World Bank Document

68157 TO THE MDGS AND BEYOND: ACCOUNTABILITY AND INSTITUTIONAL Public Disclosure Authorized INNOVATION IN BANGLADESH Public Disclosure Authorized Public Disclosure Authorized Human Development Unit South Asia Region The World Bank July 2006 Public Disclosure Authorized Document of The World Bank ABBREVIATIONS AND ACRONYMS ARI Acute Respiratory Infection ATC Agreement on Textiles and Clothing BBS Bangladesh Bureau of Statistics BIDS Bangladesh Institute for Development Studies BMA Bangladesh Medical Association BRAC Bangladesh Rural Advancement Committee CMR Child Mortality Rate DCC Dhaka City Corporation DESA Dhaka Electric Supply Authority DFID Department for International Development DHS Demographic and Health Survey DPHE Department of Public Health Engineering DPT Diphtheria and Whooping Cough DSK Dushtha Shasthya Kendra EPZ Export Processing Zone ESD Essential Service Delivery FDI Foreign Direct Investment FP Family Planning FSRP Financial Sector Reform Program FSSAP Female Secondary School Assistance Program FSSS Female Secondary School Stipend FY Fiscal Year GDP Gross Domestic Product GK Gonoshayastha Kendra GNI Gross National Income GOB Government of Bangladesh HDI Human Development Index HDS Health and Demographic Survey HIES Household Income and Expenditure Survey HIV Human Immuno-deficiency Virus HNPSP Health, Nutrition and Population Sector Program ICDDR International Center for Diarrhoeal Disease Research IDA International Development Agency IFPRI International Food Policy Research Institute IMR Infant Mortality Rate IT Information Technology IUCN International Union of Conservation LFPR Labor Force Participation Rate LFS Labor Force Survey LGED Local Government Engineering Department MDG Millennium Development Goal MFA Multi-Fiber Agreement Accountability and Institutional Innovation in Bangladesh Page 3 MIC Middle-Income Country Ministry of Local Government, Rural Development and MIGRD Cooperatives MMR Maternal Mortality Ratio MoF Ministry of Finance MPO Monthly Pay Order NGO Non Government Organization NHA National Housing Authority NPSWS National Policy for Safe Water and Sanitation OP Operational Plan PM Particulate Matter PPP Purchasing Power Parity PRSP Poverty Reduction Strategy Policy PWD Public Works Department RAJUK Rajdhani Unnayan Kartripakkha RDP Rural Development Project RMG Ready-Made Garments RRMIMP Rural Roads and Market Improvement and Maintenance Project SC Satellite Clinics SMA Statistical Metropolitan Area SOE State-Owned Enterprises TBA Traditional Birth Attendants TFP Total Factor Productivity TFR Total Fertility Rate UHC Upazila Health Complex UHFWC The Union Health and Family Welfare Center UN United Nations UP Union Parishad UPHCP Urban Primary Health Care Project VDC Village Development Committee WASA Water and Sewage Authority WB World Bank WHO World Health Organization Accountability and Institutional Innovation in Bangladesh Page 4 ACKNOWLEDGEMENTS This report was prepared by a team led by Qaiser Khan, Lead Human Development Specialist. Major sections of the report were written by Jean-Paul Faguet and Yaniv Stopnitzky. The growth and macroeconomic sections were written by Zahid Hussain and Sandeep Mahajan who drew upon the report Bangladesh: A Strategy for Growth and Employment. Others making key contributions through background papers for this include Dr. Rafiqul Huda Chowhdury, Dr. Zulfiqar Ali, Syed Rashed Al Zayed, Taifur Rahman, Allison Barret, Karen Dunn and Rafael Cortez. Very useful insights and comments were provided by Amit Dar, Kees Kostermans, Dinesh Nair, Geeta Sethi, David Savage and Kalanidhi Subbarao. Tazeen Islam and Farhan Aziz provided research support while Gertrude Cooper, Nasreen Begum, Nazma Sultana, Shahadat Hossain Chowdhury and Mahtab Alam provided administrative support. The team benefited enormously from the discussions and conclusions of a workshop in Dhaka held on June 5th and 6th which brought together numerous background papers, some of which written especially for this report. The recommendations to emerge from the workshop are the key elements of the strategy presented here. Participants included academics, officials, donors, NGOs, press and members of the general public. The research work behind this report was supported in part by the World Bank administered DFID Trust Fund for Governance in Bangladesh World Bank. Accountability and Institutional Innovation in Bangladesh Page 5 TABLE OF CONTENTS Abbreviations and Acronyms .................................................................................................................................... 2 Acknowledgements .................................................................................................................................................... 4 Table of Contents ...................................................................................................................................................... 5 List of Figures ........................................................................................................................................................... 6 Summary and Recommendations .............................................................................................................................. 8 Introduction and Context...................................................................................................................................... 8 Economic Overview ............................................................................................................................................. 8 Significant but Insufficient Progress on Child and Maternal Mortality ............................................................... 9 Attaining MDG Outcomes by Strengthening Accountability and Transparency ................................................. 9 Emerging Problems of Metropolitan Areas........................................................................................................ 11 Environment and Infrastructure ......................................................................................................................... 12 Girls’ Secondary Education as a Driver for Other MDG targets ....................................................................... 12 The Way Forward – Overall Recommendations ............................................................................................... 14 Recommendations for Different Target Groups ................................................................................................. 16 Actions for Consideration by the Government of Bangladesh ...................................................................... 16 Actions for Consideration by NGOs and Civil Society Groups .................................................................... 17 Actions for Development Partners (DPs) ...................................................................................................... 17 Actions for the World Bank .......................................................................................................................... 18 Introduction and Overview ..................................................................................................................................... 19 1. Development Performance and challenges ......................................................................................................... 21 The Development Record .................................................................................................................................. 21 Moving Development Forward .......................................................................................................................... 24 2. Maternal and Child Mortality: Trends and Projections ..................................................................................... 28 Trends ................................................................................................................................................................ 28 Projections .......................................................................................................................................................... 31 3. Special Challenges to Attainment of the MDGs ................................................................................................. 34 Emerging Challenges Created by Urbanization ................................................................................................. 34 Service Delivery in Metropolitan Areas ........................................................................................................ 37 Water and Sanitation Services in Slums Drive Outcomes in Metropolitan Areas ......................................... 38 Poor Secondary Schooling Outcomes in Metropolitan Areas ....................................................................... 40 Urban Health Care ......................................................................................................................................... 42 Urban Environmental Health ......................................................................................................................... 43 General Policy Conclusions for Metropolitan Areas ..................................................................................... 45 Infrastructure and the Environment.................................................................................................................... 49 Access to Infrastructure is Associated

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