摘要：

Bangladesh has been going through a rapid epidemiologic transition in which non-communicable diseases (NCDs) now account for two-thirds of all deaths. To assess health system preparedness and the country capacity to address this burden, we used a newly developed tool (Robinson and Hort 2011), a four-by-four matrix that assesses health system preparedness in building commitment, reorienting policies, developing new service delivery models and ensuring equity against four descriptive levels of readiness. The study reviewed research reports and policy documents and supplemented them with key informant interviews. Data were analysed according to the four-by-four matrix. The review indicated that although a national NCD plan has been developed, a dedicated unit has been established within the Ministry of Health and Family Welfare and new service delivery options were being piloted, these activities remain fragmented, both within the health sector and across other areas of government and civil society. It found that while levels of awareness and commitment were relatively high within the ministry, other key players, including development partners and non-government providers, were largely absent from current activities. This absence may result in weakened ability of both government and non-government service providers to generate the type of multi-sectoral action required to tackle NCDs and to deliver more cost-effective services that protect the poor. The key challenge for policy makers is how to build national sustainable, multi-sectoral action commensurate with the situation of NCDs. This includes designing programmatic responses that integrate various government and non-government activities, and that also reform health systems.

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