POST TIME: 21 August, 2019 00:00 00 AM
Impact of Bloomberg data for health initiatives in Bangladesh
Data for health initiative first tried to improve birth and death registration in Kaliganj upazila of Gazipur district

Impact of Bloomberg data for health 
initiatives in Bangladesh

Bloomberg data for health initiative (D4H) was introduced in Bangladesh in 2016 by Vital Strategies of USA with a project titled ‘the technical support for civil registration and vital statistics (CRVS) system improvement’ under the Cabinet Division. Vital Strategies provided technical and financial support to the project. It was targeted to improve birth, death and causes of death out of six components of CRVS. The remaining three are marriage, divorce and adoption.

Birth and death registration

Proper birth and death registration were immensely important for all ages of time. It was first introduced in 1873 with an act which was Bengal birth and death registration act. From then a long journey across century it had been utilized very poorly to register these two civil events as per crude birth and death rate.

A new birth and death registration act was enacted in 2004 in place of the previous one and subsequently few rules were issued under this act to make birth and death registration user friendly. But despite of all attempts birth and death registration within 45 days of occurrence as per law remain around 3per cent and 1per cent respectively.

Data for health initiative first tried to improve birth and death registration in Kaliganj upazila of Gazipur district involving front line health assistants who achieved 99.5per cent per cent success in first dose of expanded program on immunization (EPI). They were involved to notify birth and death to local civil registrars (Chairperson of Union Parishads) captured during their regular domiciliary visits. Upazila nirbahi officer (UNO) was entrusted with strict monitoring of timely issuance of birth and death certificates of the applications submitted to Union Parishads under his or her jurisdiction. Applying this method it was possible to register birth and death as per their crude rate. This model is called ‘Kaliganj model of birth and death registration’. This model was subsequently scaled up to another 12 upazila. These are Gazipur Sadar, Kaliakoir, Kapasia and Sreepur of Gazipur district; Trishal and Bhaluka of Mymensingh district; Anwara of Chattogram district; Phultala of Khulna district; Paba of Rajshahi district; Biswanath of Sylhet district; Gournadi of Barisal district and Kishoreganj of Nilphamari district.    


Determination of cause of death   

Determination of correct causes of death is immensely important for public health management. In Bangladesh around 850,000 deaths occurs annually. Out of these huge numbers of deaths public and private hospitals report around 100,000 deaths to the directorate of health services with causes of death. But causes of these deaths are not in accordance with WHO (world Health Organization) standard; most of them are laymen and ill defined, such as liver failure, kidney failure, brain death, heart attack, cardio-respiratory failure or irreversible cardio-respiratory failure.

These are organ failure and mode of dying not the real causes of death. So Bangladesh spotted as a ‘country of no cause of death data’ in the world cause of death data map of WHO.  To prevent the preventable deaths and future public health management physicians have to determine the train of morbid conditions for failure of organs, stopping of respiration and pumping of heart. This will be the underlying causes of death and will add value to future public health management.

World health organization introduced IMCCoD (international forms of medical certification of cause of death) in 1967 of its 20th annual assembly for determination of cause of death in health facilities.

Most of the countries adopted this form in their health facilities to determine underlying causes of death. Instead of introducing this form Bangladesh is still using backdated form 804 in hospitals. Which is basically a form of proof of death and unable to meet the WHO standard in respect of determination of causes of deaths in our hospitals.

Importance of determination of correct cause of death

To overcome this situation Bangladesh took steps to determine correct cause of death in collaboration with Bloomberg Philanthropies Data for Health Initiative (D4H). From 2016 under this initiative 10,000 physicians have been trained on IMCCoD and trained physicians were able to introduce this form in 92 public and private hospitals and health complexes including Dhaka medical college hospitals (DMCH). This scale up was triggered by a policy letter (demi official letter) of the Cabinet Secretary Mr. Mohammad Shafiul Alam to Secretary Health for introduction of IMCCoD in all public and private hospitals to determine correct causes of death as per international standard to prevent the preventable deaths and for public health management in our country. Already 80,000 deaths from these hospitals have been identified by the physicians with underlying causes of death including ICD (international statistical classification of diseases) coding. The result of this initiative reveals alarming situations in respect of some categories of deaths.

Prevention of the preventable deaths

In Dhaka medical college hospitals average monthly deaths are around 1200. Among them, number of death happening from ‘fall from height’ is alarming. Recently in some months underlying cause of up to 17per cent of total deaths were identified as ‘fall from height’.

In previous system all these deaths were labelled as ‘internal hemorrhage or head injury’ ignoring the correct causes of death. Sometimes we seen in daily newspapers that during working in high-rise buildings sporadically laborers are dying due to fall from height, people are dying in lift accidents etc.

But when we enumerate the number in a particular hospital it is certainly alarming. So, D4H initiative enabled us for determination of correct causes of death to prevent the preventable deaths. Now it is the responsibilities of concerned authorities to take immediate measures for secured working environment to prevent these preventable deaths.  

The writer is working as Country

Coordinator of Vital Strategies for

CRVS-D4H improvement in Bangladesh