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Political economy of policy and implementation in the Bangladesh health sector: Implications for reducing maternal mortality

Working paper 133

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Simeen Mahmud (with contributions from Nuzhat Sharmeen and Moogdho Mahzab)
This paper discusses the politics of maternal health in Bangladesh. It seeks to relate the paradoxical combination of weak governance and strong progress towards maternal mortality reduction to the nature of its political settlement. Typical of ‘competitive clientelist’ settlements, the effectiveness of maternal health policies tends to be diluted by ineffective coordination and poor discipline of public sector personnel. However, in Bangladesh, state ineffectiveness is at least partly alleviated by donor engagement, NGO and private provision, and pockets of state effectiveness – phenomena that can be traced to the historical origins of the Bangladeshi state.