladesh performs in a similar way as West Bengal does in majority of indicators partly due to both the structure of the public sector and pluralistic health system, which is characterised by equitable and extensive outreach to all households. Pro-poor and women-focused investments in health and social developments such as the expanded programme of immunisation, family planning, female education, subsidies and women's micro-credit may have contributed to these gains along with an active NGO presence in the country. Direct health actions in Bangladesh by many stakeholders that have delivered the highest priority health services have exerted a positive effect on health outcome. In contrast, West Bengal has had a long history of a stable and demographic and semi-socialist political climate.
In summary, the findings suggest a new dimension in Bangladesh's development paradigm. The paper confirms the similar performance across a range of maternal and child health indicators in Bangladesh compared to West Bengal - despite lower levels of income and levels of literacy in Bangladesh - may be in part due to large presence of NGO and focused interventions in key areas such as immunisation. However, other indicators such as mortality and anti-natal care (ANC) were behind West Bengal. Further, studies on programme implementation in Bangladesh may lead to the development of a replicable model for resource-poor countries.
The writer is a former Professor of Economics at Jahamgirnagar University.
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