Rethinking development agenda on post-COVID era: a case study on Bangladesh

KEYWORDS:

• Sustainable development goal
• SARS-COVID-2
• coronavirus
• development
• Bangladesh
• lMIC

Bangladesh, a densely populated country of 166.37 million with an urban population of 35.9%, has experienced a rapid spread of coronavirus disease (COVID-19) since its first officially reported case on 8 March 2020. A total of 851,668 cases have been detected from a total of 6.3 million administered tests up until 23 June 2021. Within that same period, total reported deaths stand at 13,702 (case-fatality rate of 1.6%) with a cumulative attack rate of 500/100,000. However, the situation is disproportionally dire in Dhaka, Bangladesh’s capital and the largest metropolitan city, which accounts for 58% of the overall country-level case burden [1].

The development performance of the Sustainable Development Goals (SDGs) was released on 14 June 2021 [2]. Bangladesh’s SDG index rank is low with an index score of 63.5, ranking 109th out of 166 countries. This index rank reveals a disproportionate achievement of 75% of the indicators in education completion (SDG 4), climate change (SDG 13) and responsible consumption on energy (SDG 12) [2]. Similarly, the score of over 50 in the SDG Goal for Good Health and Wellbeing (SDG 3) [2] was heavily contributed by exemplary progress in vaccination coverage of over 97% and family planning coverage of 62% [3]. Much of these developments are encompassed in protocols and policies developed with gaps in the implementation due to a plethora of issues related to capacity and coordination in the delivery of health-care services. Many of these improvements were also dependent extensively on foreign donation, creating a skewed development of some priorities in maternal and child health. Low support from the government coupled with high dependency from donor funding and out-of-pocket expenditure of over 72% of total health expenditure have led to a weak public health infrastructure and a vulnerable health system.

In response to the COVID-19 crisis, with such limited health-care capacity, delivery of all routine services was suspended by the government to prioritize COVID-19 response initiatives. This included the postponement of routine immunization of measles and rubella for 34 million children alongside other supplementary immunization activities in the event of low uptake of services. UNICEF has estimated a 25% reduction in service utilization for children under-5 in March 2020 compared to March 2019, leaving over 28,000 children under-5 at risk of death in 2021 [4]. Such a looming catastrophe has the potential to derail the achievements in the field of maternal and child interventions (SDG 3.1 and 3.2). Even though the service was eventually resumed on the eve of vaccination, they were again ceased on the onset of the second wave of the pandemic that started late March 2021.

Additionally, the small progress achieved in other major SDG indicators such as poverty reduction (SDG 1), hunger (SDG2), and economic growth (SDG 8) are dependent on labor market conditions, which are heavily compromised due to COVID-19 in low- and middle- income countries (LMICs). Moreover, due to restricted movement and reduced availability of services, the majority of informal workers comprising 85.1% of the Bangladesh workforce and 43% of the country’s GDP have been forced out of work, with a total drop of 80% income of this population [5,6]. The case study of Bangladesh indicates that most countries will struggle to meet the optimistic targets of SDGs. This calls for rethinking development goals due to the havoc caused by the global pandemic.

Initially, a revision of the expectations of the SDGs must be considered, including both an extension of the expected deadline and a revision of the individual goals’ targets. Such steps can allow some recovery from the impact of COVID-19 as economies begin to reopen, and there is opportunity for investment in health-care infrastructure. Furthermore, countries should undergo full evaluation and risk assessment of COVID-19 so that progress can be monitored within the context of specific burdens.

In the long term, there should be a focus on resource allocation and priority of sectoral implementation. Investments should be aimed at capacity building and infrastructural development as metric-based achievement might not be sustainable, especially if they get derailed by global disasters such as pandemics. For example, an investment related to health system infrastructure such as health workforce (SDG 3.c) and universal health coverage (SDG 3.8) should be given priority over disease-specific SDG indicators (e.g. SDG 3.3 or 3.4). In response to the COVID-19 pandemic and its burden of healthcare, we call for newer metrics or reevaluation of current metrics to measure health progress.

The damage to Bangladesh caused by the pandemic will take years to repair. Therefore, we call for a revision of the target matrices with reallocation of resources for sustainable growth that are resilient to global disasters.

Ethical clarence

All the data and reports used in this study were publicly available.

Contributor statement

S Huq conceptualized the study, conducted literature review, and drafted the manuscript. RK Biswas structured the manuscript and drafted the manuscript. The final manuscript was read and approved by all the authors.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.