In the mid-seventies, Bangladesh was Asia's fifth and World's eighth most populous country. Now, it ranks as the sixth and ninth respectively. The country's population estimated to be 123.80 million in January 1997, is growing at the rate of 1.75 per cent per annum. In 1973, when the country launched its First Five Year Plan (1973-78), population was 74 million and the rate of population growth was then 3.0 per cent per annum. In a span of twenty three years, the population growth rate was reduced by 1.2 percentage points, while adding 49 million more people.

In 1975, contraceptive prevalence rate (CPR) was reported to be 8.5 per cent as against the present estimate of 48 per cent, showing an average increase of 1.8 per cent per annum since then. In 1989, total fertility rate (TFR) and CPR were estimated at 4.9 and 32.0 per cent respectively. Corresponding figures for 1995 are 3.4 and 48 per cent respectively.

This progress should be viewed against the backdrop of low literacy rate, low status of women and low income per capita and so on.

Currently, population below 15 years is around 43 per cent of the total population; and women of reproductive age (15-49 years) represent 46 per cent of the total female population. The maternal and infant mortality rates are reported to be 4.5 and 78 per thousand live births respectively. Life expectancy at birth has increased to 58.1 years for male and 57.6 for female compared with the 1991 level of 55 and 54.5 years respectively.

Rapid population growth, increasing urbanisation and major shifts in disease patterns like resurgence of malaria, kala-azar and other emerging and re-emerging diseases are a few examples of these changes, whilst the risks of STD, HIV/AIDS and other infectious diseases menacing public health are fast increasing. Increase in the incidence of cardiovascular diseases, renal disorders, mental illnesses, cancer and conditions related to substance abuse, smoking and alcoholism, increasing traffic and industrial accidents, etc., exacerbate the disease burden of the population.

Bangladesh has got a large base of young age population. The serious implication of this trend in the health sector where both primary and specialised health care services are still inadequate will be a serious demand for services exists for doctors, nurses, medicine, hospital care, and so on. At present, doctor - population ratio is 1:5506; hospital bed-population ratio is 1: 3231 and per capita health expenditure is Tk. 135 per annum.

At present, population density is 850 persons per sq.km which will further increase to 913 persons in 2002 and 1,130 persons in 2020 per sq.km adversely affecting existing man-land ratio of 1:18 decimal. The number of working age population (15-59 years) is projected to increase from 66.6 million in 1997 to 80.2 million in 2002; 98.0 million in 2010; and 109.1 million in 2020.

Over the 25 years of independence, the health situation of the population has improved. Smallpox, malaria and cholera have been eradicated or are no longer major killers. Life expectancy at birth reached 58 years in 1995. Total fertility rate was reduced from 6.3 in 1975 to 3.4 in 1995. The crude death rate dropped from 12.0 in 1990 to 9.0 in 1995 and is expected to decline further.

Similarly, the under-5 mortality dropped from over 210 in the mid-1970s to 133 per 1000 live births in 1995. In terms of physical facilities, there were 897 hospitals (610 in the public sector and 287 in the private sector) of different categories with 34,786 beds (27,544 in the public sector and 7,242 in the private sector) with one bed for every 3,450 persons in the country in 1995.

With regard to health and medical professionals, the country so far produced 24,638 graduate doctors by 1995 giving a doctor-population ratio of 1:4,870. The doctor-nurse ratio was 2:1. In case of nurse-population ratio, the position was 1:10,714. Despite these, malnutrition, diarrhoeal diseases etc continue to be a major killer and the number one cause of morbidity.

At present, there are about 34,786 hospital beds giving a bed-population ratio of approximately 1:3,450. The existing Medical College Hospitals, Rehabilitation Institute and Hospital for the Disabled (RIHD), Institute of Cardiovascular Diseases (ICVD) and Ophthalmological Institute were further developed. Hospitals at Comilla, Khulna, Jamalpur and Bandarban were completed. The Cancer Institute and the IPGMR were also completed.

- (Source: Fifth Five Year Plan 1997 - 2002)