Abating malnutrition also took centre stage in the Tk 11,419 crore programme the health ministry launched in July 1998.

The maternal mortality rate in Bangladesh is still the highest in the world with about 15,000 women dying annually during childbirth.

More than 95 percent of the deliveries still take place at home aided only by untrained birth attendants. Safe delivery, especially in rural areas, is still a far cry.

Under-five child mortality rate also remains very high with an estimated 700 children dying a day, mostly from respiratory tract infections, diarrhoea and pneumonia.

The level of malnutrition in the country is also the most severe in the world, with 600 to 700 children dying from malnutrition-related causes every day. Close to 60 percent of the under-five children are underweight and more than half are stunted.

Of the pre-school-age children, more than 54 percent or about 95 lakh are stunted and 56 percent are underweight. Around 45 percent children are born with low birth weight (below 2.5kg).

Several studies also show that Bangladeshi children suffer from high degrees of micronutrient deficiencies, particularly of vitamin A, iron, iodine and zinc.

Extreme malnutrition also continues to haunt the country's women. More than 50 percent of them suffer from chronic energy deficiency and studies suggest there has been little improvement in women's nutritional status over the past 20 years.

A World Bank nutrition sector paper, "Bangladesh: Breaking the Malnutrition Barrier", estimates that malnutrition costs the country $1 billion a year. By comparison, the cost of extending nutrition services across the country is just a quarter of that amount -- about $246 million.

Bangladesh will lose $22 billion over the next 10 years in productivity costs if it does not invest in nutrition.

Extending essential service package (ESP) to the poor and the most vulnerable through about 11,000 community clinics (CCs) was another major component of the programme.

But, the benefits of the CCs, each designed for catering health services to roughly 6,000 people at union level, is still a dream, although millions of taka have been spent on the construction of the CC buildings.

The family planning (FP) outlet services also faltered. Contraceptive promotion was geared towards temporary method (of using pills and condoms) instead of the long-acting or permanent ones (like sterilisation), which was essential for the reduction of total fertility rate (TFR) and was included in the HPSP. This strategic deviation since 2001 has led to low use of contraceptives.

Even now, 50 percent of the couples do not practice FP in Bangladesh, according to the status of performance indicator of health ministry. Use of contraceptive pills is confined to 23 percent, injection 7.2 percent, traditional method 10.3 percent, intra-uterine device (IUD) 1.2 percent, Norplant 0.5 percent and sterilisation 6.7 percent.

The supply of drugs especially to the rural health centres is scanty. Financial sustainability through health insurance scheme or cost recovery, users fee collection, retention and recycling -- all major reform activities envisaged under the HPSP remain unrealised.

The health ministry had agreed to a number of measures with its development partners to streamline health service delivery system and bring more transparency. But both present and past governments failed to carry out the measures, which at the end of 2001 led to suspension of credit by the donors.

All reform activities stalled then leading to widespread chaos and confusion at the field level, which appears to affect the delivery of health and family planning services.

Talking The Daily Star recently, Health Secretary AFM Sarwar Kamal expressed dissatisfaction with the performance of the HPSP, saying 'the health sector is in total disarray.'

A recent survey found the percentage of households that rated the government's health and family planning services as good decreasing from 38 in 1999 to less than 10 in 2003.

The same survey, commissioned by the health ministry and the World Bank, found the proportion of households using government health and family planning services to have reduced to only 10 percent.

Both the indicators clearly reflect the mismanagement, poor co-ordination and performance of the overall health and family planning delivery services. Experts say, the HPSP mission and vision failed largely due to mismanagement and lack of enthusiasm.