C COMMUNITY MANAGEMENT: RAHMAN and JAHAN

BANGLADESH, WITH AN estimated population of about 111 million, is one of the most densely populated countries in the world. In a predominantly rural economy, with a per capita income of US$ 220 about 48 per cent of rural and 44 per cent of the urban population live below the poverty line defined as 2122 calorie intake per person. Average households spend 59 per cent of their income on food, yet 60 per cent of children below 5 years of age are malnourished. Resources required to bring about improvement in standards of living are limited. More than 90 per cent of the rural people have access to safe drinking water and only 18 per cent use proper sanitation facilities. 47 per cent of the total urban population have access to public water supplies and 42 per cent to hygienic sanitation (Rashid, et al 1994). UNICEF (1996) however, claims that 96 per cent of the rural and 99 per cent of the urban population have access to safe drinking water while 44 per cent rural and 79 per cent urban people use hygienic latrines of one kind or another. Yet the health status of this poverty stricken country is appalling poor. Infant mortality rate and under five mortality rate persists at a high 77 and 134 deaths per 1000 live births in 1995 (MoH&FW, 1996). Water related diseases still remain a common occurrence in Bangladesh despite significant improvement in drinking water supply and sanitation over the past decade. Number of deaths due to diarrhoeal diseases alone stands at 230,000 annually and in 1992 some 6.9 million cases of diarrhoeal diseases have been reported (MoH&FW, 1996). Experiences of the past years have indicated that physical provisions of services alone are not a sufficient precondition for improvement of health. Building alliance with people, changing their hygiene habits and more importantly the ability of the institutions to adapt to ever changing priorities are, among others, some major challenges to be taken on. These are discussed in this paper with particular emphasis on institutional, social issues and technological issues.