This was presented in the first national public health conference of Bangladesh in January, 2013

1. One Health, Shared
Responsibility
Shamim Ahmed
Yael Vellemen
National Public Heath Conference 2013

2. Prologue
» It is a well-established truism that a successful
effort to reduce disease and improve wellbeing
requires preventive as well as curative
interventions.
» Despite this underlying truth, the roles of
‘prevention’ and ‘cure’ are often split among
different institutions and professional communities,
causing a practice gap that results in poor
progress on prevention.
» In no other area is this gap more evident, than the
links between the health and the water, sanitation
and hygiene (WaSH) sectors.
www.wateraid.org/bangladesh

3. Objective
»The purpose of this presentation was to
draw attention to simple, workable
practices that can bring the varied sets of
actors together, in a cost-effective and
holistic approach that will deliver better
health outcomes for Bangladesh’s
population.
www.wateraid.org/bangladesh

4. Methods
»Available secondary literatures
»Peer reviewed (or not!)
»Policy papers
› to establish the association between the
claimed hypothesis of the need for joining
health and WaSH expertise for better public
health outcomes which is self-evident, and
has led to the introduction of public health
acts.
www.wateraid.org/bangladesh

5. Discussion
WaSH vs Vaccination
[prevention (vaccines) and cure (ORS, zinc,
antibiotics) ]
Hand washing vs Vaccination
for Avian Influenza
Nutrition
Urban vs Rural
www.wateraid.org/bangladesh

6. Nutrition vs WaSH
www.wateraid.org/bangladesh

7. Economic impact
» The total economic impact of inadequate sanitation in
Bangladesh has been estimated at £2.5 billion in 2007,
equivalent to 6.3% of GDP.
» Health-related impacts account for 85% of this burden,
with a per capita health burden of £15 per capita per
year.
› Abul Barkat (2010) Economic Impacts of Inadequate
Sanitation in Bangladesh, Dhaka University.
www.wateraid.org/bangladesh

8. Policy
» National Health Policy 2011
» National Nutrition Plan of Action 1997
» National Food Policy Plan of Action 2008-15
» National Agriculture Policy 2010
» National Food Safety Policy/National Food Safety plan of
action 2012
» Infant & Young Child Feeding (IYCF) National Plan of
Action 2009-2011
» National Strategy for Infant & Young Child Feeding in
Bangladesh 2007/2010
www.wateraid.org/bangladesh

9. Policy
» National Fisheries and Livestock Policy
» NNS operational plan 2011-16
» Bangladesh Country Investment Plan 2010
» 3rd NATIONAL STRATEGIC PLAN FOR HIV and AIDS
RESPONSE 2011-2015
» Maternal Health Review Bangladesh 2003
» Integrated Management of Childhood Illness Protocol
www.wateraid.org/bangladesh

10. Implication
»There are mention of water and sanitation
in the national health policy several times.
»It has been given certain level of
importance by mentioning why without
water, sanitation overall health goals can’t
be achieved.
»But hygiene is not adequately mentioned
and there is no specific instruction or way
forward given in the national health policy
regarding WaSH.
www.wateraid.org/bangladesh

11. Implication
»WaSH has been almost ignored in all the
nutrition related documents and received
almost no attention in any of the policies.
»Hygiene has been addressed scattered
but why it is associated with WaSH and
nutrition is missing.
www.wateraid.org/bangladesh

12. Implication
»Nothing has been mentioned about WaSH
in this policy. (HIV/AIDS strategies)
»None of the words ‘water’, ‘sanitation’,
‘hygiene’, ‘toilet’, ‘latrine’, has been
mentioned even for once in the
documents.
www.wateraid.org/bangladesh

13. Collaborations
» Ministry of Health, Donor Govt health
programs (e.g., USAID, UKAID), health
clinics (e.g., AIDS clinic or MCH clinic), health
care worker programs, Nutrition programme,
Neglected Tropical Disease programmes
such as trachoma or helminth control,
academic health institutions (e.g. schools of
public health), health-focused NGO partners
such as Save the Children, PLAN, CARE,
CSO coalitions (HIV/AIDS Alliance, other
CSO coalitions and networks).
www.wateraid.org/bangladesh

14. Collaborations
Why WaSH and Health should collaborate?
»The health sector can play an important
proactive role in public health
improvements through intersectoral
collaboration; the Ministry of Health and
Family Welfare can and should become an
advocate for public health beyond the
medical aspects of the healthcare system
www.wateraid.org/bangladesh

15. Collaborations
»The human resources capacity of the
Ministry as well as its broad network of
service delivery systems down to the
community level including female
Community Health Volunteers offer
potential for leveraging additional
resources to advance WASH provision,
and is critical for achieving sustained
results by increasing political prioritization
for WASH
www.wateraid.org/bangladesh

16. Collaborations
»The health sector has an excellent Health
Management Information System
(HMIS) that produces a range of detailed
service delivery information, which could
allow better WASH planning based on the
WASH-related burden of disease.
»Equity->inclusion->disability
www.wateraid.org/bangladesh

17. Concluding remarks
» To strengthen institutional functional strategic
links between the health and WASH sectors for
overall effectiveness of WASH programme
performance, resulting in the inclusion of WaSH
in the promotional work of the health sector
» To provide strategic support and technical inputs
to any ‘WASH in Health’ related policies,
strategies and programme development aspects
www.wateraid.org/bangladesh

18. Concluding remarks
» To establish links and relationships with health
academia, research, networks, organizations, external
development partners, INGOs, and specialized
organizations to enrich WASH practice through
evidence-based learning and programming
» To contribute to the reduction of the WASH-related
disease burden through collective work by WASH and
health organizations, and strengthen the health sector
through WAN’s technical expertise on the health-related
aspects of WASH
www.wateraid.org/bangladesh

19. Concluding remarks
» To provide technical support and emphasize the links
between poor WASH and health outcomes, poverty,
marginalization, and social exclusion
www.wateraid.org/bangladesh

20. THANKS
WaterAid
House 97/B, Road 25, Block A
Banani, Dhaka 1213, Bangladesh
Tel.: +880 2 8815757, 8818521
Fax: +880 2 9882577
info@wateraidbd.org
www.wateraid.org/bangladesh