COMILLA UNIVERSITY

Department of Management Studies

Submitted to:

MD .MahbubAlam

Associate Professor, Management Studies

Comilla University

Submitted By:
MD. Saiful Islam Foysal
Batch: 10th
ID: 11605058

Submitted Date: 14 November 2020

 TABLE OFCONTENT
Serial INDEX Page
NO No

Literature review 4-6

1
Abstract 7
2
Introduction 8-13
3
Bangladesh Preparedness and Response Plan for 14-66
4
COVID-19

Matarbari coal-fired power plant 67-84

5
HazratShahjalal International Airport Expansion 85-94
6
Findings 95-96
7
Recommendation 97
8

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 LITERATURE REVIEW:
Economic Growth
1. What Is Economic Growth?
Economic growth is an increase in the production of economic goods and services, compared
from one period of time to another. It can be measured in nominal or real (adjusted
for inflation) terms. Traditionally, aggregate economic growth is measured in terms of gross
national product (GNP) or gross domestic product (GDP), although alternative metrics are
sometimes used.
2. KEY TAKEAWAYS
 Economic growth is an increase in the production of goods and services in an
economy.
 Increases in capital goods, labor force, technology, and human capital can all
contribute to economic growth.
 Economic growth is commonly measured in terms of the increase in aggregated
market value of additional goods and services produced, using estimates such as GDP.
3. Understanding Economic Growth
In simplest terms, economic growth refers to an increase in aggregate production in
an economy. Often, but not necessarily, aggregate gains in production correlate with
increased average marginal productivity. That leads to an increase in incomes, inspiring
consumers to open up their wallets and buy more, which means a higher material quality of
life or standard of living.
In economics, growth is commonly modeled as a function of physical capital, human capital,
labor force, and technology. Simply put, increasing the quantity or quality of the working age
population, the tools that they have to work with, and the recipes that they have available to
combine labor, capital, and raw materials, will lead to increased economic output.

There are a few ways to generate economic growth. The first is an increase in the amount of
physical capital goods in the economy. Adding capital to the economy tends to increase
productivity of labor. Newer, better, and more tools mean that workers can produce more
output per time period. For a simple example, a fisherman with a net will catch more fish per
hour than a fisherman with a pointy stick. However two things are critical to this process.
Someone in the economy must first engage in some form of saving (sacrificing their current
consumption) in order to free up the resources to create the new capital, and the new capital
must be the right type, in the right place, at the right time for workers to actually use it
productively.
A second method of producing economic growth is technological improvement. An example
of this is the invention of gasoline fuel; prior to the discovery of the energy-generating power
of gasoline, the economic value of petroleum was relatively low. The use of gasoline became
a better and more productive method of transporting goods in process and distributing final
goods more efficiently. Improved technology allows workers to produce more output with the
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same stock of capital goods, by combining them in novel ways that are more productive. Like
capital growth, the rate of technical growth is highly dependent on the rate of savings and
investment, since savings and investment are necessary to engage in research and
development.
Another way to generate economic growth is to grow the labor force. All else equal, more
workers generate more economic goods and services. During the 19th century, a portion of
the robust U.S. economic growth was due to a high influx of cheap, productive immigrant
labor. Like capital driven growth however, there are some key conditions to this process.
Increasing the labor force also necessarily increases the amount of output that must be
consumed in order to provide for the basic subsistence of the new workers, so the new
workers need to be at least productive enough to offset this and not be net consumers. Also
just like additions to capital, it is important for the right type of workers to flow to the right
jobs in the right places in combination with the right types of complementary capital goods in
order to realize their productive potential.
The last method is increases in human capital. This means laborers become more skilled at
their crafts, raising their productivity through skills training, trial and error, or simply more
practice. Savings, investment, and specialization are the most consistent and easily controlled
methods. Human capital in this context can also refer to social and institutional capital;
behavioral tendencies toward higher social trust and reciprocity and political or economic
innovations like improved protections for property rights are in effect types of human capital
that can increase the productivity of the economy.
4. Measured in Dollars, Not Goods and Services
A growing or more productive economy makes more goods and provides more services than
before. However, some goods and services are considered more valuable than others. For
example, a smartphone is considered more valuable than a pair of socks. Growth has to be
measured in the value of goods and services, not only the quantity.
Another problem is not all individuals place the same value on the same goods and services.
A heater is more valuable to a resident of Alaska, while an air conditioner is more valuable to
a resident of Florida. Some people value steak more than fish, and vice versa. Because value
is subjective, measuring for all individuals is very tricky.
The common approximation is to use the current market value. In the United States, this is
measured in terms of U.S. dollars and added all together to produce aggregate measures of
output including Gross Domestic Product.

Development economics
1) What Is Development Economics?
Development economics is a branch of economics that focuses on improving fiscal,
economic, and social conditions in developing countries. Development economics considers
factors such as health, education, working conditions, domestic and international policies, and
market conditions with a focus on improving conditions in the world's poorest countries.
The field also examines both macroeconomic and microeconomic factors relating to the
structure of developing economies and domestic and international economic growth.
2) KEY TAKEAWAYS
 Development economics is a branch of economics whose goal is to better the fiscal,
economic, and social conditions of developing countries.
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  Areas that development economics focuses on include health, education, working
conditions, and market conditions.
 Development economics seeks to understand and shape macro and microeconomic
policies in order to lift poor countries out of poverty.
 The application of development economics is complex and varied as the cultural,
social, and economic frameworks of every nation is different.
 Four common theories of development economics include mercantilism, nationalism,
the linear stages of growth model, and structural-change theory.
3) Understanding Development Economics
Development economics studies the transformation of emerging nations into more prosperous
nations. Strategies for transforming a developing economy tend to be unique because the
social and political backgrounds of countries can vary dramatically. Not only is that, but the
cultural and economic frameworks of every nation different also, such as women's rights and
child labor laws.
Students of economics, and professional economists, create theories and methods that guide
practitioners in determining practices and policies that can be used and implemented at the
domestic and international policy level.
Some aspects of development economics include determining to what extent rapid population
growth helps or hinders development, the structural transformation of economies, and the role
of education and healthcare in development.
They also include international trade, globalization, sustainable development, the effects of
epidemics, such as HIV, and the impact of catastrophes on economic and human
development.
Prominent development economists include Jeffrey Sachs, Hernando de Soto Polar, and
Nobel Laureates Simon Kuznets, Amartya Sen, and Joseph Stiglitz.

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ABSTRACT
Bangladesh is both an inspiration and a challenge for policymakers and practitioners of
development. While the country recorded strong performance in income growth and human
development, Bangladesh faces daunting challenges with an increased level of vulnerability
with about 39 million people still living below the national poverty line.
Bangladesh's economy has made significant progress during Sheikh Hasina's rule.
Bangladesh is now close to achieving middle income country status with vision stretched to
become a developed country by 2041.
Sheikh Hasina, who glorified Bangladesh in the comity of nations, has coolly survived a
series of deadly attempts on her life perpetrated by her rivals but did not resort to retaliation.
Rather she let bids to kill her to be dealt with by the law of the country. Under pressing
situations she never lost control on anything but handled them with tolerance and patience.
The COVID-19 pandemic will deepen the challenges including a decline in exports, lower
private investment, and job losses. Investment and exports are likely to continue to suffer
amid uncertainty about the recovery of global demand. The poor and vulnerable are more
impacted with income loss and poverty may rise. The implementation of the government’s
COVID-19 response program will remain a paramount priority.
Matarbari thermal power plant will be developed on a 1,500-acre site. It will consist of two
thermal units based on ultra-supercritical coal-fired technology, with an installed capacity of
600MW each.
HazratShahjalal International Airport had been failing to cope up with the increasing number
of flights and passengers. To expand the cargo handling capacity, a cargo village was
constructed. Then in order to increase the passenger handling capacity, the terminal building
has been extended, in 2 phases, 1.5 times the older one. In the 1st phase, the ground floor and
in the 2nd phase, the 1st, 2nd and mezzanine floors were constructed. HazratShahjalal
International Airports passenger handling capacity now therefore raised to 8 million per year,
almost 2 times the previous capacity, and we expect that this airport will go on meeting well
the needs for further 20 years or more.

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 INTRODUCTION:

DEFINATION OF SUCCESSFUL LEADERS

Successful leaders are the power and intellect behind their organizations. They
are the visionaries charged with steering their brand around pitfalls. They must
know when to seize opportunities and how to rally employees to work hard
toward their company's goals.

Sheikh Hasina: A futuristic leader:

Leaders are distinct people

who have many followings.
The greater number of
followers and supporters, the
more popular a leader. A
national leader is one who
has a whole nation of
followers and supporters.
People’s support and
adulation turn an ordinary
person into a leader. There
are certain qualities that
people seek in a leader whom
they choose to follow, and
most of these qualities are
present in our Prime Minister
Sheikh Hasina.

Prime Minister Sheikh

Hasina was elected President
of Bangladesh Awami
League in 1981 while in
exile in India to succeed
Bangabandhu following his
assassination in 1975. Since then she has been leading the party from success to success,
winning elections to become prime minister multiple times, gaining popularity as a national
leader and proving to be a worthy daughter of the Father of the Nation Bangabandhu Sheikh
Mujibur Rahman.

As a leader, Sheikh Hasina is dynamic and futuristic. Her vision of the country’s future
extends to the next 100 years and beyond. She has turned her vision of “Digital Bangladesh”
into a reality within a decade, bringing all kinds of services like payments of water and
electricity bills to the people’s doorsteps. Before she came to power, only the rich could
afford cell phones, but due to her people-friendly policies the price of mobile sets and
services became so affordable that even a household help or a day worker now own cell
phones.
Under her visionary leadership the mobile services rapidly progressed to 4G and now going
towards becoming 5G, with all the associated facilities and services. She visualizes Dhaka to
become like other modern cities of developed countries of the world. Towards that end, the
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city transport system is being modernized with a metro rail system and elevated expressway.
Once these are completed, the traffic problem of Dhaka city will be a thing of the past.

Now Bangladeshi parents educate the girl child because of pro female education policies of
the government. This broke the age old traditions of educating only the boys. Nothing brings
more dynamic change than education. Our leader took a decision to steer the people on a path
to progress, prosperity and development for a brighter future. Her love for the people and the
country is the reason for her popularity in Bangladesh and abroad.

Why Sheikh Hasina’s leadership essential for Bangladesh?

Sheikh Hasina has successfully completed the second consecutive term of office as the prime
minister and is optimistic about the third. It has set a new record in the history of the
constitutional government in Bangladesh after the resurrection of democracy in December
1990. However, the state of democracy, human rights and the rule of law which were driven
to extinction after the 1975 August tragedy, could not have a healthy revival in 1990s with
BNP in the ascendency for, they failed to live up to the expectations of the 1990 Mass
Uprising. It is, however, none but Sheikh Hasina who supplemented the post-1990 democracy
by ensuring good governance and development as she was voted to the position of trust for
the first time in 1996. She succeeds  not only in completing her terms as the premier but also
in preparing grounds for the next general election to be held under the incumbent
constitutional government. This has been a resounding achievement especially after the
legacy of so-called Caretaker Governments, which had started assuming unlawful political
ascendency over the country, proved abortive and met with popular rejection.  Hasina could
very well understand her people’s language and contrary to all apprehension, has organised
the 30 December 2018 national election paving the way for people’s participation and
political inclusiveness.
The success of Sheikh Hasina is nothing less than a miracle. She has developed the country
almost from nothing. That the least developed country, Bangladesh is now a developing
country is but Hasina’s contribution to development.  Her first term of office as the Prime
Minister (1996 to 2001) was a warm up phase after years of decay and deadlock caused by
the assassination of Bangabandhu Sheikh Mujibur Rahman. It, however, faltered as the BNP-
Jamaat alliance took over and unleashed a reign of corruption, violence, extremism and
religious militancy that lasted for the  Begum’s full tenure (2001—2006). Sheikh Hasina once
again appeared as the saviour of the country, came up with his party’s manifesto— the 23-
Point Charter for Change—Vision 2021 and swept to landslide victory in the 9th
Parliamentary Election on 29 December 2008. She took up the reins of office as premier for
the second time and made the country rise like a phoenix from the ashes of ruination. The
journey continued and is still continuing against all the odds. 
The economy of Bangladesh today is booming! Recent statistics of HSBC Global Report say
that Bangladesh is becoming the 26th largest economy in the world and will be followed by
Philippines, Pakistan, Vietnam and Malaysia. The country has been enlisted into what we
now call the Next 11, i.e. the eleven countries— South Korea, Mexico, Bangladesh, Egypt,
Indonesia, Iran, Nigeria, Pakistan, the Philippines, Turkey and Vietnam ,which are ready to
become the biggest economies in the  21st century world after the BRIC (Brazil, Russia,
India, China) countries. As the second largest economic sector in the Subcontinent,
Bangladesh is moving forward as the member of Commonwealth, D-8, and Organization for
Economic Cooperation, SAARC, IMF, World Bank, World Trade Organization and Asian
Infrastructure Investment Bank. It is nothing but Sheikh Hasina’s leadership which has
helped the country achieve these astonishing feats. She has shown us how we can venture
into the Padma Bridge construction all by ourselves defying the opposition of the big powers.

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As a matter of fact, Sheikh Hasina has her own independent policy of development and the
guts to walk away from those of the western masters. 
One of the biggest successes of Sheikh Hasina and her Government is the bold move to bring
the war criminals to trial. Those who have lost their loved ones at the War of Liberation in
1971 would realise the magnitude of the thing. They must have been happy to see the
perpetrators of crimes against humanity stood trial after quite a long time. Many of the top
brass were punished and the pro-liberation folks heaved a big sigh of relief. This was a very
courageous decision on the part of the Government and the trial could be treated on an equal
footing with the Nuremberg trials, Tokyo trials or Manila trials. This is a new history in the
dispensation of justice in Bangladesh which proves crimes against humanity never go void.
Another thing the Hasina Government can be credited with is that it is fighting an uphill
battle against religious militancy. It is one of the most serious problems besetting the world at
the present time. People are dropping like flies in Pakistan, Afghanistan, Syria, Iraq and other
places in the hands of the militant forces. Unbridled sectarian violence has turned human
habitations into death valleys. Bangladesh too was going to be infected by the militancy
virus. The defeated forces of 1971 used religion to grab power, and thereby gave rise to
militancy, which sometimes took on massive proportions. The terrible RamnaBatamul
bombings on 14 April 2001, the heinous grenade attack on 21 August (2004), the series of
bomb-blasts rocking the whole country on 17 August (2005), and the latest Gulshan Cafe
standoff on 1 July 2016 herald the existence of religious militancy in our secular soil. And
quite unfortunately for us, they were indulged by the power of the State. If these deadlier
social evils had not been fought back in right earnest by Hasina Government, they would
have, by now, risen to a point of no return. Hasina is taking a tough line on them and her anti-
militancy role can provide a model that other Muslim countries can follow.
Women empowerment is another remarkable success of Sheikh Hasina Government. This is
for the first time in post-independence Bangladesh that the largest numbers of women have
been made to hold high offices. The Nobel laureate Amarta Sen affirms that Bangladesh is
ahead of India by all indexes of gender equality and empowerment. The Government adopted
a national policy on women empowerment, and tried to bring about a radical change in their
social and legal status by implementing it.
Bangladesh under the dynamic leadership of Sheikh Hasina is playing a significant role in
regional and global peacekeeping activities. Given its geographical location, it has an added
importance in the contemporary geopolitical context. It has immense potential for
contributing to Southeast Asian peace process and thereby to the global harmony. The
founding father of the Nation, Bangabandhu Sheikh Mujibur Rahman, himself was a
champion of peace and was awarded the Joliot Curie Prize in 1973. Sheikh Hasina, the heir to
Bangabandhu’s blood and political ideology, too, during her first premiership in 1997 drew
up the Chittagong Hill Tracts Peace Accord and put an end to the decades-long insurgency
between the so-called Shanti Bahini and government forces. Not only did this historic peace
accord help restore national security, it paved the way for regional peace and harmony.
Hasina also plays a major role in curbing the obnoxious growth of the Islamist militants,
which poses the biggest threat to regional and global peace.
Sheikh Hasina is a visionary leader of 160 million people of Bangladesh. She has explored
endless possibilities in her country and its people. She has come to realise that the prime
concern of today’s world is not the size of a country but its population. The main reason for
the development of India and China is their population. She knows it full well if we can turn
our 160 million people into human resources, we won’t have to look back. The chief motto of
her development policies is the human resource development.

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Sheikh Hasina is, by all accounts, the uncrowned Queen of developing Bangladesh.
Bangabandhu gave us independence. Hasina is giving us economic growth and all out
development! Kissinger’s ‘bottomless basket’ is now filled to the brim. All our successes are
but feathers in Hasina’s cap. She is the longest serving Prime Minister in Bangladesh and is
still expected, by popular demand, to serve way longer. The country is thriving under her
leadership and her strong leadership is needed to captain her party too. That Hasina wins
means all developments continue to accelerate and that she loses means, once again, drops
the era of stagnation. And hence, Sheikh Hasina’s leadership is essential for the country, the
region and the world as well.

chase and grab the militants down to the farthest corner of the country. The
drive is still on.
Sheikh Hasina has been more than eight years in power facing a tough-nut
opposition Bangladesh Nationalist Party (BNP) and its Islamist allies who
together vowed to dislodge her from power and make sure the incumbent does
not retain power for long. But several local and international Hasina: A leader
with courage, vision, humanity

Despite many challenges, the just ended year 2017 was very special for Bangladesh,
especially for piles of honour and praises showered on Prime Minister Sheikh Hasina from all
over the world. These are just not decorating the leader with laurels but recognition of her
hard work and achievements in several fields both local and international.
Around end of 2017 Sheikh Hasina was proclaimed "Mother of Humanity" by the British
media which was instantly endorsed by rest of the world. She got this extraordinary title for
allowing nearly one million Muslim Rohingya refugees to take shelter in Bangladesh fleeing
from barbarous military persecution in the Buddhist majority Myanmar. Sheikh Hasina
earned support of the world leaders by saying that her government would give shelter and
feed
the huge number of refugees purely on humanitarian reasons - despite her country is
overcrowded and still impoverished - until they can go back to their own country (Myanmar).
She opened up the Bangladesh border to the streams of Rohingyas while many countries, big
or - for repatriating the Rohingya refugees. The deal was made possible due to Sheikh
Hasina's personal initiative and contacts with world leaders and her government's undaunted
diplomacy when many in Bangladesh and in the international community were skeptical
about solution of the Rohingya crisis. It was a tempting idea of diplomatic solution in view of
the existing circumstances but Sheikh Hasina said she would settle the issue peacefully with
Myanmar government, though it would be a painful task. She never back steps and that has
made her one of the world's top leaders from a small country and a role model of leadership.
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Domestically, she strongly pursued a policy of "zero tolerance" against the Islamist militants
who terrorized the country through links with international terror groups such as ISIS and Al
Qaeda. The home-grown militants in Bangladesh posed a massive threat to the country and
people until the Zero Tolerance policy was framed and implemented. In the last half of 2017
militancy and terrorism came substantially under control with the law enforcing agencies
strictly following the directives of the Prime Minister. This success also adds to the credit of
Sheikh Hasina who has asked the law enforcers to studies have found that about 70 percent of
Bangladesh people want to vote for Hasina'sAwami League in the coming Parliamentary
election slated to be held around end of 2018. While struggling to strengthen her rule and
make her mark more visible as a top politician and uncompromising, brave and visionary
leader she has pushed Bangladesh on the road to development by significantly reducing the
country's endemic poverty, improving relations with neighbouring countries and sending a
message of peace and harmony through the volatile time as the world faced endless
controversies, confrontations and war cries from the nuclear powered countries.
Bangladesh's economy has made significant progress during Sheikh Hasina's rule.
Bangladesh is now close to achieving middle income country status with vision stretched to
become a developed country by 2041.
Sheikh Hasina, who glorified Bangladesh in the comity of nations, has coolly survived a
series of deadly attempts on her life perpetrated by her rivals but did not resort to retaliation.
Rather she let bids to kill her to be dealt with by the law of the country. Under pressing
situations she never lost control on anything but handled them with tolerance and patience.  
Sheikh Hasina stunned her friends and foes after the World Bank had pulled back from its
promised loan to Bangladesh to build the country's longest bridge on the Padma River.
Sheikh Hasina asserted once the bridge plan has been adopted it will be built with
Bangladesh's own funding. And construction of the bridge is now going on smoothly. People
now believe, Sheikh Hasina means business and sticks to what she pledges. The WB should
now feel ashamed as its imaginary charge of graft in the bridge project has been proved
baseless and influenced by alleged enemies of Bangladesh.
In the year 2017, besides "Mother of Humanity" PM Sheikh Hasina received a series of other
accolades. These include, Honest Head of Government, Lady of Dhaka, New Star of the East,
Charismatic Leader, Leader of the World, Pillar of Women's Rights, Messenger of Global
Peace, Conscience of World Humanity and Lighthouse of Global Humanity.
Thus, she proved her envious leadership qualities and the nation is proud of her. People wish
she continues her journey with courage, vision and humanity in 2018.

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 Project one

Bangladesh Preparedness and Response Plan for

COVID-19

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Project summary
This document sets out the “Bangladesh preparedness and response plan” (BPRP) for the
coronavirus disease 2019 (COVID-19) and outlines the objectives, planning scenarios, areas
of work and priority activities required for the Bangladesh health sector to scale up its core
capacities to prevent and quickly detect the spread of the virus, and characterize the response
and efficiently control the threats, in a coordinated manner and as required under the
International Health Regulations (2005).The main goal of the proposed plan is to prevent and
control the spread of COVID-19 in Bangladesh in order to reduce its impact on the health,
wellbeing and economy of the country, as well as to set out the framework to treat the
population that has been infected. The key interventions to achieve this goal include: the
enforcement of compulsory mask-wearing and safe hygiene practices outside the home,
including within the workplace; a zoning approach to containment; community-based
prevention practices, case identification, and quarantining utilizing local community health
capacity for slowing spread of disease and sustaining behavior change following lockdown;
the maintenance of physical distancing regulations based on latest expert and industry
guidance; and the empowerment of frontline health workers and other essential workers to
make them agents of change to turn the epidemic around and address their potential COVID-
19 related fears and concerns. The plan outlines a multi-sector coordination structure, which
includes as its principal response mechanism ten technical pillars that focus on the
epidemiological response and health service delivery, including surveillance and laboratory
support, contact tracing and mitigating community transmission, points of entry and
quarantine, infection prevention and control, COVID-19 case management, ensuring essential
health, population and nutrition services delivery as well as three cross-cutting pillars—
planning coordination and response strategy, logistics and procurement, risk communication
and community engagement, and research. The document also includes an estimated budget
and work plan that lays out the priority activities determined by each of the technical pillars.
A monitoring and evaluation framework will enable the continuous review and updating of
the BPRP to reflect the progress of implementation and emergence of new evidence.
Introduction and background
COVID-19 context
Severe Acute Respiratory Syndrome Coronavirus 2 is a novel coronavirus that emerged in
China in 2019 and causes COVID-19 disease. Coronaviruses are zoonotic viruses that
circulate amongst animals and spill over to humans from time to time and have been causing
illnesses ranging from mild symptoms to severe illness. On 7 January 2020, Chinese
authorities confirmed the outbreak of COVID-19 and on 30 January 2020, the Director
General of the World Health Organization (WHO) declared the COVID-19 outbreak a Public
Health Emergency of International Concern. On 1st February 2020, 312 Bangladesh citizens
were brought back from China’s Wuhan city and quarantined for 14 days. Eight of them were
immediately isolated and three more were subsequently isolated upon showing symptoms.
Their samples were tested on the 2nd February 2020 in the laboratory of the Institute of
Epidemiology, Disease Control and Research (IEDCR) and found negative for COVID-19.
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On 8 March 2020, Bangladesh confirmed its first COVID-19 case. On 11 March, WHO
declared COVID-19 a pandemic. As of 8 July 2020 1, a total of 11,500,302 confirmed cases
and 535,759 deaths were reported in almost all countries worldwide, except for a few remote
island states. As of the same date, 168,645 Bangladeshi citizens were diagnosed positive with
COVID19 and a total of 2,151 passed away.

The WHO International Health Regulations (IHR) Emergency Committee for the COVID-19
convened on 22 and 23 January emphasized that “it is expected that further international
exportation of cases may appear in any country. Thus, all countries should be prepared for
containment, including active surveillance, early detection, isolation, and case management,
contact tracing and prevention of onward spread of COVID-19 infection, and to share full
data with WHO”. Information, facts and knowledge available when the COVID-19 was first
detected are rather limited. As the situation evolves globally, crucial information such as
population at increased risk, case fatality ratio, complication rate, basic reproduction number
and other transmission characteristics are increasingly coming to light. With the new
information becoming available, the risks are being assessed and reviewed to ensure that the
appropriate corresponding measures are adopted based on the most updated scientific
knowledge and the latest situation. The core response strategy is based on ongoing
assessment of the rate of disease spread against available health system capacity. If the
disease is spreading too quickly and bed capacity is projected to be insufficient, then
additional social distancing measures can be introduced at either a local or national level to
further slow-down the reproduction rate of the virus while minimizing the negative impacts
to the economy. Based on available studies, public mask wearing, community-based family
quarantine and social distancing measures would likely need to continue until either an
efficacious vaccine or treatment is widely available. Given this is a novel coronavirus,
significant knowledge will also be gained as countries are learning from each other how best
to suppress the epidemic waves in their populations and ultimately bring the pandemic under
control while maintaining essential health services and minimizing negative impacts to lives
and livelihoods. In practice, this results in a national suppression of disease transmission
followed by targeted interventions to slow spread while continually strengthening
surveillance and health system capacity.

The country will implement the response activities under a national plan through committees
from the national level down to the upazila level with multi sectoral involvement representing
the relevant ministries, the United Nations agencies, national and international organizations
and development partners through a pillar-based multi-sectoral coordination mechanism. The
plan includes mechanisms for developing surge capacity to manage the patients, to sustain
essential services and to reduce social impact. The response strategy and actions will have to
be continuously reviewed and adjusted as necessary to ensure efficient use of financial and
human resources for the effective response to the outbreak, and to be reflective of any new
information, operational research advances, good practices internationally and updated
recommendations from WHO.

Disease surveillance alongside response is an important component for prevention and

control of the transmission. The country started screening at points of entry (PoE) and
successfully quarantined a large number of persons. The country is implementing the plan
through over 500 local committees. Beside, the Rapid Response Teams (RRT) from national
1
Who Coronavirus disease 2019 (COVID-19) Situation Report – 150
https://www.who.int/docs/defaultsource/coronaviruse/situation-reports/20200618-covid-19-sitrep-150.pdf?
sfvrsn=aa9fe9cf_2
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to all subnational levels are also in place. With established community transmission, high
dependence health services along with Intensive Care Units (ICU) facilities will be
strengthened. Emphasis will be given to prevention of hospital acquired infections and
protection of the caregiver both at the health care facility, at home and within the community.
Emphasis will be given also to the prevention of a catastrophic health expenditure with the
principle of ‘No One is Left Behind’ and social and gender inclusion. Strong concerted
efforts will be taken for communication and advocacy nationally and locally using all media
and means of risk communication and community engagement. In case of quarantine,
especially during community-based quarantine, measures will be taken to ensure the basic
needs of the people are met and the security of people’s property is ensured through an active
involvement of the law enforcing agency.

Sufficient budget allocation along with political commitment from the highest level will
be of paramount importance for the successful implementation of the plan2.

Bangladesh: country profile

Bangladesh is a democratic country surrounded by India from east, west and north, Myanmar
from south-east with Bay of Bengal at south side. The estimated size of the population in
Bangladesh is 1666.5 million (on 1 July 2019). The male to female ratio is 100.2:100. The
average household-size is 4.2. The life-expectancy is 72.6 years (71.16 years for males and
74.2 years for females) (2019 and population growth rate is 1.32% (2019, SVRS)3. It is
estimated that about 2.4 million Bangladeshis are living abroad. Bangladesh has a unitary
form of government, with no state or province. There are 64 districts in the country. Each
district is again divided into several upazilas (sub districts). There are 491 upazilas in the
country. The upazilas are divided into unions, and each union is divided into 9 wards. There
are 4,554 unions and 40,977 wards in the country and approximately 87,310 villages.
The urban areas have 12 city corporations and 327 municipalities. There are 58 ministries and
functional divisions. The Ministry of Health and Family Welfare (MoHFW) is one of the
largest ministries of the Government of Bangladesh. Bangladesh is a country with a very high
populationdensity. Around 63.4% of the total population in 2018 lived in rural areas. The
Gross Domestic Product (GDP) growth rate is 8.2% and the GDP per capita (current price as
per 2019 estimate) is US$ 1,9064. Bangladesh has had a long history of hosting displaced
Rohingyas. In 1978, more than 200,000 Rohingyas first entered Bangladesh. While the
Rohingyas legally fall under the category of “de jure stateless,” the Government of
Bangladesh (GoB) recognizes them as “Forcibly Displaced Myanmar Nationals”. A total of
914,998 population of Forcibly Displaced Myanmar Nationals (FDMNs) are living in
211,383 households in Ukhiya and TeknafUpazila of Cox’s Bazar district.

Bangladesh: health system

The Ministry of Health and Family Welfare is responsible for planning and management of
curative, preventive as well as promotive health services to the population of the country. But
in urban areas, primary healthcare services are mandated to the Ministry of Local
Government, Rural Development and Cooperatives. Since the late 1990s, the Government of
Bangladesh and its development partners have pursued a sector-wide approach in the Health,
Nutrition and Population (HNP) sector. The Ministry of Health and Family Welfare is

2
Bangladesh National Guidelines on Clinical Management of Coronavirus disease (COVID-19),
http://www.mohfw.gov.bd/index.php?option=com_docman&task=doc_download&gid=22424&lang=en .
3
The World Bank 2020,https://www.worldbank.org/en/country/bangladesh/overview
Pag15
currently implementing the 4th Health, Population and Nutrition Sector Program (2017-
2022). The present government has taken steps to revitalize Primary Health Care (PHC)
services by making the community clinics operational. These community clinics, one for
every 6000 members of rural populations, were constructed in 2000-2001, but were not used
for service delivery during the non-Awami League government. These service points have
some unique characteristics. They are managed by a Community Clinic Management Group
which includes local public leaders and representatives. The policy in this regard is to place
the responsibility for the health of the people in the hands of the people themselves.
Functional community clinics with adequate staff, supplies and logistics along with
strengthened union and upazila level services are required to be rapidly institutionalized to
improve the delivery of preventive and curative services at the PHC level, particularly for
vulnerable women, children and marginalized populations. In the public sector, upazila health
complexes and district hospitals are providing curative care at primary and secondary levels
respectively. Tertiary- level curative care is mostly provided at national and divisional levels
through large hospitals affiliated with medical teaching institutions. Most of the curative,
preventive, promotive and rehabilitative services are rendered by public sector facilities and
institutions. A large cadre of health care workers are working at the grassroot level to provide
immunization, community based-family planning and other primary health care services
including interpersonal communication at household and community level5.

Non-governmental organizations (NGOs) and the private sector are also important players in
the health care delivery system of Bangladesh, including COVID-19 response. In regular
times, health sector NGOs deliver doorstep and clinic-based services and provide health
education in many parts of the country. Many of these NGOs have health care workers who
are entrenched in the communities they serve. Several NGOs concentrate their efforts in
hard-to-reach areas. These NGOs 185,000 CHWs, with approximately 70,000 employed by
the GOB and the remainder by NGOs (Bangladesh National Strategy for Community Health
Workers. MoHFW, July 2019)

have played important roles in spreading preventive messages during COVID-19 and have
worked closely with local administration and government functionaries in planning/managing
quarantine/isolation centres. In urban areas, a number of hospitals/clinics in the private sector
has been designated as COVID-19 hospitals and have been providing management of infected
patients. A substantial number of testing laboratories enrolled for COVID-19 testing also belong to
the private sector. Army medical corps usually provide curative and preventive services in the
cantonments and neighboring areas of the country. During emergencies, these medical corps merged
with the national level response in providing testing facilities, tertiary care to patients through well-
equipped hospitals. Thus, public private partnerships play an important role in providing
preventive services in the urban areas with the help of NGOs funded by different donors.

The IHR capacities in Bangladesh have been significantly improved over the past several years,
reaching 68% and exceeding both the global and regional averages. In Bangladesh there is national
capacity to confirm COVID-19 through Polymerase Chain Reaction (PCR) testing. Preparation is also
underway to expand the range of tests through introduction of newly emerging COVID-19
tests according to WHO guideline.

The Institute of Epidemiology, Disease Control and Research (IEDCR), the Institute of
Public Health (IPH), the Institute of Public Health Nutrition and the National Institute of
Preventive and Social Medicine are the major public health institutes of public sectors.

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Among these institutes, IEDCR is the focal institute for conducting public health surveillance
and outbreak response and IHR focal institute.

Pag17
Figure 1. Managerial hierarchy according to types of facilities from national
to the ward level

The Director of the Communicable Disease Control (CDC) of the Directorate General of
Health Services (DGHS) is the national IHR focal point and there is a program for IHR under
CDC of the 4th Health, Nutrition and Population Sector Program. CDC, DGHS & IEDCR
coordinated response activities during pandemic influenza (2009), Ebola preparedness (2014),
Chikungunya (2017), 1st,2nd and 3rd national avian and pandemic influenza preparedness and
response plan. IEDCR identified the presence of dengue virus (2000), Nipah virus (2001),
H5N1 (2008), and the first case H1N1 (2009) in the country.

Health workforce
The health workforce in Bangladesh is already overstretched, with only 8.3 health workers per 10,000
population as compared to 45/10,000 recommended by WHO4. The COVID-19 outbreak deepens
this crisis. The MoHFW has already recruited an additional 2000 doctors and 5000 nurses to start
addressing this situation, and the process is underway to recruit additional 2000 health technicians.
4
WHO Global Health Workforce Strategy 2030

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Additional innovative motivation schemes will be tested to improve the human resource management
in health.

Bangladesh has a nationwide network of health facilities, medical colleges, nursing and paramedical
institutes. There are 49 postgraduate medical teaching institutes (28 public, seven of them autonomous and
14 private), 113 medical colleges (75 of them are private), 77 nursing colleges (59 of them are private),
208 nursing institute (165 of them are private), 209 medical assistant training schools (200 of them are
private), and 110 institute of health technology (97 of them are private). In addition to the above
institutes, there are 35 dental colleges and dental units (of them 26 are private), and six Armed
forces & Armed Forces Medical Colleges. In spite of this growth of the health workforce
production, the country still has a health workforce shortage and geographical imbalances.
Existing health workforce of Bangladesh is periodically trained in responding to emerging and
reemerging diseases by CDC, DGHS & IEDCR. This trained workforce participates in
surveillance and outbreak response at a national, district and upazila level.

Health information system and e-health

The Management Information System (MIS) is a department of the Directorate General of

Health Services under the Ministry of Health and Family Welfare. The main objective of MIS
is to establish and run the Health Information System (HIS), e-health in Bangladesh and build
capacity among line directors and program managers to use the data for decision making. The
HMIS data is an online system, sourcing data from different platforms, such as District Health
Information System (DHIS2), Human Resources Information System (HRIS). The DHIS-2
platform is used for gathering data from different health facilities and points of entry.

A COVID-19 dashboard has been developed and is updated daily 5. This portal displays the
data from the laboratory, number of people in quarantine and isolation as well displays the
number of health facilities where COVID-19 patients can be managed and provides an
overview of the stock availability of the health facilities.

The Supply Chain Management data is managed through a separate system, e-LMIS and has
been made interoperable with the coronavirus data dashboard.6 While about 80% of the health
facilities have reported the stock data, more work needs to be done to ensure full reporting and
improved stock management, including at the Central Medical Store Department (CMSD).

MIS includes the client feedback mechanisms and manages the e-health with ShashtoBatayan
as major tele-medicine operator under DGHS. Additional tele-medicine capacity will be
required to address the COVID-19 response.

5
Corona dashboard: http://103.247.238.81/webportal/pages/covid19.php .
6
Corona supply chain dashboard https://scmpbd.org/index.php/covid-19-dashboard

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Thanks to the “Digital Bangladesh 2021” vision launched by the country in 2009, the entire
health sector (including national, sub-national and grassroots community health workforce) is
digitally connected to robust national databases.

A data management system has been developed for individual case monitoring of COVID-19
positive cases from lab sample testing, collection, results, and dissemination.
A key function of the information management system is not only to collect data from various
sources and provide real-time status across a range of variables, but also integrate
epidemiological data with laboratory and health systems data to enable dynamic analytics and
forecasting. The required data normalization for such dynamic integration will be expedited
and introduced into the core health MIS for existing datasets and further data sources will be
integrated using the normalized data structure as necessary. This initiative will be led by the
director of MIS.

Medical products and technologies

Enhancing the access of citizens to essential quality medicines has been one of the priorities of
the government. With support from the government there is a big domestic pharmaceutical
industry manufacturing drugs for the local consumption as well as exporting to other countries.
Currently, the local production meets about 97% of the overall local demand for drugs and
100% of that for essential drugs.Several candidate medicines for COVID-19 treatment are
being produced locally including Remdesivir, Hydroxychloroquine, Favipiravir,
Ivermectin, Doxycycline, Azithromycin and other supplementary medicines. Several
clinical trials have been conducted in-country and Bangladesh has expressed interest to
participate in the WHO-led solidarity trials, to contribute to the global efforts for identification
of evidence-based treatment options. Post-marketing surveillance activities are being
intensified to ensure that substandard and/or falsified medical products claiming to detect, treat
or prevent COVID-19 do not infiltrate the supply chain. Regulatory preparedness is needed for
expedited access in case a vaccine is developed in the near future.

Health financing
Bangladesh spends 3% of its GDP on health. At present, per capita spending on health is only
USD 37, whereas government spends USD 8.5 per capita on health in the country. Nominal
government spending on health increased over the last few years. Government’s allocation to
Ministry of Health and Family welfare from its annual budget has been around 5% over last
five years. Households, paying fees at the point of service (i.e. out of pocket), constitute the
main source of financing for health in Bangladesh comprising 67% of total health expenditure.
Against this backdrop, health system has been strained further while tackling the COVID-19
crisis. Thus, Increasing the fiscal space for health is imperative to make response for the
COVID-19 crisis as well to recover and strengthen the health systems.

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Communicable disease law in Bangladesh
Bangladesh updated its “INFECTIOUS DISEASES (PREVENTION, CONTROL AND
ELIMINATION) ACT, 2018” on communicable diseases. Section 3(k) of the Act states “keep
or quarantine any suspected person infected with an infectious disease, at a specific hospital,
temporary hospital, establishment or home”. This law empowers the government in
notification, isolation, quarantine, sample collection and testing in emerging diseases.

Section 1: Rationale, scope, and objectives of the plan

Rationale
It has been proven by numerous experiences that the ability to effectively respond to a ‘threat’
is strongly influenced by the extent to which such threats have been assessed in advance and
prepared for with corresponding prevention and mitigation measures. Preparedness planning
for health emergencies aims to reduce the burden associated with the health threat in terms of
mortality and morbidity, hospitalizations and demand for health care goods and services; to
maintain essential services, protect vulnerable groups, minimize economic and social
disturbance and enable a quick return to normal conditions.

Understanding COVID-19 impact

The COVID-19 pandemic has emerged as the world’s population exceeds 7.7 billion people,
with high contact rates and international movements fueling global spread. Beyond the high
human densities, especially in urban and slum areas, the main challenges in Bangladesh to
combat the pandemic are the economic conditions compared to higher-income countries, the
saturation of health structures in semi-urban and rural settings, and the inability of low and
middle-income families to refraining from work due to their basic livelihood needs. Exposure
of healthcare workers is also forecasted to be common given experiences in other countries,
current infection prevention control practices, fragmented personal protective equipment
(PPE) supplies, and general need for improving logistics and equipment availability in all
health care facilities. Of particular concern are geographic areas and vulnerable populations at
increased risk for rapid spread, including communities living in urban slums, of Ready-Made
Garments workers, refugees/Forcibly Displaced Myanmar Nationals, street children and
migrant workers. There are also continued risks of stigmatization and possibly unintended
discrimination in access to healthcare and safety nets.

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Figure 2: Pandemic response phases

Studies indicate that conventional social distancing tools for mitigating infectious disease
outbreaks, such as case isolation, school closure, or home quarantine alone may be insufficient
to flatten the curve enough to preserve intensive care capacity. Only a combination of all
interventions simultaneously, referred to as “suppression”, is expected to provide sufficient
reduction in contact rate to blunt the epidemic. The impact of any suppression strategy is
dependent on two factors: timing and the ability to diagnose cases. The Government of
Bangladesh has already rapidly implemented a number of interventions which have been
critical for slowing down the spread of the virus. Due to exponential growth rates of the
epidemic, each day that passes before interventions are implemented results in an exponential
increase in case burden and a significantly lower likelihood that the suppression interventions
will thwart the outbreak. The ability to diagnose cases is also an essential requirement for the
case isolation intervention, so rapidly expanded testing capacity is urgently needed.

1.2 Scope
On 30 January 2020, the Director-General of WHO declared the COVID-19 outbreak a public
health emergency of international concern under the International Health Regulations (2005).
Building upon core elements required to address generically different types of health threats,
whether anticipated or unexpected such as COVID-19, the strategy developed in this document
is based on the WHO global COVID-19 preparedness plan published in April 2020 and the
WHO Country Readiness Checklist. This document sets out the ‘Bangladesh preparedness and

Pag22
 response plan’ for COVID-19 Acute Respiratory Disease and outlines the planning scenarios,
areas of work and priority activities required for the Bangladesh health sector to scale up its
core capacities to prevent, quickly detect, characterize the response and efficiently control, in a
coordinated manner to the COVID-19 threats, and as required under the International Health
Regulations (2005).

Current situation assessment

1. The DGHS established an Emergency COVID-19 Integrated Control Center in the main
office with working committees for thematic areas. The committees developed guidance and
training materials that were posted on-line.
2. Although testing facilities were not yet available nationwide, sample collection was rolled
out quickly across the country. actions were taken swiftly to implement a suppression
strategy starting with the national holiday beginning 26 March to slow viral transmission
rates; communication to promote safe hygiene practices and the combined social distancing
impact of school, business, and public transport closure nationally, resulted in the COVID-19
reproductive rate (spread rate) being at its lowest level since introduction to Bangladesh in
order to buy time to prepare the healthcare system and build surveillance capacity.
3. All available real-time diagnostic testing facilities (61 as of June 19) were rapidly assessed
for capability to undertake COVID-19 testing. Expanded testing capacity not only enables
better intelligence of the disease situation nationally, but also more precision for identifying
those individuals and families who need to remain in home quarantine.
4. Immediate nationwide case searching and identification has been initiated utilizing existing
community networks as well as telecom-based reporting via 16263; 333; and IEDCR
hotlines. A novel Community Support Team intervention was piloted so that individuals
with symptoms could be evaluated and those who meet the clinical criteria will be isolated at
home with their families with the full support of rapid response and community support
teams comprised of MOHFW Community Clinic, BRAC community health, and available
medical students and interns doctor staff volunteers. The Community Support Team also
facilitates access to hospital care for those who develop a severe disease.
5. Procurements were launched immediately for healthcare worker PPE and hospital equipment
and supplies required to expand care of critically ill and severe patients. Due to global
supply chain shortages, locally manufactured solutions were also explored to enable
sustained national production.
Healthcare worker training programs were initiated for improving infection prevention control and
case management. Recently graduated intern doctors were also mobilized to support triage at
hospitals with highest case burdens.
Risk communication and community engagement was focused on encouraging the spirit of
solidarity, empowering individuals and communities to stop the spread of COVID-19 through
behavioral change, informed individual decisions and collective community action. The
communication strategy uses a range of communication techniques from traditional and social

Pag23
media communications, community radio, community influencers (Imams, social media
influencers, positive role models) and community engagement and is built on a sound
understanding of people’s perceptions, concerns and beliefs as well as their knowledge and
practices and an early identification and management of rumors, misinformation and other
challenges, such as stigma and discrimination. Audience-specific messages are designed and
disseminated through different networks to amplify and widen the reach. Gender-targeted
messaging to address gender specific issues such as domestic violence and the psychosocial
burden of increased care work at home on women were also increased.
National social distancing measures have been continued until sufficient testing capacity is
established to assess the rate of spread. When the rate of spread has sufficiently decreased and
hospitals are better prepared, distancing restrictions are being reassessed and adapted
accordingly.
Goal and objectives of the plan
Goal
The main goal of the proposed plan is to prevent and control the spread of COVID-19 and to
reduce morbidity and mortality due to COVID-19 infection in Bangladesh in order to reduce its
impact on the health, wellbeing and economy of the country. The specific objectives are as
follows:
Objectives
To establish, strengthen and maintain surveillance capacity nationwide for the detection,
reporting, and monitoring and COVID-19 cases, including requisite laboratory capacity;
To slow the rate of community transmission and prevent amplification events;
To prevent transmission and enhance infection prevention and control in health care settings;
To identify, isolate and care for patients early and effectively;
To ensure continuation of essential health and nutrition services;
To communicate critical risks, disease information, and best practices to the communities and
counter misinformation.
This plan is in line with WHO’s overall strategic objectives for the COVID-19 response.
Section 2: Planning, coordination, and response strategy
Planning and coordination
In Bangladesh, COVID-19 triggered a national outbreak similar to those experienced in other
countries. Therefore, a response of similar appropriate scale and scope is needed to mitigate
both the public health impact of the disease as well as the broader impacts on the national
economy and social stability, which could also threaten core development aspirations such as
achieving the Sustainable Development Goals (SDG). Additionally, the highly technical nature
of the national plan requires precise, efficient execution and multi-sectoral coordination.

Pag24
Experience with recent infectious disease crises of similar magnitude have demonstrated the
effectiveness of a single, clearly structured, national multisectoral coordination system across
the entire response to achieve necessary technical precision and operational scale. The current
GoB and MoHFW response coordination mechanism is in accordance with global WHO
operational planning guidance and consistent with the current United Nations (UN)
coordination system.

2.1.1. High Level Multi-Sectoral Coordination Committee

Addressing COVID-19 essentially requires a well-coordinated multisector response. The
Government of Bangladesh has formed a high level COVID-19 committee led by the
Honorable Minister for Health & Family Welfare that advises the Prime Minister’s Office on
multi-sector interventions to reduce spread of infection.

2.1.1a. Sub-national multisectoral COVID-19 committees

The Ministry of Health and Family Welfare also constituted subnational multisectoral COVID-
19 committees at each Division, District, Upazila (Sub-district), City Corporation,
Municipality and Union to coordinate and enforce all local social, administrative, legal, and
service delivery mechanisms to contain the COVID-19 epidemic in the respective domain on
behalf of the government.

2.1.2 National Technical Advisory Committee

The MoHFW has established a high-level National Technical Advisory Committee consisting
of government and independent experts to advise the government on identifying the key
strategies, priority interventions and measures that need to be taken to implement the
government response, based on emerging findings and recommendations, including WHO
guidance, global evidence. In addition, the committee members will participate in the various
operational level core committees and communicate progress and raise issues discussed in the
core committees.

2.1.3 National Public Health Coordination Group

An 8-member national level public health coordination group i.e. one member for each of the 8
divisions of Bangladesh, has been formed by MOHFW for coordinating the COVID-19
containment activities in the division level. The group also provides necessary public health
advice to the DGHS/MOHFW.

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Coordination at the Office of the Director General of Health Services

The Directorate General has reviewed the ongoing COVID-19 situation and based on the need
for adopting to the new normal in the face of COVID-19 pandemic and reenergizing the
essential health services, revised the existing committees and sub-committees core of COVID-
19 and constituted 10 core committees for efficient operation and coordination of the
activities.

i. Coordination Committee.
ii. Committee on COVID-19 Lab testing, quality, pricing and supervision at government
and private levels.
iii. Committee for clinical guideline and treatment management. iv.Committee on
strengthening healthcare capacity of public and private hospitals.
v. Committee for infection prevention and control at hospital, laboratory, and environment.
vi. Committee on mental health in COVID-19.
vii. Committee on information management, mass communication and community
mobilization. viii.Committee for maternal and child healthcare. ix.Committee for essential
and routine health services.
x.Committee for advising and applying zoning system in high risk areas for COVID-19
containment.

The names of the committees are self-explanatory and help understanding the functions of the
committees. The coordination committee is chaired by Director General of Health Services.
The members include chair and member secretary of each of the other committees. Both chair
and member secretary of each of committee have been chosen from DGHS key personnel to
ensure implementation and strong accountability. To improve coordination with the National
Technical Advisory Committee and Public Health Coordination Group, representatives from
each of the group have been incorporated in each of the committees except the Coordination
Committee. Representatives of experts and development partners are also included in some
committees. All the committees meet very frequently.

The committees have link with the technical pillars (described below) of the Bangladesh
Preparedness and Response Plan (BPRP).

2.1.1.5 Issue-specific technical sub-committees

Beside the committees and group mentioned above, the respective director or committees can
make temporary and regular technical committees/subcommittees to accomplish certain
functions. Representatives of development partners are also included in some of the
committees.

2.1.2. Pillar-based coordination

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The key principle of the coordination mechanism is pillar-based technical coordination, with
each pillar led by the designated DGHS official with coordination support provided by a
designated UN agency. Pillar leads are tasked with providing technical guidance to the
response, including development of evidence-based standard operating procedures, setting
policy guided by a human rights-based approach and leave no one behind principle,
mobilization of assets for the pillars, and provision of technical analysis to the Government
including on the socioeconomic situation and trends on the ground.

Pillar coordination builds upon the existing structures within the Ministry of Health and
Family Welfare and supports integration of the COVID-19 response within existing local and
national institutions. The pillar coordination mechanisms will be regularly reviewed and
refined to ensure timely and effective coordination support to the Government, in coordination
with the Development Partners Consortium for Health and other development partners (please
refer to annex for full list of partners).

The technical pillars described in the subsequent sections are as follows:

Technical pillar Link with core committee

Planning, coordination and response
strategy
Surveillance and laboratory support
Contact tracing and mitigating
community transmission (Linked with
Points of entry and quarantine
Infection prevention and control
COVID-19 case management
including telemedicine
Ensuring essential health, population
and nutrition services delivery while
responding to COVID-19
Procurement, logistics and supply
management
Risk communication and community
engagement
Coordination committee
Committee on COVID-19 Lab testing, quality,
pricing and supervision at government and private
levels
Committee for advising and applying zoning
system in high risk areas for COVID-19
containment
Committee for advising and applying zoning
system in high risk areas for COVID-19
containment
Committee for infection prevention and control at
hospital, laboratory, and environment
Committee for clinical guideline and treatment
management; and Committee on strengthening
healthcare capacity of public and private hospitals
Committee for essential and routine health and
nutrition services; and Committee for maternal
and child healthcare
Committee on strengthening healthcare capacity
of public and private hospitals
Committee on information management, mass
communication and community mobilization

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Research All core committees

Figure 3: Pillar organization

The Surveillance and Laboratory Support, the Contact Tracing and Community Transmission,
and the Quarantine and Point of Entry Pillars of the BRRP encompass epidemiologic response
to the pandemic. The overarching objective of these three pillars is to reduce COVID-19
transmission in Bangladesh through classic epidemiological tools such as contact tracing,
surveillance, quarantine and isolation, instead of clinical and pharmaceutical tools such as
vaccines and medicines.

The Infection Prevention and Control, the Case Management, and the Essential Services Pillars
of the BPRP encompass the health service delivery response to the pandemic. The overarching
objective of these three pillars is to ensure that both COVID-19 and non-COVID-19 patients
receive essential health care services.

All the pillars that fall under the epidemiological response and health service delivery response
are supported by the cross-cutting pillars of Planning, Coordination and Response Strategy,
Logistics and Procurement, Risk Communication and Community Engagement, and Research.

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 2.2. Response strategy
2.2.1. Key multi-sector interventions to slow the spread

As the national holiday restrictions are eased for economic activities to restart, COVID-19 is
expected to spread more quickly. However, the Government of Bangladesh, with technical
advice from the Health Ministry, will continue to take measures that will limit spread to reduce
the pressure on the national health systems, including:

1. Enforcement of compulsory mask-wearing and safe hygiene practices outside the home,
includingwithin the workplace, school and public transport: Mask-wearing is likely the
most powerful and cost-effective intervention to slow down community transmission. Both
nose and mouth must be covered at all times, especially when the wearer is speaking,
sneezing or coughing. Enforcement of mask-wearing and access to water and
soap/sanitizers to ensure safe handwashing/sanitizing should be accompanied by a strong
and extensive communications campaign on mask wearing, social distancing and safe
hygiene practices (avoid touching face, including the nose and mouth, regular handwashing
or sanitizing) to raise awareness and sustain behavior change, particularly at “super-
spreader” interfaces with highest risk of spread such as markets, places of worship, and
ferry boats. Local industry is able to manufacture affordable, high-quality, non-surgical
reusable masks to prevent dependence on more expensive imports and disposable masks.
Coordination with the government’s law enforcement institutions will be required to ensure
that compulsory mask wearing is enforced. For technical guidance on mask wearing, refer
to the annex.

2. Zoning approach to containment: Technology-enabled epidemiological health surveillance

by analyzing data from various sources has empowered the health system to predict
formation of hot zones. Such techniques will be utilized to inform interventions in
geographically-focused areas (zones) without the need for full national lockdown. For
technical information on zoning refer to the annex.

3. Community-based prevention practices, case identification, and quarantining utilizing

localcommunity health capacity and a digital platform for slowing spread of disease and
sustainingbehavior change following lockdown
a. Full family quarantine for individuals with symptoms of COVID-19 for 14 days;
b. Targeted food distribution for 14 days to vulnerable households under isolation,
zoned containment and quarantine is important for supporting those families most
in need and ensuring quarantine compliance; this will be coordinated by the
relevant ministries.
c. Supportive monitoring of home quarantine via telemedicine and by local
community health service providers;

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 d. Strong nationwide communications to empower symptomatic individuals and their
families to report symptoms. Destigmatizing the disease is essential for people to
feel safe in divulging symptoms and seeking necessary assistance;
e. Effective community engagement strategies to empower communities to support
and enforce safe behaviors of mask wearing, social distancing and safe hygiene
practices is essential for ensuring and sustaining safe behaviors and practices;
f. Locally managed isolation centers for dwellers of slums and other congested areas
where home quarantine or isolation is not possible because of shared facilities.
4. Maintenance of social distancing regulations based on latest expert and industry guidance
asdeveloped by MOHFW and to be enforced by higher-level committees:Recognizing their
fundamental importance to slowing disease spread, social distancing measures will be
applied based on epidemiological evidence with the primary objective of ensuring hospital
bed capacity is not exceeded due to rapid spread of the disease. Regulations for public
transportation, factories, offices, markets, shops, including in the informal sector, will be
developed and reviewed regularly based on epidemiological assessments. In the case of
rapid spread of the disease and insufficient bed capacity, additional social distancing
measures will be introduced at either local or national level to further slow- down the
reproductive rate of the virus while minimizing the broader negative impacts to the
economy.

5. Empowerment of frontline health workers and other essential workers through

communicationsand behavioral change to make them agents of change to turn the epidemic
around and addresstheir potential COVID-19 related fears and concerns: Ensuring essential
frontline workers are
safe from infection is vital to maintain morale and to prevent spread of the disease by the
workers themselves. Equipping them with necessary information, guidelines as well as
periodic reporting of symptoms and tracking the respective management of essential
workers will help supervisors to make timely management decisions including withdrawing
the workers from field duty.

Given this is a novel coronavirus, significant knowledge will also be gained as countries are
learning from each other how best to suppress the epidemic waves in their populations and
ultimately bring the pandemic under control while maintaining essential health services and
minimizing negative impacts to livelihoods.

2.2.2 Key focus areas

The COVID-19 epidemic is an emergency situation and the impact in terms of morbidity and
mortality as well as social and economic consequences may be extremely high. To meet the
emergency situation and reduce the impact, the response plan will need to include mechanisms
for developing surge capacity to manage the patients, to sustain essential services and to
reduce social impact.

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The above interventions are expected to result in a national suppression followed by targeted
interventions undertaken by each pillar to slow spread while continually strengthening
surveillance and health system capacity, with the following key areas of focus:

1. Nationwide further expansion of lab testing capacity, ensuring good laboratory practices
and biological safety, with immediate action taken on each lab result. As the outbreak
unfolds, the surveillance strategy will need to evolve to account for available laboratory
capacity, to ensure prioritization of testing for high-risk individuals, and to monitor disease
trends and overall progress of the response strategy
2. Community-based prevention practices, case identification, and quarantining (including at
points of entry) utilizing local community health capacity for slowing spread of disease
following lockdown.
3. Expansion of facility-based and healthcare worker training programs nationwide, for
improving triage, infection prevention control, and case management.
4. Mobilization of recently graduated intern doctors to support triage and case management at
hospitals with highest case burden.
5. A set of targeted immediate actions for the Government of Bangladesh to reorganize and
ensure continued access to essential quality health services for all.
6. Strong nationwide communication to empower symptomatic individuals and their families
to report symptoms. Destigmatizing the disease is essential for people to feel safe in
divulging symptoms and seeking necessary assistance.
7. Effective community engagement strategies coupled with access to masks, soap/sanitizers,
water to empower communities to support and enforce safe behaviors of mask wearing,
social distancing and safe hygiene practices for ensuring and sustaining safe behaviors and
practices, particularly at super-spreader interfaces;
8. Development of a single list of supplies and use of the global supply chain system for
expediting procurement of supplies in highest demand globally.
9. Optimum utilization of local manufacturing solutions, particularly for PPE production,
including standardization.
10. Establishing research coordination committee / mechanism to facilitate pharmaceutical
and nonpharmaceutical research related to COVID-19.

2.2.3. Monitoring of progress

Presently, Bangladesh is in the community transmission phase. The response strategy and actions will
need to be continuously reviewed and adjusted as necessary to ensure efficient use of financial and
human resources for the effective response to the outbreak. Any new information, Research and
Development (R&D) advances, good practices internationally and updated recommendations from
WHO, will need to be considered, consistently.

At the national level, information will be made available in real time to senior decision-makers
through the establishment of a virtual disease and resource monitoring dashboard supported by

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the a2i initiative and closely tied into existing data management systems within the Health
sector. In addition, conditions on the ground will be studied for early warnings of emerging
socia

2.3. Multisectoral coordination and partnerships

Facing the unprecedented challenge, the GoB will review the experience from other health
emergencies and global guidance from WHO, to respond to COVID-19 while also ensuring
that critical development programs continue. This l and economic dynamics.

includes the immediate response in the health sector and connect with other line ministries to
respond to the needs and ensure safety nets are in place for poorest populations and population
affected by COVID-19, including food security of vulnerable groups and protection of women
and children from violence in their homes during public health measures such as lockdowns.
The Government of Bangladesh will try at the same time to reduce negative impacts of the
outbreak in the social economic and human rights spheres which disproportionately impact the
well-being and livelihoods of marginalized and vulnerable groups. As the immediate response
is ongoing, early planning for socio-economic recovery and planning for continued essential
services will be done, with support of the UN and development partners.

Moving forward, there will be a need to coordinate the support to COVID-19 socioeconomic
recovery. The role of the Local Consultative Group (LCG) mechanisms, chaired on the
Government side by the Economic Relations Division Secretary, can play an important
immediate role in coordinating the response to COVID-19. In addition to being, the conduit
for dialogue between development partners and the Government on the 8th Five Year Plan, the
LCG mechanism can serve to coordinate partners' support to the socio-economic recovery
depending on the impact of the health emergency.

2.3.2. COVID-19-the case for Universal Health Coverage

The COVID-19 crisis demonstrates like no other, that universal health coverage is a must for
Bangladesh. Before the crisis, Bangladesh made huge progress in poverty reduction and had
about 30-40 million people who are poor, by any standard. This may rise substantially in the
next few months and years. The economic shock the population faces is unpredictable and puts
everyone at risk, be it for the disease or for poverty due to job loss or lockdown. This points to
the need of a publicly financed healthcare system that protects everyone from a financial shock
due to health expenditure.

Covid-19 is, it is argued, the ultimate example of why we need universal health coverage
(UHC)—if anyone is left out, it threatens the health security of everyone. The Ministry of
health and Family Welfare has already established a UHC committee and the time is there to
build a better health system, and advocate for Universal Health Financing for UHC, with a
focus on basic essential health services – promotive, preventive, curative and palliative. The

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recovery plan for the Ministry of Health should focus on reviewing the health financing
strategy that is universal and maybe launched in the course of 2021, at the time of the 50 years
celebration of Bangladesh.

The COVID-19 crisis hit hardest in urban areas, such as Dhaka, where the health system is
fragmented. Tertiary and specialized public hospitals fall under MoHFW management,
whereas primary health care is managed by the local government institutes and private
facilities are poorly regulated. This makes the role of oversight and regulation only harder.
Urban health reform has been started and the urban health strategy will be accelerated to
ensure improved delivery of comprehensive health services, including primary health care to
the urban population in Bangladesh.

Section 3: Surveillance and laboratory support

3.1 Overview
Testing of suspected cases is critical to responding to COVID-19. The various response
measures for managing the patients and reducing and breaking the chain of transmission are
largely dependent on the outcome of the laboratory tests and surveillance findings.

3.1.1 Laboratory Diagnosis

Currently, real time quantitative Reverse Transcriptase Polymerase Chain Reaction (qRT-
PCR) testing is the most common form of laboratory testing for COVID-19 in the country.
There are currently 73 laboratories in Dhaka and Dhaka, both in government and private sector
carrying out COVID-19 tests within the public health system. The National Reference
Laboratory in Bangladesh for COVID-19 is the Biological safety Level (BSL)-2 laboratory at
IEDCR in Dhaka. Besides this, several private hospitals are carrying out the rtPCR tests for
patients seeking care at these facilities. Laboratory diagnosis is being conducted according to
Standard Operating Procedures (SOP) developed by technical stakeholders following national
and international guidelines.

Sample collection for testing is being carried out both through household collection and
through kiosks, located in hospital premises and in other facilities in collaboration with NGOs.

Currently there are several challenges that limit laboratory testing capacity in Bangladesh. The
main challenges are: limited availability of testing kits and associated consumables; inadequate
numbers of laboratories with proper infrastructure/equipment to conduct COVID-19 testing;
lack of required biological safety measures in the laboratories, required for safe testing
environment; shortage of necessary trained human resources such as virologists,

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microbiologists and medical technicians in the public health system, for conducting RT-PCR
tests; proper and safe disposal of laboratory wastes.

Given the limitations in laboratory testing capacity and finite resources for COVID-19
response, it is evident that Bangladesh cannot possibly tests all individuals who need it.
Instead, an optimal number of lab tests will be done per day (e.g. 10 per 100,000 population
i.e. 16,500 tests per day) so as to provide standardized and comparable data for monitoring
progression of COVID-19. There is a need to strengthen other forms of surveillance such as syndromic
surveillance, and measures to isolate all probable and confirmed cases to reduce community
transmission.

As diagnostics evolve, community-level testing via kiosks can further decentralize and expand
testing capacity while antigen-based rapid testing may eventually enable immediate testing at
household level, thereby greatly simplifying the logistics and reducing the overall cost of
diagnostic testing.

3.1.2. Surveillance

Surveillance is the systematic and routine collection, transfer, analysis and interpretation of
information related to a particular disease (e.g., COVID-19) in a country. Surveillance helps
monitor trends of disease spread in respect to persons, place and time. In Bangladesh, different
surveillance systems for COVID-19 will be used to guide national and local response measures
to reduce COVID19 transmission. It is important to note that COVID-19 surveillance needs to
be dynamic and should adapt with the changing nature of disease transmission/progression in
the country (for example, from widespread community transmission to an expected prolonged
phase of low/steady transmission).

The objectives of COVID-19 surveillance are7:

1. Help in rapid detection
2. Guide management of suspected cases
3. Help identify and follow up contacts
4. Guide implementation of control measures
5. Detect and help contain outbreaks among vulnerable populations
6. Monitor longer term epidemiologic trends and evolution of COVID-19 virus

Existing surveillance systems for COVID-19

DGHS is providing oversight for all COVID-19 surveillance systems through its “Corona
Control Room” in coordination with IEDCR and CDC. In general, Bangladesh has the
capacity to conduct sentinel-based, event-based, community-based, web-based and cell phone-
based surveillance. The following surveillance mechanisms are being utilized for COVID-19:
7
Based on https://www.who.int/publications/i/item/surveillance -strategies-for-covid-19-human-infection.

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a. Screening at points of entry (PoE): Screening of passengers for signs and symptoms
suggestive of
COVID-19 is being conducted at all 28 PoEs including air, sea and land ports (as per the
directive of the National Advisory Committee and National Technical Committee). Screening is
being conducted through self-declaration health forms, visual observation for respiratory-illness
like symptoms, body temperature recording through a thermal scanner (metallic archway or
hand held infra-red digital thermometer), and information collection (contact history) at health
desks in the facilities (please see section 5 for details).
b. Sentinel surveillance: existing sentinel surveillance systems for influenza is being used to
monitor COVID-19; these are the National Influenza Surveillance Bangladesh (NISB) and
Hospital-based Influenza Surveillance (HBIS) platforms. Respiratory tract samples are being
collected for influenzalike illness (ILI) and severe acute respiratory illness (SARI) from 18
sentinel hospitals of NISB and HBIS platform under the National Influenza Center, IEDCR,
MoHFW.
c. Syndromic Surveillance: The Government of Bangladesh initiated immediate nationwide
monitoring of symptoms suggestive of COVID-19 in the general population through existing
community networks, web apps, as well as telecom-based reporting via a number of hotlines
(e.g., 333 and 16263) and Unstructured Supplementary Service Data (USSD). These reports
have helped to indicate distribution of probable cases throughout the country; in addition,
individual reports were assessed using other risk criteria and those deemed to be at high risk
for COVID-19, were referred for laboratory testing.
d. Laboratory Testing Data: Laboratory confirmed cases is considered a rather small proportion
of individuals at high risk of COVID-19 (identified through self-reporting of symptoms to
any of the above-mentioned platforms; contact tracing; high-risk professions such as health
care providers; or individuals directly contacting private laboratory services/ kiosks) who are
undergoing laboratory tests to confirm COVID-19 diagnosis. The number of laboratory-
confirmed COVID-19 cases is also helping to monitor disease progression. However, there
are several limitations in relying on the number of confirmed cases only as best estimate to
monitor trends as the number of tests done per day for a particular area has not been
standardized yet; the number of tests done is very low; there are chances that tests are not
available equally across all geographic locations and among all populations (please see 3.1.2
for details).

3.2 Strategic interventions

Increase laboratory testing for appropriate case management and to provide standardized and
comparable data for monitoring progression of COVID-19.

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3.2.1. Strengthening laboratory testing

1. Undertake short to long term plan with target for daily laboratory testing for the medium
to long term, considering available resources;
2. Implement the plan engaging stakeholders like the development partners, NGOs, private
sector;
3. Increase sample collection through collection teams and kiosks.
4. Collect samples from all corners of the country to get representation of all geographic
areas and populations of the country;
5. Assess RT-PCR diagnostic testing facilities in the country to evaluate if they can be
converted to BSL-2 COVID-19 testing facilities;
6. Expand/establish new COVID-19 testing laboratories; where needed establish
collaboration/ partnership with private providers to ensure collected samples get tested at
the earliest.
7. Identify and train adequate human resources for conducting COVID-19 tests;
8. Fill in the vacant positions for virologists and medical technicians at the earliest; create
new positions where required.
9. Ensure consistent availability of testing kits, PPEs and associated consumables and
establish fast and efficient procurement processes;
10. Establish proper biological safety measures in all COVID-19 testing laboratories
(availability of required equipment and ensure adequate training and orientation of
laboratory personnel); notification;
11. Fee basis;
12. Ensure proper waste disposal from COVID-19 laboratories;
13. Introduce rapid tests;
14. Allow more private sector institutions to carry out COVID-19 confirmation tests.
15. Explore and strengthen capacity for local production of kits;

3.2.2. Strengthening surveillance

1. Ensure surveillance system is geographically representative across age, gender,

vulnerability and levels of risk;
2. Strengthen community-based syndromic surveillance by empowering communities to
monitor and report cases with symptoms suggestive of COVID-19, such as the Community
Support Team (CST) initiative and telephone hotlines (including an active cell phone
surveillance) and web app reporting. Develop artificial intelligence-based surveillance.

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3. Expand the ILI and SARI sentinel surveillance systems to also capture COVID-19 cases
4. Triangulate data from different surveillance platforms to provide a comprehensive picture
of COVID-19 progression in the country
5. Develop clear case definitions for probable and confirmed cases based on available data;
continuously review and update case definitions (if required) based on surveillance data;
6. Establish proper population and laboratory testing denominators to aid in data
interpretation
7. Ensure uniform data reporting formats across all surveillance systems and create a central
data reporting platform
8. Ensure fast data analysis and reporting to detect new cases and clusters and to respond to
these as soon as possible
9. Ensure daily monitoring of COVID-19 deaths in the hospitals and identify ways to capture
COVID19 deaths occurring in the community
10. Once reliable antibody-based serological tests become available, sero-surveillance can be
utilizedto monitor overall population exposure and to periodically assess rate of spread of
the disease atboth community level and within high-risk populations such as frontline
healthcare workers.

3.2.3 Strengthening Laboratory Testing Capacity

1. Forecast requirement of testing kits and associated consumables and establish fast and
efficient procurement processes;
2. Establish proper biological safety measures in all COVID-19 testing laboratories
(availability of required equipment and ensure adequate training and orientation of lab
personnel);
3. Ensure proper waste disposal from COVID-19 laboratories;
4. Standardize a maximum number of testing to be done per day (based on the availability of
resources) to monitor trends in disease progression.

Section 4: Contact tracing and mitigating community

transmission

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4.1 Overview
Contact tracing is the process of identifying, assessing, and managing people who have been
exposed to a disease to prevent onward transmission8.

Contact tracing is a classic epidemiological tool used to reduce contact rate between an
infected individual and susceptible populations, and in doing so, it reduces the effective
reproduction number (R) that determines the spread of an infectious disease (if effective
reproduction number/R is greater than one, then the disease will continue to spread in the
population).

COVID-19 is spread through droplets and contact transmission. Evidence suggests that a large
proportion of COVID-19 cases are infected through pre-symptomatic individuals 9, which
means that an infected individual will likely expose a lot of contacts to the virus without
realizing that they are spreading COVID-19. Manual contact tracing in the case of COVID-19
might be too slow to be effective, and in the context of densely populated Bangladesh, manual
contract tracing’s impact on timely identification, notification and quarantining of contacts to
prevent further spread is even less promising.

The government of Bangladesh has established several quarantine and isolation facilities
across the country to support suspected and probable cases to maintain quarantine and
isolation, respectively, and reduce community transmission.

Contact tracing in Bangladesh is being led by DGHS. The Corona Coordination Cell played an
important role in supporting contract tracing using surveillance data. However, as mentioned
above, with widespread community transmission, we need to focus on other approaches to
limit community transmission.

4.2 Strategic Interventions for reducing community transmission

1. Explore potential for and feasibility of implementing innovative approaches contact tracing
based on the local context, stage of the epidemic, etc.
2. Implement other interventions that will lead to the same output as contact tracing, i.e.,
reducing contact rate between probable/confirmed cases and susceptible populations. One
such intervention is the Community Support Team (CST) intervention based on syndromic
quarantining of the entire household to reduce risk of COVID-19 spread;
3. Ensure widespread use of mask to prevent transmissibility of the virus;
4. Ensure adherence to isolation for all COVID-19 confirmed cases (and their household
members);

8
https://www.who.int/publications/i/item/contact -tracing-in-the-context-of-covid-19
9
Ferretti, L.; Wymant, C.; Kendall, M.; et al. Quantifying SARS-CoV-2 transmission suggests epidemic control with
digital contact tracing. Science 10.1126/science.abb6936 (2020) (doi: 10.1126/science.abb6936).

Pag38
5. Ensure adherence to quarantine for all contacts (of suspected and confirmed cases);
6. Continue to improve isolation and quarantine facilities across the country to support
contacts and cases to quarantine or isolate properly.

Section 5: Points of entry and quarantine

5.1 Overview of points of entry
Points of entry are passages for international entry or exit of travelers, baggage, cargo,
containers, conveyances, goods and postal parcels, as well as agencies and areas providing
services to them on entry or exit. In Bangladesh, screening at PoEs is being used as a
surveillance approach to identify and quarantine/isolate individuals who are at risk for
bringing COVID-19 across international borders into Bangladesh. This system aims to prevent
further transmission in the community and will also prevent further outbreaks from
international passengers once the epidemic has slowed down in Bangladesh. Currently there
are 23 official land ports, three international airports and three sea ports which function as
PoEs in the country. Of these, currently, five land ports (i. Benapole Land Crossing, Jashore;
ii. Ahkaura Land crossing, Brahmanbaria; iii. Burimari land crossing, Lalmonirhat; iv.
Banglabandha land crossing, Panchagarh; and iv. Teknaf land crossing, Cox’s Bazar), one
international airport (HazratShajalal International Airport, Dhaka) and two sea ports (Seaport,
Chattogram and Mongla Seaport, Bagerhat) are active in allowing either passengers or cargo
to enter or exit the country.

The ‘PoE and Quarantine’ pillar is being led by the Communicable Disease Control Unit,
DGHS. There are three International Health Regulation (IHR 2005) designated PoEs in the
country (HazratShahjalal Intl Airport, Dhaka; Seaport, Chattogram and Benapole Land
Crossing, Jashore) mandated to achieve IHR core capacities. An Inter-Agency Health
Mobility Management task force has been established to support coordination centrally and also at
PoEs. DGHS has already started and will continue screening and implementing risk
communications activities at PoEs. Rapid assessments have been conducted for eight PoEs;
personnel have been trained to conduct screening of passengers; SOPs are being developed to
provide detailed guidance on screening and follow-up actions, customized for airports, land
ports and sea ports; healthcare personnel have been deployed in some PoEs; screening/health
information booths have been established, printed materials with information on COVID-19
symptoms, contact information of hotlines/hospitals, etc. are also being provided to incoming
passengers.

Currently, passengers are being screened for signs and symptoms suggestive of COVID-19 through
self-declaration health forms, visual observation for respiratory-illness like symptoms, body
temperature recording through a thermal scanner (metallic archway or hand held infra-red
digital thermometer), and information collection (e.g., contact history) at health desks adjacent
to the thermal scanning zones. If any suspected COVID-19 case is detected, it will be

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communicated with the COVID-19 Control Room as per existing Standard Operating
Procedures (SOPs).

All of these measures are functioning in the active abovementioned PoEs, and are also present
in some capacity in the rest of the PoEs (but requires further strengthening to achieve
minimum IHR requirement). However, thermal scanners are currently only available in Dhaka
and Sylhet international airports, Chittagong sea port and Benapole land port. Other PoEs will
not only require thermal scanners, but also need associated equipment, infrastructure and
trained human resources to conduct screening of incoming passengers.

Since the emergence of Covid-19 outbreak till 13 June 2020, 343,483 passengers have been
screened through the airports (271,735 at HazratShahjalal Int’l Airport, Dhaka; 52,113 at Shah
Amanat
Airport, Chattogram and 19,635 at Sylhet Int’l Airport), 344,396 passengers through land ports
(highest 198,918 at Beanpole), and 22,304 crew and staff screened through the seaports.
Passengers with significant/severe symptoms are being sent to institutional isolation centers.
At present, if screening at the PoEs identifies individuals with mild or inconclusive symptoms,
the health officials are sending them to government designated institutional quarantine centers.
At the institutional quarantine center, government designated authorities are in charge of food,
logistics and overall management while MoHFW through DGHS is monitoring health issues
and Infection Prevention and Control (IPC) measures. Passengers with no symptoms are
instructed to respect a mandatory home quarantine of 14-days at their declared residence.
Health officials at the PoE extract information from the Health Declaration Forms and CDC of
DGHS follow up with these individuals through mobile applications/ other means to ensure
adherence to quarantine. During the above mentioned time, 300,975 persons have been sent to home
quarantine and of them 243,738 persons have completed their 14 days of quarantine; while,
during the same period 16,669 persons were sent to quarantine facilities and of them 13,121
persons have completed their tenure by this time.

Passengers with significant/severe symptoms are being sent to institutional isolation centers.
At the institutional quarantine center, government designated authorities are in charge of food,
logistics and overall management while MoHFWthrough DGHS is monitoring health issues
and Infection Prevention and Control measures. Passengers with no symptoms are instructed to
respect a mandatory home quarantine of 14-days at their declared residence. Health officials at
the PoE extract information from the Health Declaration Forms and CDC of DGHS follow up
with these individuals through mobile applications/other means to ensure adherence to
quarantine.

DGHS is also continually strengthening coordination to increase awareness among travel and
tourism industry personnel regarding the importance of infection prevention and control;
reiterating the need for airlines to adhere to compliance guidelines developed by the
International Air Transport Association; developing PoE contingency plans; and informing

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 those in the tourism sector (hotels, cruise lines, travel agencies, etc.) about outbreak evolution,
international recommendations and government’s response.

Strategic priority interventions

Strengthening coordination

1. Ensure effective coordination between DGHS, PoE authorities, transportation authorities

and law enforcement agencies/or stakeholders involved with supervision of government
designation quarantine centers and isolation centers;
2. Ensuring effective coordination with the Surveillance and Laboratory Pillar to ensure
testing of suspected cases (as and when required and feasible);
3. Ensure effective coordination with the Case Management Pillar to provide appropriate
treatment to passengers in quarantine/isolation centers based on symptom severity (e.g.,
referral to hospitals for individuals with severe/critical symptoms).
4. Ensure effective coordination with the RCCE Pillar to produce and disseminate effective
IEC materials for passengers, vehicle operators and PoE staff.

Providing technical guidance

1. Development of detailed SOPs and other materials guided by the International Health
Regulations (IHR) for: oconducting screening; ocontingency plans when passengers with
indications of COVID-19 are identified; omanaging quarantine/isolation of such
passengers; oreferral to testing facilities and hospitals; oprotocols for following up with
passengers who will maintain 14-day mandatory quarantine at home.

Note: The SOPs need to be developed for all types of PoEs (land, sea and air) and the
contingent plan needs to be PoE specific.

2. Development of communication materials to educate passengers about COVID-19 and

provide important information on seeking help or reporting symptoms (in collaboration
with the RCCE
Pillar).

Strengthening screening at points of entry (this refers to all air, land and sea
PoEs prioritized by the government)

1. Ensure availability of all equipment/proper infrastructure (e.g., paper forms; booths;

thermal scanners, protective equipment for the screeners, etc.) required to conduct
screening;
2. Ensure availability of adequate trained human resources for conducting screening

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 3. Coordination with travel and tourism industry to facilitate screening of passengers at
the point of source;
4. Training of healthcare providers and other personnel on maintaining infection
prevention and control measures; data recording and follow-up;
5. Mechanisms for disinfecting vehicles (aircrafts, ships, trains, buses, etc.);
6. Mechanisms for disinfecting luggage, cargoes, containers, parcels and goods;
7. Provide communication materials containing information or signs and symptoms and
where to seek medical support if needed to passengers without any indications of
COVID-19, who will maintain 14-day home quarantine;
8. Ensure regular follow-up with passengers maintaining 14-day mandatory home
quarantine through cell phone-based surveillance to ensure proper quarantine
adherence;
Management of passengers with indications of Covid-19

1. Availability of a customized contingency plan for each PoE in the event any passenger
with Covid-19 symptoms are identified, including details on transportation, testing,
management of Covid-19 symptoms and referral to hospitals;
2. Ensure fast track process and transportation of suspected passengers to designated
quarantine/isolation centers/hospitals depending on symptom severity.
3. Ensure availability of systematic transportation facilities for transporting suspected
passengers (e.g. ambulances/cars, etc.) for each PoEs;
4. Ensure proper monitoring of each passenger sent to quarantine centres and isolation
centers, with follow-up for testing (whenever feasible) and medical attention (as and
when required).

Note: This section describes quarantine/isolation for passengers identified as eligible for
quarantine or isolation through screening at Points of Entries (PoEs). Quarantine mechanisms
for contacts and suspected cases identified outside PoEs are described in 4.1 and 4.2.

Section 6. Infection prevention and control

Overview
Infection Prevention and Control (IPC) measures in health-care settings are of central
importance to the safety of patients, health-care workers and the environment, and to the
management of communicable disease threats to the global and local community. Early
identification, prompt isolation, proper patient placement and adequate ventilation, are

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 essential to contain and mitigate the impact of pathogens that might constitute a major public
health threat.
The success of the IPC system depends on practices and actions in each health facility,
meaning that all concerned need to take responsibility. The leadership of the facility has a
critical role to motivate each of the workers to adhere to the IPC protocols and practices and
other standards related to protecting patients from infection in the facilities are upheld. In the
case of COVID-19, Personal Protective Equipment (PPE) is required. Since the outbreak,
national guidelines for health care providers’ infection prevention control of COVID-19
pandemic, rational use of personal protective equipment10, SOP for infection prevention and
control for the burial of dead bodies, guidelines for environmental cleaning, disinfection and waste
management have been developed and accessible via the DGHS’s website11. Through mid-May
2020 DGHS, trained 2200 doctors, nurses and other staff from 240 facilities on IPC. This will
be continued for others concerned. In addition, guidelines on triage, early recognition, standard
precautions, isolation capacity, and referral procedures are being implemented.
Adequate water and sanitation in health facilities including soap and hand sanitizers are
required in sufficient quantities for all workers, patients and their attendants to ensure infection
prevention. Considerable investments are required to meet WASH in health care facility
standards. Waste management is critical for the outbreak response and the protection of health
workers and patients and their attendants, as per the National Guideline for Health Care
Provider on Infection Prevention and Control of COVID-19 pandemic in Healthcare Setting.
The proper disposal and disinfection of PPE, medical and lab waste management within and
outside the health facility needs to be ensured.
Since the outbreak, national guidelines for health care providers’ infection prevention control of
COVID-19 pandemic, rational use of personal protective equipment for COVID-19, SOP for
infection prevention and control for the burial of dead bodies, guidelines for environmental
cleaning, disinfection and waste management have been developed and accessible via the
DGHS’s website12. Through mid-May 2020 DGHS, trained 2200 doctors, nurses and other
staff from 240 facilities on IPC. It will be continued for others concerned. DGHS with support
from development partners have assessed 131 hospitals and annexed institutions to see facility
readiness including for IPC and case management, WASH and waste management for
Covid19. Data is being analyzed in the DGHS dashboard. This will inform both GOB and
partners to identify gaps around IPC and others domains on Covid19 pandemic13.

10
DGHS guidelines on RATIONAL USE of PERSONAL PROTECTIVE EQUIPMENT for COVID-
19,https://dghs.gov.bd/images/docs/Notice/20_03_2020_PPE_FINAL_WEBSITE.pdf .
11
DGHS guidelines on COVID-19 IPC measures,https://dghs.gov.bd/index.php/bd/publication/guideline.
12
DGHS guidelines on COVID-19 IPC measures,https://dghs.gov.bd/index.php/bd/publication/guideline.
13
https://dghs.gov.bd/index.php/en/component/content/article?id=5393

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6.2 Strategic priority interventions for IPC
6.2.1 IPC

1. Constitute IPC or Quality Improvement (QI) Committee in each health facility with
superintendents or managers of the facilities accountable for performance of their IPC or QI
committees. Designate IPC focal points in all facilities under direct supervision of the
superintendent.
2. Assess health facilities as per WHO standards for compliance with IPC standards.
3. Develop and implement action plans for IPC for each facility taking into account resources
required.
4. Develop, disseminate IPC materials with pictorial and flowchart for HCW and patients to
be displayed in the health facilities;
5. Ensure consistent availability of PPE and their allocation and use to various categories of
healthcare providers, as per set guidelines.
6. Build capacity of health workforce on IPC and enhance capacity of frontline clinical and
nonclinical staff on personal safety including use of PPE through continued learning,
mentoring and coaching tactics;
7. Design the engineering aspects of hospital buildings to reduce the risk for infection through
improved ventilation of all hospital rooms;
8. Improve airflow control in ICU to control infections in installing negative air pressure
facilities;
9. Set up mechanism to monitor effective implementation of IPC measures as per national
guidelines;
10. Strengthen coordination among national and sub-national stakeholders under DGHS
such as Corona Emergency Cell, Hospital & Clinics, communicable disease control,
community-based health care, Management information system (MIS) and primary to
tertiary level health facilities for integrated approach for strengthening COVID-19
emergency responses for implementation of IPC;
11. Designate IPC focal points in all facilities under direct supervision of the superintendent,
develop and implement action plans for IPC and set up monitoring systems to effectively
ensure the implementation of IPC measures as per national guidelines;
12. Build capacity of health workforce on IPC and enhance capacity of frontline clinical and
nonclinical staff on personal safety including on use of PPE through continued learning,
mentoring and coaching tactics as well as online supportive supervision; Develop protocols
for tracking healthcare personnel exposed to confirmed cases of COVID-19, regularly test
or check for symptoms compatible with COVID-19, and record, report, and investigate all
cases of healthcareassociated infections to address root causes of infection;
13. Increase confidence among health workers in government and private sector facilities on
mastering IPC practices and develop a motivational communication and behavior change

Pag44
 campaign for health workers to improve their IPC practices (in coordination with the RCCE
Pillar);
14. Assess health facilities as per WHO standards for compliance with IPC standards and
develop and implement improvement plans.

6.2Triage
1. Reorganize the facility for triage aligned with national guideline on COVID-1914 and ensure
IPC compliance and practice at the first point of care. Protect non-COVID-19 patients from
possible infection in health care facilities;
2. Ensure facilities have two entrances (COVID-19 and non-COVID-19) to ensure triage.
3. Ensure the critical infection prevention measures such as wearing masks, physical
distancing, provision of hand washing facilities, for care seekers visiting the health facilities
through innovative strategies.

6.3WASH in health facilities

1. Assess WASH situation of the health facilities.
2. Implement recommended protocols for hand hygiene, personal protective equipment,
environmental cleaning, and waste management;
3. Improve/ expand WASH facilities in health facilities ensuring continuous and adequate
supply of running water and soap. Ensure chlorination points at water source as per
protocol;
4. Establish mechanism for functioning of the WASH facilities;
5. Build capacity of cleaning/ support staff in environmental and personal hygiene in the
context of COVID-19;
6. Where necessary, ensure adequate cleaners in health facilities through collaboration and
partnerships;
7. Ensure appropriate protection for health facility cleaners;
8. Monitor IPC and WASH implementation using the Infection Prevention and Control
Assessment Framework, the Hand Hygiene Self-Assessment Framework, hand hygiene
compliance observation tools, and the WASH Facilities Improvement Tool;
9. In coordination with the Department of Public Health Engineering (DPHE),
support access to WASH services in public places and community spaces most
at risk.

14
Ibid.

Pag45
 6.4Medical waste management

1. Implement waste management as per national standards, including color-coded bins, and in
collaboration with relevant program managers under DGHS;
2. Ensure appropriate disinfection of the PPE and disposal as per guidelines;
3. Ensure adequate and consistent supply of necessary logistics including garbage bags, bins,
gloves, boots, disinfectants, dead body disposal bags etc.;
4. Ensure medical wastewater management in coordination with local government following
the national guidelines;
5. Enforce proper disposal and waste management through environmentally friendly
incinerators in the facilities, through local authorities or through contracting with private
entities while ensuring adequate personal protection for the operators.
6. Monitor jointly, waste disposal mechanisms of COVID-19 designated hospitals in the
public or private sectors.

6.5Safe disposal of dead bodies

1. Set up multi-sector mechanisms at local level for care of deceased persons with suspected
or confirmed COVID-19 cases, observing necessary sensitivity;
2. Ensure adherence to necessary precautions (national guidelines available) for everyone
attending a patient died of clinical or epidemiological history compatible with COVID-19;
3. Engage/ collaborate and strengthen the capacity of private agencies and other stakeholders
involved in burial practices;
4. Follow burial guidelines for COVID-19 of the Ministry of Religious Affairs;
5. Before attending to a body, people should ensure necessary hand hygiene and personal
protective equipment (PPE) supplies are available;
6. Patients who died and are suspected with COVID-19 should be tested (oral swab). In these
situations, an autopsy is contraindicated;
7. Respect and protect the dignity of the dead, their cultural and religious traditions, and their
families throughout the process.
8. Observe adequate IPC measures as per national guideline while preparing and packing the
body for transfer from a patient room to an autopsy unit, mortuary, burial site or
crematorium; The dead body must be kept whole and its handling should be minimum.
Regardless of the funerary practice of the family of the patient, the body must not be
embalmed. It should be disinfected with hypochlorite solution 0.05% and placed in resistant
fluid extravasation body bags, which must be properly closed before burial;
9. The place and used materials need to be cleaned as per national protocol.

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Section 7. COVID-19 case management

Overview of case management

Bangladesh has confirmed community transmission of COVID-19, with several epicenters,
and 102,292 confirmed cases and 1,343 deaths were reported as of 18 June 2020. While most
people with COVID-19 develop only a mild illness, approximately 14% develop a severe
disease that requires hospitalization and oxygen support, and 5% require admission to an ICU
(WHO).. Current management of COVID-19 consists of supportive care, including invasive
and noninvasive oxygen support and adjunct therapy with recommended drugs.
As one of the strategic priority areas, DGHS has already developed various guidelines on Case
Management and ICU Management, as well as 27 other COVID-19 guidelines 15. The
government has quickly recruited and trained 2000 doctors and recruited 5000 nurses and
mobilized public health experts. Hospitals, public and private, have been designated at
different levels for isolation and case management. As risk of infection is higher at health
facilities, the demand for telemedicine and other options for clinical management and case
follow up has increased several folds. Currently, there are several digital platforms such as
“Shastho Batayon-16263”, and national health call centers that provide 24/7 teleservices
including on COVID-19. The strengthening and professionalization of the telemedicine system
is required and may be used for COVID-19 response.
However, preparedness of the facilities to manage both streams of patients is suboptimal.
Availability of high flow medical oxygen in specialized hospitals, medical college hospitals
and district hospitals is insufficient. The existing ICUs do not meet the standards for infectious
diseases. All medical college hospitals and district hospitals need to expand their liquid
medical oxygen systems and establish an infectious disease department during the crisis that
need to remain to cope with the huge burden of existing infectious diseases and future
infectious disease threats. DGHS and partners are conducting training sessions and facility
assessments.

Strategic priority interventions

Strategic priority interventions for COVID-19 case management include:
Screening and triage systems in health facilities

1. Establish a screening and triage system in all health facilities for patients with suspected
and confirmed COVID-19 at the first point of contact with the health care system and
through digital platforms;

15
DGHS novel coronavirus guidelines, https://dghs.gov.bd/index.php/bd/publication/guideline .

Pag47
2. Develop, update and disseminate the triage SOP for suspected COVID-19 cases;
3. Establish designated areas for clinical triage at different levels of facilities (public &
private) to triage and screen cases with fever and respiratory distress;
4. Equip triage areas with necessary equipment (portable X-Ray);
5. Train and build capacity of health managers and service providers for screening and triage
at facilities and early recognition of patients with COVID-19 including IPC and appropriate
biohazard measures.

COVID-19 management in existing facilities according to clinical severity

Ensure care for all suspected and confirmed COVID-19 patients in the designated
facility/treatment areas according to disease severity and acute care needs include:

1. Rapidly assess facility readiness to identify gaps and undertake necessary actions to
continue COVID-19 and non-COVID-19 essential health services (public & private);
2. Develop and update guidelines, SOPs and training modules on clinical management and
provide appropriate training to health professionals and support staff on case management
including ICUs;
3. Ensure adequate HRs and capacity building on COVID-19 case management; Establish
expertise to administer high flow oxygen and ICU teams for the management of COVID-
19;
4. Ensure psychosocial support for health workers managing COVID-19 patients;
5. Ensure adequate oxygen supply mix, including high flow medical oxygen with appropriate
training and mentoring as per level of the health system, with oxygen concentrators, liquid
oxygen, oxygen plants and oxygen cylinders, with required accessories for oxygen supply;
6. Ensure adequate supply of pharmaceuticals and other consumables;
7. Equip ambulances for COVID-19 case management and IPC as per national protocols;
8. Ensure comprehensive clinical, nutritional, and psychosocial patient care and
institutionalize quality improvement initiative including mentoring and death review of
COVID-19 cases;
9. Support monitoring and supervision, as well as data-driven performance reviews,
adjustments and knowledge management.

Management of mild and moderate cases

1. Manage all mild cases without comorbidities in designated community facilities (isolation
centers) or at home with access to rapid health advice through telemedicine/ call centers
and/ or community health team and refer them to hospital following the referral protocol;
2. Manage all mild cases with co-morbidities, moderate, severe and critical cases in
designated Covid hospitals;
3. Ensure adherence to isolation protocols in case of home management of mild cases;

Pag48
4. Ensure adequate supply of pharmaceuticals and other consumables; and functional supply
chain system;
5. Establish a comprehensive eHealth platform/Web/ App based follow up for home-based
care, psychosocial support and referral transport;
6. Develop guidelines and applications for telemedicine practitioners.
7. This may require collaboration with NGOs to provide feasible advice and support
households especially in the slums and rural areas; others may seek guidance from the
digital platforms and DGHS website; Coordinate telemedicine agencies, ensure adherence
to minimum standards of clinical practices to ensure quality of care;
8. Organize community awareness sessions on risk management including using digital
platforms (16263/ 333 / corona checker / chat bot etc.);
9. Ensure social protection for the poorest to alleviate financial hardship and accessing care,
through appropriate line-ministry.
Management of severe and complicated cases
1. Establish Infectious disease department in all Medical College Hospitals and District
Hospitals (Advocate to set up ID Department in medical universities including in
BSMMU) to cope with COVID-19 in the short run, that can remain in part after the
epidemic is controlled to cope with existing and future infectious disease threats in
future;
2. Equip triage areas with necessary equipment (i.e., Improve the readiness (including
logistics and supply chain) of different levels of hospitals and health facilities for
screening, triaging of suspected COVID-19 patients, isolation, case management and
referral with proper IPC system at point of care;
3. Establish real-time monitoring system for triaging at all facilities through integrating in
the existing HMIS/ DHIS2.

Surge capacity
Surge capacity: expand the health system with increased capacity for care delivery, including
rapid extension of designated hospitals to care for COVID-19 patients.

1. Establish Rapid Response Teams at divisional and district level to support the DGHS
and partners to undertake rapid risk analysis and develop appropriate response plans;
2. Designate and prepare public, private and alternate facilities to strengthen in-patient
care and surge capacity with clinical and support staff;
3. Establish makeshift/field hospitals as necessary;
4. Ensure essential support service and psycho-social counseling (lodging, food,
transport) for the health service providers and institutionalize incentive mechanisms or
risk coverage for health workers at risk;

Pag49
 5. Develop job aids, update guideline, and provide mental health and psychosocial
support for patients and health care providers through face to face and call centers;
6. Ensure sufficient stocks of vital supplies with a functional supply chain system.

Section 8. Ensuring essential health, population, and nutrition services (ESP)

delivery while responding to COVID-19

Overview
The health system of Bangladesh is currently facing competing demands: while shifting the
health systems focus towards the COVID-19 response, the pandemic is disrupting the delivery
of essential and lifesaving health, population and nutrition services. The COVID-19 pandemic is
expected to have long-term impact at individual level, nationwide and across the globe, on key areas
such as health care, food and nutrition, social and economy.The evidence fro m the MIS based service
utilization data shows a drastic reduction in the utilization of the major essential health,
population, and nutrition services across all levels of health systems during January-April
2020. For instance, the outpatient visits and inpatient cases dropped by 12% and 22%
respectively at Upazila Health Complex and 21% and 23% respectively at the district
hospitals. Indirect effects of the pandemic will likely increase mortality from other diseases
rather than COVID-1916.

Maternal, newborn child and adolescent health (MNCAH)

There has been significant reduction in the utilization of maternal, newborn, child and
adolescent health services. In April 2020, immunization rate decreased by more than 50%,
delivery in health facilities by 60% and adolescent health services by 70%, compared to
January 2020. Children visiting health facilities with fever and signs of pneumonia also
reduced significantly since January 2020. The services utilization in Adolescent Friendly
Health Services reduced by 70% in April 2020 from January 2020.
Family planning and reproductive health services
The need for contraception and family planning information and services remains, despite the
pandemic. House-to-house community distribution, counseling, and satellite sessions have
been hampered while there has been a significant decrease in utilization of long- term
reversible contraceptives e.g. IUDs by 46% and implants by 66.5%, for March 2020 compared
to March 2019. While the central and regional warehouses of the Directorate General of
Family Planning (DGFP) have adequate stocks of contraceptives, the service delivery points at
lower levels are likely to face shortages due to the lockdown in the country. A review of the
DGFP’s e-LMIS, shows that all five modern contraceptive methods had steady consumption

16
The Lancet Global Health- Early estimates of the indirect effects of the coronavirus pandemic on maternal and
child mortality in low- and middle-income countries.

Pag50
trends in 2019 but in March and April 2020 reports show around 30% to 40% decline in consumption
of the five modern contraceptives.
Nutrition services
An analysis published in The Lancet projects that in the worst-case scenario, if there is further
reduction in health services in Bangladesh, an additional 28,000 children under the age of five
could die in the next six months as an indirect result of the pandemic. Wasting, a severe form
of malnutrition, would be a significant contributory factor to such under-five deaths, which
might increase to as high as 10-50%. The proportion of children screened for malnutrition in
IMCI nutrition corners declined from 35% in March to 31% in April while admissions of
children suffering from severe acute malnutrition dropped by 90%.
Non-communicable diseases
The service reductions can be attributed to many factors such as the shortening of outpatient
visiting hours of the public facilities to prevent the virus spread or redistribution, re-
assignment and task shifting of frontline health workers towards COVID-19 response. The
change in health seeking behavior of communities triggered by travel restrictions during the
lockdown and the loss of daily earnings of vulnerable groups, is also likely to affect utilization
rate and access to routine health services.
Such a scenario demands a balance between effectively responding to COVID-19 and
mitigating the risk of health system collapse as well as reducing new barriers to accessing essential
health services to avoid unintended health outcomes. Guided by the WHO Global guideline on
maintaining essential health services during an outbreak, a set of strategic interventions are proposed to
strengthen the health systems resilience and the functional capacity of the primary health
system to maintain the continuity of essential health services at the national, regional, and local
level.

Communicable diseases
Critical communicable disease services need to continue to combat TB, Malaria, HIV,
diarrheal diseases, Dengue and other communicable diseases. The general holiday (lockdown)
has already led to a substantial drop in the total number of TB notifications from 24,457 in
April 2019 to only 5,015 in April 2020. This when the disease, according to WHO estimates,
kills an average of 129 people per day in the country. This sharp drop in notifications, TB
experts warn, could not just lead to a rise in transmission of the disease as patients miss out on
medical care and continue to spread the disease, but also worsen outcomes at a later stage and
even accelerate dropouts from TB’s long treatment cycle. Similar drop on HIV services and
mitigation measures are reported. While in 2019, the health system was occupied and
sometimes overwhelmed by Dengue, COVID-19 takes all capacity of the health facilities and a
Dengue outbreak would lead to further severe complications in the health system.

Pag51
Strategic actions for maintaining essential health and nutrition
services

Strengthen governance and stewardship roles of the government

1.Strong stewardship role and regulatory enforcement to ensure quality health, population
and nutrition services to all citizens;
a. Declare a set of priority health, population and nutrition services as ‘essential’;
b. Ensure provision of essential HNP services by all health facilities besides COVID-
19 response.
c. Ensure provision of emergency HNP services, irrespective of COVID positive or
negative status;
Health workforce
1. Motivate and retain the existing health workforce with appropriate incentive measures;
2. Recruit health workforce to fill up existing vacancies in various positions;
3. Identify and mobilize additional qualified workers, retirees and trainees, reassign the
staff from non-affected area;
4. Ensure skill mix and reallocate the health workforce within the facility to ensure a
balanced redistribution to provide both COVID-19 and non-COVID-19 services;
5. Optimize utilization of existing platforms for telemedicine, both public and private, for
essential health and nutrition services, with apps with standard protocols for clinical
decision-making to ensure best practices;
6. Develop an e-training platform for capacity building of the service providerson
essential health, population and nutrition services in the context of COVID-19. Create
web-based platforms for clinical decision support for direct clinical service;
7. Develop a strategy for psycho-social support with physical teams present in facilities
backed up by specialized teams available using telemedicine options.
Service delivery
1. Arrange/ set up infrastructure for ESP services with arrangement for isolation and
triage for patients/ clients and accompanying persons as well as ensuring IPC, as per
national guideline;
2. Organize catch up activities for preventive services (EPI, nutrition, FP, ANC, NCD
screening and referral, TB, Malaria, HIV) and organize MR campaign to ensure full
protection of the population while maintaining social distancing and HW safety
measures;

Pag52
 3. Explore alternative and innovative strategies for continued service delivery options to
reach the remote and hard to reach areas such as using digital health interventions for
appointment, tele-consultation etc;
4. Develop and implement SOP to ensure quality of services in COVID-19 situation for
maternal health (ANC, facility delivery, PNC, emergency obstetric care), Newborn
Health (Essential Newborn Care, SCANU), immunization, IMCI, Nutrition, TB,
Malaria, HIV, NCDC, mental health including psychosocial support. For example,
implement the national guideline on routine immunization during COVID-19 pandemic
situation17, adapted to the current geographic hotspots of COVID-19 cases;
5. Actively mobilize the population to rebuild trust in health services and promote
essential services (immunization, ANC/PNC, institutional delivery, neonatal care,
family planning, breast feeding, nutrition diet, lifestyle change) through social media
platform, using FAQ, optimizing communication networks of cellular companies and
cloud service providers;
6. Provide outbreak response support in case of other disease outbreaks (measles, cholera,
dengue etc).

Medicine and logistic supplies

1. Ensure need-based allocation of quality essential medicines, medical devices,
contraceptives, vaccines, biologicals and diagnostics and nutrition supplies.
2. Create a platform for reporting inventory and stockouts, and for coordination of
redistribution of supplies and establish on-line MIS system for essential medicines and
supplies (e-LMIS) for ESP, interoperable with DHIS-2;
3. Strengthen procurement and supply chain management to ensure uninterrupted supply
of necessary equipment, quality medical supplies including medicines, medical
devices, contraceptives, vaccines, biologicals and diagnostics, essential nutrition
commodities including anthropometric materials, and relevant tools for GMP, supplies
(IFA, calcium tablets, therapeutic milk, therapeutic milk preparation kit) on priority
basis.
4. Strengthen pharmaceutical services to improve appropriate use of medical products and
to enhance quantification and forecasting.
5. Strengthen DGDA to reach maturity level three according to the WHO Global
Benchmarking Tool indicators, to enable effective regulatory preparedness for vaccines
and other medical products.

17
National guidelines on routine immunization during COVID-19 pandemic in Bangladesh,
https://drive.google.com/file/d/1lXj4QReRqvS28UNjB37SCIvEX -n5R3ey/view.

Pag53
Health information system
1. Develop strategy and plan for routine data analysis on ESP information system during
COVID-19 responses using DHIS2 & E-MIS of DGFP;
2. Closely monitor provision and utilization of ESP to understand level of sustainability
in terms of equity, access, coverage and quality;
3. Carry out disease surveillance and outbreak response;
4. Conduct facility readiness assessments for delivering essential health and nutrition
services during the COVID-19 crisis;
5. Conduct rapid population-based assessments on service barriers and client satisfaction
for essential health and nutrition services;
6. An appropriate platform for monitoring and reporting inventory and stock-outs should
be created, along with a mechanism for quick re-distribution and mobilizing supplies.

Health financing
1. Review the health financing strategy and ensure Universal Health Coverage through
public finance options, taking the crisis as an opportunity to build a better health
system fit for UHC;
2. Revisit public financial management for rapid procurement and flexible use of the
budget according to needs;
3. Ensure contingency funds at the local level for procuring necessary supplies,
transportation, repairing and maintenance of equipment and infrastructure by their own
arrangement.

Multisectoral actions and community participation

1. Community engagement and mobilization for awareness raising to promote healthy
social behavior across all sections of society including the urban slums;
2. Activate various community platforms (CG, CSG, MSG, nutrition clubs) and engage
volunteers at the community level (urban & rural) to serve the most vulnerable
populations with essential health, population & nutrition services;
3. Establish and strengthen referral linkage between community to CC to increase the
coverage of essential health, population & nutrition services and tracking for improved
service utilization;
4. Create awareness on essential health, population and nutrition services through social
media and SBCC engagement through different communication approaches, including

Pag54
 innovative engagements PSA, theatre, all media platform (religious leaders, influential
people etc);
5. Liaise with appropriate line ministries to ensure food safety and social security of poor
& vulnerable groups through social safety nets;
6. Liaise with appropriate line ministries to reduce violence against women through
provision of legal and social support.

Project Tow
Matarbari coal-fired power plant

Pag55
Pag56
Project summary
Some 30 per cent construction work on the 1200MW Matarbari coal-fired power plant was
completed as of July last as Coal Power Generation Company Bangladesh Limited (CPGCBL),
the implementing agency, has a target to complete the most expensive scheme by June 2023,
shows an official document.
The document was placed at a progress review meeting of the annual development programme
(ADP) of the Power Division on August 31.
However, officials at the implementing agency claimed that the progress of the project work is
37 percent as of August. 
They said though the coronavirus pandemic was a great concern, it had little impact on the
project work.
“We’re making good progress as per our schedule and hope to be able to cover the work
hampered for a few months due to the pandemic,” CPGCBL managing director Abdul Mutalib
told UNB.
On completion of land development, he said, now piling and other civil construction works are
being carried out at the project site.
The Executive Committee of the National Economic Council (ECNEC) approved the project
titled ‘Matarbari 2x600 MW Ultra Super Critical Coal Fired Power’ involving TK 35,984.46
crore (equivalent to $4.5bn) in 2014.
It is considered to be the country’s most expensive power generation project as it has included the
construction of a berthing port for handling imported coal.
Japan International Cooperation Agency (JICA), a Japanese donor agency, is providing Tk
28,939.03 crore for the project located at Matarbari and Dhalghata under Moheshkhaliupazila in
Cox’s Bazar while CPGCBL will finance Tk 4,926.66 crore from its owned fund.
CPGCBL officials said the Matarbari project will be an Ultra Super Critical Technology (USCT)-based
power plant with 41.99 percent energy efficiency against the average 34 percent efficiency in coal-
power projects.
They said the main activities of this project, having two units each capacity 600 MW, are
construction of power plant (civil), jetty and channel, setting up of power plant boiler (EPC part),
establishment of power plant turbine and generator (EPC part), and power plant coal and
produced ash management (EPC part).
Matarbari thermal power plant will be developed on a 1,500-acre site with two thermal units
based on ultra-supercritical coal-fired technology, having an installed capacity of 600MW each.
The Matarbari power plant project was conceived in the government plan in September 2011 and
received environmental approval in October 2013. The ground-breaking ceremony for the project
was held in January 2018 as its operation is expected to begin by June 2023.

Pag57
Officials said a new deep-sea port facility named Matarbari Port will be developed for importing
the coal required for the power plant which will include a 760m-long container and a multi-
purpose terminal.
The port terminal will include a fuel berth, fuel transportation facility, and two coal-handling
jetties. The channel length will be 14km, while the width 250m and the maximum depth
approximately 18.5m.
CPGCBL officials said the power plant may require 3.73 million tonnes (Mt) of coal a year,
which will be imported from Indonesia, Australia and South Africa through the Matarbari Port.
A consortium of Sumitomo, Toshiba and IHI was awarded the engineering, procurement and
construction contract for the project in August 2017.
Sumitomo subcontracted Toshiba Plant Systems and Services for constructing the port and
providing other plant equipment and associated civil work, while Penta-Ocean Construction was
awarded a $1.4bn-worth subcontract for the construction works related to Matarbari port.
Toshiba will supply the steam turbines and generators for the power plant, while IHI will provide
the boilers, said one official at CPGCBL.
He said Sumitomo awarded the civil engineering contract worth $840m to Posco E&C, a
company based in Korea, reports UNB.
Matarbari Power Plant Ecnec JICA Matarbari Coal-Fired Power Plant Coal Power Generation
Company Bangladesh Limited CPGCBL

Matarbari coal-fired power plant is being developed in Maheshkhali in the Cox’s Bazar district
of Bangladesh.
Coal Power Generation Company Bangladesh (CPGCBL), a state-owned enterprise of the
People’s Republic of Bangladesh, is developing the 1.2GW project with an estimated investment
of $4.5bn.
The Matarbari power plant was proposed in September 2011 and granted environmental approval
in October 2013. Ground-breaking ceremony for the project took place in January 2018, while
operations are expected to begin by 2024.
The plant is expected to account for 10% of the total generation capacity of Bangladesh.

Pag58
PROJECT GALLERY

Matarbari coal-fired power plant make-up

Matarbari thermal power plant will be developed on a 1,500-acre site. It will consist of two
thermal units based on ultra-supercritical coal-fired technology, with an installed capacity of
600MW each.
Each of the two units will consist of a steam-based pulverised coal-fired boiler unit, a 600MW
steam turbine and a 750MVA steam generator. The plant will feature a 275m-high flue gas stack
and an electrostatic precipitator, which will limit the particulate emissions to 100mg/Nm³.
The power plant will require 180,000m³/h of water, which will be provided by a reverse osmosis
(RO) desalination plant. The RO plant will draw water from the Bay of Bengal, which is located
on the western side of the project site.
Infrastructure for the power plant
A new deep-sea port facility named Matarbari Port will be developed for importing the coal
required for the power plant. The port will include a 760m-long container and a multi-purpose
terminal.
The port terminal will include a fuel berth, a fuel transportation facility, and two coal-handling
jetties. The channel length will be 14km, width will be 250m and maximum depth will be
approximately 18.5m.
A new 400kV transmission line will be developed to transmit the electricity generated by the
power plant to the national grid.
Coal supply for Matarbari power plant
The power plant is expected to require 3.73 million tonnes (Mt) of coal a year, which will be
imported from Indonesia, Australia and South Africa through the Matarbari Port.

Pag59
A coal unloading system equipped with rail-mounted continuous bucket type unloaders will
transport the imported coal to the power plant.
Financing
Japan International Cooperation Agency (JICA) provided an Official Development Assistance
(ODA) loan of ¥10.74bn ($90m) for the project, in June 2014. The ODA loan has a repayment
period of 30 years and grace period of ten years.
JICA awarded another ODA loan worth ¥2.65bn ($20m) to the Government of Bangladesh in
June 2018 for the development of the Matarbari port.
Contractors involved
JICA Study Team and Tokyo Electric Power Services prepared the environmental impact study
for the power plant.
A consortium of Sumitomo, Toshiba and IHI was awarded the engineering, procurement and
construction contract for the project, in August 2017.
Sumitomo subcontracted Toshiba Plant Systems and Services for constructing the port and
providing other plant equipment and associated civil work, while Penta-Ocean Construction was
awarded a $1.4bn-worth subcontract for the construction works related to Matarbari port.
Toshiba will supply the steam turbines and generators for the power plant, while IHI will provide
the boilers.
Sumitomo awarded the civil engineering contract worth $840m to Posco E&C, a company based
in Korea.
Roads and Highways Department (RHD), Bangladesh contracted DevCon for the detailed design
and supervision of access road construction for the Matarbari coal-fired power plant.

Pag60
Background of the Project
As Bangladeshi economy grows, its demand for energy has steeply increased. The domestic
energy  supply in 2013 is about 180% of the supply in 2000. According to the draft of Power
System Master  Plan 2015 (draft PSMP2015), Bangladeshi economy is estimated to grow at 6.0-
6.5% per year toward  2041. To cover this economic growth, the power source needs to be
developed progressively. The draft  PSMP2015 estimates that the power demand will grow from
15,475 MW in 2015 to 57,000MW in  2041. The draft PSMP2015 also estimates that the total
demand for coal in 2041 will be 80,728  thousand ton, of which 97.5% i.e. 79,500 thousand ton
will be imported. However, it is difficult to  import fuel coal to each coal fired power plant
(CFPP) directly by large-scale coal carrier since most  of the coastal area of Bangladesh has a
shoaling beach. It is also inefficient to transport imported coal  by small vessels which can pass
through existing channels to each power plant in terms of economy  and stable coal supply.
Therefore, the construction of a coal transshipment terminal (CTT) that can  accommodate large-
scale coal carriers is indispensable to the realization of the above-mentioned  CFPPs. As the
Matarbari area in Cox’s Bazar District in Chittagong Division is the only promising site  that has
easy access to the deep sea area and has limited adverse impact on the surrounding  environment,
construction of the CTT with deep sea-port that can accommodate large coal carriers at the
Matarbari area and realising the economic and efficient imported coal supply to the CFPPs
constructed in the country are considered imperative. 
This study aimed to improve the stable supply of imported coal by constructing CTT as a
common  infrastructure for Bangladesh where many CFPPs are planned to be constructed. This
study also aimed to develop the assistance plan assuming the participation of Japanese investor
and to develop a project  implementation program in which the utilisation of official
development assistance (ODA) loan and  the Japan International Cooperation Agency (JICA)
overseas investment loan was considered. For  these aims, this study focused on the following
two issues; 
(1) To develop the coal logistics system to satisfy the imported coal demand for planned CFPPs 
(2) To formulate the CTT plan to secure the returns of the investment from the CTT operation
and to  make this investment as a meaningful investment. 
(Coal Demand) 
Annual coal handling volume at CTT was estimated based on the future development plan of
CFPPs.  The Power System Master Plan 2015 (draft PSMP2015) Study, which is being studied
under JICA,  estimates the total electric power demand in 2041to be 52,000 MW. According to
the draft PSMP2015’s scenario, the proportion is as follows: natural gas: 35%; coal: 40%; oil:
5%, and others  (nuclear: 8% and imported power: 12%). The draft PSMP2015 estimates that the
total demand for coal  in 2041 will be 80,728 thousand ton, of which 97.5% i.e. 79,500,000 t will
be imported. It alsoestimates that 86.5% of coal will be used for the power sector. The coal
demand was also considered  based on the draft PSMP 2015.  

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The maximum annual coal handling volume was determined based on the planned CFPPs using 
imported coal for which the Bangladeshi government has signed a memorandum of
understanding  (MOU). Development of CFPPs using imported coal started in 2012 with a
capacity of 1,320 MW and  consuming 3.82 Mt of coal per year. The capacity will reach 23,691
MW with 68.7 Mt of coal per year  in 2041. However, it is difficult to make a precise estimate of
the commencement date of operation. 
Therefore, phased development plan of CTT was recommended to have enough flexibility, i.e.,
to  expand the CTT when the power generation program develops and the realistic commission
operation  date (COD) becomes certain. 
As the first phase of the CTT will commence operation in 2025, the object of the 1st Phase will 
include these power stations that will commence operation by 2029 and use the CTT. The total
generating capacity of these units will be 3,800 MW. The following 2nd Phase, which is planned
to  commence operation in 2030, targets those plants with COD later than 2030, and the total
generating  capacity will be 5,240 MW. 
(Coal Logistics) 
It was assumed to procure coal from Australia and Indonesia in the CTT project, although
procurement  plan of coal for CFPPs has not been decided and loading ports have not been
specified yet. Australia  and Indonesia are main supplying countries of coal and the distances
from Australia and Indonesia are  more efficient than from other coal producing countries.
Transit time from Australian coal loading  ports to Matarbari is about 19 days, and transit time
from Indonesian loading ports is about eight days. 
From the view-point of loading operation and chartering vessels, vessel size for imported coal is
Panamax size which is the acceptable maximum size for channel of Matarbari CFPP.
Considering the  current conditions of canal, secondary transportation through conveyor is used
in the 1st Phase, and  secondary transport vessels of 5,000 DWT are considered in the 2nd
Phase. 
(CTT Layout Plan) 
The capability of expansion, impacts on the surrounding environment, construction cost,
construction  work impact and others were considered for the determination of the layout of
CTT. The CTT facilities include coal unloading berth, coal loading berth, expansion of inner
harbour for Matarbari CFPP, coal  stock yard and belt conveyor from unloading berth to coal
stockyard. Secondary transportation  facilities to the surrounding CFPPs are not within the scope
of CTT but under the CFPPs. 
The layout plan in the 1st Phase was mainly considered to minimize the effect to the
surrounding  society and environment, since early start of operation is required in Bangladesh.  
There are several options for the determination of the layout plan in the 2nd Phase depending on
the  existence or non-existence of resettlement before the implementation of the 2nd Phase. In
this study,  the case where resettlement has not been conducted until the start of the 2nd Phase

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study is employed  as the base case. If resettlement has been conducted based on other applicable
studies, alternative plan  is also considered. 

Source：JICA Study Team 

Figure CTT Layout Plan (Left：Base Plan, Right：Alternative Plan) 
(Port Plan) 
The above mentioned coal import ships and secondary transport ships were considered for the 
determination of the port plan. Survey results of existing facilities and dimensions of coal
transport  ships were considered for the determination of the capacity of the coal unloader and
two continuous  coal unloader of 2,500 t/h per berth with unloading efficiency of 75% were
selected. Based on a 
similar study, one loader of 1,500 t/h per berth with loading efficiency of 90% was selected. 
Considering the existing CTT, annual operation days of 350 days and working hours of 18 hours
were  considered. 
The recommended berth occupancy ratios shown in “Port Development – A handbook for
planner in  developing countries” issued by the United Nations Conference on Trade and
Development  (UNCTAD) as well as the above mentioned conditions were considered for the
determination of the  required number of coal unloading berths. Average waiting time of vessels
computed by queuing 
theory and other factors were also referred for the determination of the required number of
unloading  berths. 
(Terminal Plan) 
The outdoor coal storage was proposed as the coal storage type in this study from the perspective
of  safety control against spontaneous combustion in handling sub-bituminous coal because it
may cause  serious damage by fire accident unless appropriate measures against spontaneous
combustion are 

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provided. The outdoor coal storage such as that involving stockpile, stackers, and reclaimers is
used  for piling and delivering the coal because of its advantage in terms of expenses and
handling operation  convenience, including its measure against spontaneous combustion.
However, it requires appropriate  coal dust control such as installation of dust-control fence and
sprinkling of water because it may affect the surrounding environment. 
For general operation in the CFPP, 1 to 2 month’s coal stock is required in the CFPP stockyard.
In this  study, one month stock is necessary to operate stably. The effect of rough wave
conditions during the  monsoon season on berth working ratio was considered in determining the
necessary coal stockyard  area for the case of offshore unloading berths without breakwater.  
(Outline of Execution Plan and Schedule for Construction Works) 
The outline of execution plan for the construction works was prepared based on the proposed
phased  development plan of this project. Outline of construction schedule was prepared based
on the  conceptual design for each development phase as well as the above mentioned execution
plan.  Tentative overall project schedule was also presented based on the phased development
plan and  outline of execution plan and schedule of construction works. 
This information includes trade secrets. 

Source：JICA Study Team 

Figure Tentative Overall Project Schedule (Original Plan) 
The possibility of earlier opening of CTT was studied according to the request of the Coal
Power  Generation Company Bangladesh Limited (CPGCBL). The recommended
countermeasures were  mentioned for the construction stage and preparation stage. When all the
countermeasures are applied,  it is possible to open half of the area of the CTT after 36 months
from the commencement of  construction, which is 12 months earlier than the original plan.
Construction schedules and the project schedule as a result of the study shown in this section are
the earliest schedules and the actual required  time of opening CTT is not considered. Reasonable
time of opening and the possibility of the  recommended countermeasures shall be studied in the
next stage. 

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Preparatory Survey for the Construction and Operation of Imported Coal
Transshipment Terminal Project in Matarbari Area This information includes
trade secrets.

 Source：JICA Study Team 

Figure Tentative Overall Project Schedule (Shorter Plan) 
(Terminal Management) 
In order to make the project successful, it is important to determine the project risk assignment 
between the government and the private sector. For this reason, the application of Japanese
ODA, which the government manages, is expected for the lower part of the infrastructure for
unloading berth,  loading berth, and coal stockyard, and for the CTT project including the
investment for the upper part  of the infrastructure, the private sector consisting of both Japanese
and Bangladeshi firms shall set up  a special purpose company (SPC) and invest and operate the
terminal. For the performance of each  work, it was expected that reliable companies will be
selected for each work and the work will be  performed under subcontract arrangement. For the
organisation of SPC, the following scheme was investigated. 
This information includes trade secrets.

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 Source: JICA Study Team  
The running cost of CTT operation was obtained from personnel expenses, utilities expenses,
water  charge, depreciation cost, maintenance cost of coal handling equipment, insurance cost,
land usage fee,  maintenance cost for the lower infrastructure and other necessary expenses
which were obtained by  considering the anticipated project scheme and the features of the
organisations and the port and  terminal. 
(Financial Analysis) 
Construction cost, maintenance cost and operation cost for each phase have been obtained and 
financial and economic analysis has been done. Several general conditions such as application
of  normal market price at the project site, negligence of price fluctuation and interest of rent
money, and  inclusion of consultant fee for detailed design and supervision of construction works
were applied for  obtaining the construction cost. The estimation of terminal operation cost is
obtained from above studies. Feasibility is evaluated by calculating terminal handling charge
(THC) per tonne which fulfills  the equity internal rate of return (IRR) of the special purpose
company (SPC) required by the public  investor. It is common to calculate the minimum rate of
return on a capital investment project (hurdle  rate) for investment as “capital cost plus spread
between domestic and overseas interest rates”.  
The term of the project is from 2021 to 2055, and the financial analysis was considered from the 
commencement of the construction work. Thirty percent of the total project cost was assumed to
be  financed by the investors’ equity from both Japan and Bangladesh and the rest of the project
cost was  assumed as loan under the JICA “Private Sector Investment Finance (PSIF)”. 
The THC is assumed to be based on take or pay mechanism, which consists of capacity charge
(fixed  charge for installed capacity of CFPP) and variable charge. Fluctuation of capacity
charge, which  includes the cost of compensation for the financing cost, its interest and capital
cost including dividend and tax cost, and compensation for the fixed operation and management
(O/M) cost such as labour  cost and periodic maintenance during the project period, was

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considered based on the idea that phased  development is employed in accordance with the
increase of coal demand. The THC is based on the  assumption that the capacity charge
guarantees the agreed income amount of SPC as long as CTT  maintains its performance, which
is mutually agreed in advance. In other words, the price in each  phase was obtained based on the
assumption that the coal demand in each phase will not increase  during the project term. 
(Economic Analysis) 
The “With Project Case”, wherein the CTT project will be conducted, and the “Without Project
Case”,  in which coals from Indonesia and Australia will be imported and transshipped form
large vessels to  small barge offshore, and transported up to 5,000 DWT for other CFPPs, were
considered in the economic analysis. The benefit is considered as the difference between the total
project cost for the  “With Project Case” and “Without Project Case”. 
An economic internal rate of return (EIRR) of more than 12% was obtained from the economic 
analysis and this is larger than the social discount rate (SDR) of 12%, which is employed in
similar  study in Bangladesh indicating that the project will be feasible from the perspective of
the national  economy. 
(Concerned Local Laws and Regulations) 
Currently, projects developed jointly by the private and public sector, whether as build-operate-
transfer  (BOT), build-own-operate (BOO), build-own-operate-transfer (BOOT) or otherwise, are
generally  subject to Bangladeshi Law. Whilst exemptions may be negotiated with the
government on a project  by project basis, e.g. with respect to public procurement, transfer
restrictions, and foreign exchange  rules. there is currently not yet a dedicated legal regime for
public-private partnership (PPP) projects. 
Based on the indicative time schedule of the project, it is likely that the PPP Law would have
been  passed by the time the CTT project is being tendered, but it is uncertain to what extent
secondary  legislation would have been promulgated at that point. 
Implementing a large infrastructure project such as the CTT project will involve various kinds of 
project risks such as country/political risks, natural risks, legal risks and commercial risks. These
are  the typical types of risks which investors would carefully consider and which should be
carefully  allocated between the government and the private investor in order to ensure the
commercial viability  and bankability of the CTT project. 
(PPP Project Plan) 
The SPC is supposed to be formed through the joint investment of the government entity and private 
company to fund the construction of the upper infrastructure of the CTT. It was recommended that the 
SPC, which raises funds, constructs, manages, and operates the upper infrastructure of the CTT, should 
have an experience of operating and managing the CTT in Bangladesh or some other countries
and of  procuring and supplying coal domestically and internationally and is a coal user, such as
independent  power producers (IPPs) operators.  
Debt financing under the JICA private sector investment finance (PSIF), which is long term and
low  interest non-recourse project finance is the most probable option to improve the profitability

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of the  project. Then, SPC will be responsible for its management and operation after completion
of the  construction. 
(Proposed Plan of CTT) 
The recommendation plan was proposed for the efficiency of the CTT project. The plan is to manage  the
coal handling facilities of Matarbari CFPP No.1 and No.2 and the CTT integrally. The Matarbari  CFPP
No.1 and No.2 plan to construct coal unloading berth and coal stockyard whose capacity has leeway for
operation. Therefore, it is possible to make the operation more efficient through the unified 
management of the CFPP and CTT. 
The current study was categorised by JICA as category B because the environmental impacts are
not  significantly critical adverse impacts and they are site specific and mitigable by normal
mitigation  measures. Considering the case with small-scale resettlement at the planning stage,
the study covers  the environmental study at the initial environmental examination (IEE) level
and the framework of the  resettlement action plan (RAP) and the terms of reference (TOR) for
the required study such as  environmental impact assessment (EIA) and RAP. The environmental
study to meet the requirement  under the official process for the EIA should be continued by the
implementation agency after the  current JICA study through the submission of the IEE report
and TOR for EIA to obtain the approval of the Department of Environment (DoE).

Project Site 

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Country: Bangladesh; District: Matarbari 
Currently, the construction of Matarbari CFPP No.1 and No.2 and deep seaport for
accommodating  large coal import ships is in the planning stage. In this study, use of this deep
seaport for importing  coal and secondary transport of coal to the anticipated CFPP by CTT were
assumed. Ship operation for  coal import to Matarbari CFPP No.1 and No.2 and future land use
concept of this region were also  considered in the study. 

So
urce：http://www.in2bangla.com/upazilaMap.php?id=293 
Figure 1.3.1 Project Site 
Natural Conditions of the Region 
Topographical Feature 
The People’s Republic of Bangladesh is located at the east side of the Indian subcontinent facing
the  Bay of Bengal. Most part of Bangladesh is located in the world’s biggest delta of the Ganges
River  (Padma River in Bengali), the Brahmaputra River (Jamuna River in Bengali), the Meghna
River, and  their distributaries. The project area is located about 150 km south of Chittagong in
the southeastern  part of Bangladesh, and on the coast near Cox’s Bazar. 

Climate 

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(1) Outline 
Bangladesh has a tropical climate which changes by season. During the summer season from
March to  June, it is hot and humid and the maximum temperature is about 24-35 ℃, and
occasionally over  40 ℃. During the monsoon season from June to October, the temperature
decreases due to rainfall.  The winter season from October to March is warm. The yearly average
rainfall in Bangladesh is about  2,300 mm and the rainfall from June to September accounts for
80% of the total rainfall. 
(2) Temperature 
Weather observation stations are located in Cox’s Bazar and Kutubdia near the project area.
Annual  changes of temperature in both areas are not so different, and seasonal change is nearly
fixed. The  temperature in January is 19-21 ℃. After January, the temperature is getting higher
and higher and it  is 28-29 ℃ in April. During April and October, the temperature remains at 27-
29 ℃. However, the  temperature during July and October gets cooler than that during April and
June. During November  and December, the temperature is getting cooler and the temperature in
December is 21-23 ℃. The  maximum monthly average temperature in Kutubdia is 29.4 ℃ in
May 2010, and that in Cox’s Bazar  is 29.9 ℃ in April 2010. On the other hand, the minimum
monthly average temperature in Kutubdia  is 18.9 ℃ in January 2003, and that in Cox’s Bazar is
19.6 ℃ in January 2003. 
(3) Rain fall 
The yearly average rainfall in Kutubdia is 4,321-5,905 mm, and that in Cox’s Bazar is 5,286-
6,707 mm. Most of the rainfall is during May and October. On the other hand, it has never rained
in some  months such as November and April. In this way, the rainy season is obviously different
from the monsoon season. 
(4) Humidity 
Annual change of humidity in Kutubdia and Cox’s Bazar is calm, and seasonal change is nearly
fixed.  Throughout the year, the humidity is 65-90%. In the rainy season from May to October,
the humidity  is 75-90%. And in the other season from November to April, the humidity is 65-
85%. 
(5) Wind 
In Cox’s Bazar, the wind is usually “calm (less than 0.5 m/s)”. Especially during September and 
March, the wind is “calm” for more than 50% of the day. However, in the other points, the
features of  wind directions are same in both areas. In January and February, prevailing wind
direction is northerly.  However, there is no especially strong wind. During March and October,
prevailing wind direction is  southerly, and it is significant especially during April and
September. In July and August, the wind  speed of southwesterly is slightly strong. Apart from it,
however, the speed of strong wind is not  significant. In October, wind direction changes from
south to north, and the wind speed of  southwesterly tends to be strong. In November and

Pag70
December, prevailing wind direction is northerly.  However, wind speed of southwesterly tends
to be strong. 

Socio-economic Condition of the Project Area 

Location 
Project site is located between Matarbari Union and Dhalghata Union in MaheshkhaliUpazila in 
Cox’s Bazar District of Chittagong Division. 

Figure 2.2.1

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Project Three
HazratShahjalal International Airport Expansion

Pag72
AIRPORT DEVELOPMENT HISTORY
During the nine-month long liberation war in 1971, the entire aviation infrastructure of the
country was severely damaged. The Department of Civil Aviation (DCA) and the Airports
Development Agency (ADA), together hand in hand with all their past experience and patriotic
enthusiasm, reconstructed and repaired the airports at Tejgaon (Dhaka), Chittagong, Sylhet,
Jessore, Ishurdi, and Coaxes Bazar within amazingly short period of time that facilitated post
liberation relief operations and enabled civil air transportation to re-commence

Tejgaon Airport, Dhaka

Tejgoan Airport had been the only international airport of the country until HazratShahjalal
International Airport was commissioned. In addition to the post liberation reconstruction woks,
the runway of this airport was re-carpeted in 1976, along with an apron for Boeing operation. In
the same year, the terminal building was extended to meet the increased demand for more office
space. By the year 1983 the aeronautical and navigation equipment along with the office
establishments were shifted to HazratShahjalal International Airport at Kurmitola.
Initial works
It was in the year 1966 that a project was taken by the then Pakistan Government to construct a
new airport at Kurmitola, Dhaka in order to meet the provincial and regional demand.
Construction work also started that came to a halt due to liberation war in 1971. After liberation,
the Government of Bangladesh decided to build the airport as the principal international airport
of the country and appointed the Airport de Paris of France as consultant for the purpose. The
airport was put in operations in the year 1980 while the project took three more years to
complete.
Later works
In the later days, three major complexes at HazratShahjalal International Airport were
constructed. These were VVIP terminal, domestic terminal and flying club along with associated
aprons and taxiways. A flood protection embankment around the airport was constructed in the
year 1988-89. Six boarding bridges and associated corridor and holding lounge were constructed
in 1993-94. Two more boarding bridges are under process  for procurement and installation by
June 2010

Cargo village
The old cargo complex had been insufficient for long. As HazratShahjalal International Airport
plays the most vital role in cargo transportation, increasing the cargo handling capacity of the

Pag73
airport was inevitable. To comply with the demand, CAAB took a project of constructing a giant
cargo village with a terminal and a separate building for associated office works. By the year
2000, the construction work of the village having a floor-area of two hundred thousand square
feet was complete. Afterward, the complex was handed over to Biman Bangladesh Airlines ltd.
for management of cargo operations.
Multi-storied car park

Recently a multi-storied car park has been constructed at the north side of the old car park in
front of the terminal building. Presently, with three layers, capacity of the park is 500 cars. It was
opened for public on 24th August, 2002. Another layer shall be constructed in the future which
shall increase the capacity to 600 cars.

Renovation of Departure Floor

In order to facilitate departing passengers, the Departure Floor of the terminal building under
went a complete renovation and refurbishment. Check-in counters and immigration desks were
smartened up turning it into more aesthetic in fashion and efficient in work. Biman Bangladesh
Airlines ltd. equipped the check-in counters with a computer network called CUTE (Common
User Terminal Equipment).

Extension of Terminal Building

HazratShahjalal International Airport had been failing to cope up with the increasing number of
flights and passengers. To expand the cargo handling capacity, a cargo village was constructed.
Then in order to increase the passenger handling capacity, the terminal building has been
extended, in 2 phases, 1.5 times the older one. In the 1st phase, the ground floor and in the 2nd
phase, the 1st, 2nd and mezzanine floors were constructed. HazratShahjalal International
Airports passenger handling capacity now therefore raised to 8 million per year, almost 2 times
the previous capacity, and we expect that this airport will go on meeting well the needs for
further 20 years or more.

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Replacement of existing DVOR & DME at HazratShahjalal International
Airport

HazratShahjalal International Airport is the main gate-way of Bangladesh. The DVOR and DME
was installed in 1993 at HazratShahjalal International Airport. To provide modern navigational
facilities for safe and secured landing of aircrafts on the runway at HazratShahjalal International
Airport, a project name �Replacement of Existing DVOR and DME at HazratShahjalal
International Airport, Dhaka� was taken in hand in the year 2003 and completed in 2008

Up-gradation of HazratShahjalal International Airport

A project named �Up-gradation of HazratShahjalal International Airport (HSIA)� has been

taken in hand to up-gradate HSIA in respect of implementing new communication and
navigational system and strengthening of Taxi-way of the Airport under Mixed credit financing
of the Ministry of Foreign Affairs of Denmark. The DPP of the project has been approved in
ECNEC meeting held on 15.07.08. Total project cost is Tk. 41404.75 Lakh. The project is
scheduled to be completed by June�2012

Pag75
HAZRAT SHAHJALAL INTERNATIONAL AIRPORT, DHAKA

Dhaka’s Shahjalal International Airport is the first point of contact with Bangladesh for many
visitors to the country. As the largest airport in Bangladesh, Shahjalal International Airport
started operating in 1980, taking over the international air travel traffic from Tejgaon Airport,
which is now a domestic airport. Shahjalal International Airport handled 5.6 million passengers
and 214,000 metric tons of air cargo in 2012, and has the facilities to serve 8 million passengers
per year. So, according to analysts, the airport will not need to be expanded until 2026. Twenty-
eight passenger airlines operate from the airport, offering both domestic and international flights.
Government-owned Biman Bangladesh Airlines is the airport’s ground handling agency.

The history of Shahjalal International Airport goes back to World War II when the British
government built a landing strip on the site as an alternative for the Tejgaon military airport. In
1947, following the creation of Pakistan, Tajgaon Airport gained status as the first civil airport in
the area then known as East Pakistan, and today is Bangladesh. In 1966, the Pakistan
Government undertook to construct a new airport north of Kurmitola and a railway was built to
transport construction materials. Today, this is the passenger railway station serving the airport.
The new airstrip was only halfway done when the 1971 Bangladesh Liberation War erupted and
the airstrip was badly damaged. After Bangladesh gained its independence, construction of the
airport was resumed, with Aéroports de Paris as consultants.

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The airport started operating with one runway and part of the main terminal complete, being
officially opened as Dacca International Airport in 1980 by President Ziaur Rahman.
Construction continued for a further three years and during this time President Rahman was
assassinated. When the airport was completed in 1983, President AbdusSattar renamed the
airport Zia International Airport in honor of the late president. The airport was renamed
Shahjalal International Airport in 2010 in honor of one of the country’s most respected Sufi saint
Shah Jalal.

Project Outline

The objective of the Project is to meet future demand of air transportation and to ensure
international standard of safety, security and facilitation by expanding airport terminal facilities
and developing related infrastructure at the HazratShahjalal International Airport, thereby
contributing further economic growth in Bangladesh.Mitsubishi and Fujita of Japan and
Samsung of Korea were awarded to construct the terminal under a consortium.The new
international passenger terminal building is set to have a floor area of around 2.25 million square
feet whereas the existing two terminals of the airport have space of around one million square
feet together.The expansion of HazratShahjalal International Airport will increase the airport's
annual passenger handling capacity from the current eight millions to approximately 20 million,
and cargo capacity from 200,000 tonnes to 500,000 tonnes.The three-storey third terminal
building, designed by RohaniBaharin of internationally renowned CPG Corporation (Private)
Limited Singapore, will have a floor space of 230,000 square metres.It will have 115 check-in
counters, including 15 self-service, 66 departure immigration counters, including 10 automatic

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passport control counter, 59 arrival immigration desks, including five automatic check-in counter
and 19 check-in arrival counters, while 16 arrival baggage belts will be set up.According to the
project design, the third terminal will have 12 boarding bridges and conveyer belts each.
Summary
The Ministry of Civil Aviation and Tourism (MCAT), Bangladesh, plans to undertake the
expansion of an airport in Bangladesh.The project involves the construction of a third terminal
building and a cargo facility. It is being developed in two phases.The first phase includes the
construction of the third terminal on 52.6ha of land, a cargo village, a VVIP complex and a
domestic terminal with a project value of US$ 1,368 million and the second phase includes a
new runway, an extension of apron and other related facilities with a project value of US$294
million.The project also includes the construction of a parking facility, an air traffic control
complex, duty-free shops and other related facilities.In April 2013, CAAB invited the
consultancy firms for the feasibility study.In May 2014, Yooshin Engineering Corporation
(Yooshin), CPG Corporation Pte Ltd (CPG Corp), and Development Design Consultants Limited
(DDC) were appointed as feasibility study consultants.

On May 20, 2015, China Airport Construction Group Corporation (CACC) submitted its interest
to finance the construction of the terminal.In June 2015, all preliminary procedures for building
the terminal was completed.CAAB submitted development project proposal (DPP) to Civil
Aviation Tourism Ministry.Nippon Koei Co Ltd has been appointed to build a third terminal and
other infrastructural development at the airport.In February 2016, Japan shows its interest to fund
the project and in May 2016, Government of Bangladesh and Japan has finalized the investment
agreement for the project.On November 3, 2016, CAAB issued tender to undertake the extension
of apron for the second phase of the project with a submission deadline on February 14, 2017,
and the date was extended to June 22, 2017.Japan International Cooperation Agency (JICA) will
finance the construction.
On June 11, 2017, CAAB has signed design and management consultant contract agreement for
the project Development Design Consultants Ltd as design and Oriental Consultants Global Ltd
for management consultant.Construction activities on the project scheduled to commence in
April 2018 and are expected to be completed in April 2021.

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HazratShahjalal International Airport Expansion, Dhaka

The HazratShahjalal International Airport in Dhaka, Bangladesh, is being expanded in order to

address the continued increase in domestic and international passengers and cargo passing
through the facilityTheHazratShahjalal International Airport in Dhaka, Bangladesh, is being
expanded in order to address the continued increase in domestic and international passengers and
cargo passing through the facility.The airport is anticipated to witness passenger traffic of
approximately 12 million by August 2022 and up to 22 million by 2035.
The ground-breaking ceremony of the third passenger terminal building and other infrastructure
was held in December 2019. Being executed by Civil Aviation Authority of Bangladesh (CAAB)
and the Ministry of Civil Aviation and Tourism, the expansion is scheduled for completion in
2022.
It is set to more than double the airport’s annual passenger handling capacity from the current
eight million to approximately 20 million, and the cargo capacity from 200,000t to 500,000t.
It is also expected to improve air transportation, as well as economic and social development in
Bangladesh.

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Shahjalal airport expansion details

The expansion includes the construction of the third passenger terminal building known as
Terminal 3, as well as a 5,900m² VVIP complex, 41,200m² cargo building and multi-level car
parking building with tunnel.

The new international passenger terminal building will have a floor area of roughly 226,000m².

Additionally, the project will see the construction of several exit and connecting taxiways, a
parking apron in Terminal 3, new roads to connect the terminal with the airport road and a
drainage system. Various water treatment, power supply, rescue and fire-fighting facilities will
also be built as part of the development.
Various water treatment, power supply, rescue and fire-fighting facilities will also be built as part
of the development.
A feasibility study is currently underway for the construction of a second runway parallel to the
main runway.

Contractors involved in the Bangladesh airport expansion

CAAB awarded a five-year contract worth ¥4.6bn ($42.1m) to a consortium led by Japanese
engineering and consulting company Nippon Koei for the project in August 2017.

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The consortium comprises Singapore-based CPG Consultants, Bangladesh-based Development
Design Consultants, and Japanese engineering consulting firm Oriental Consultant Global.
Yooshin Engineering, CPG Corporation, and Development Design Consultants took part in the
feasibility study of the project.

Hazrat Shahjalal International Airport history and existing facilities

Situated on an 802ha site in Kurmitola, north of the capital Dhaka, HazratShahjalal International
Airport began operations in 1980.

The airport has one domestic terminal and two international terminals with a maximum capacity
of eight million passengers a year.

The existing terminals will not able to accommodate the growing number of passengers due to
capacity constraints.

In addition, HazratShahjalal International’s existing cargo facility is facing flaws regarding its
safety and security systems and is also regarded as insufficient to accommodate the growing
cargo volumes.

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FINDINGS
The primary function of health systems is to provide high-quality and universal health services.
At the same time, through their spending and investments, health systems play an important role
in the status and stability of national and regional economies. To date, this economic contribution
has not been captured. Health systems play an increasingly important role in driving inclusive
and sustainable development through responsible practices in the areas of employment and the
purchasing of goods and services. This social benefit of health systems is not well documented or
currently considered in many mainstream policies and practices. This report sets out the
rationale, evidence and methods to understand the significant potential economic and social
impacts and benefits. The work seeks to support broader efforts to see health systems as key in
promoting equitable and inclusive development, helping to create benefits for the whole
community, in particular for those who are often left behind. Health and well-being contribute to
economic and social progress and in turn, economic security and social cohesion are two key
determinants of health. To achieve better social and economic conditions for health is mixed, and
that lack of economic security and of social cohesion are major factors in the differences
between countries, in terms of gaps in life expectancy, premature morbidity, and life-limiting
illness. In addition to health systems’ function to protect and promote the health of the
population, they have many economic and social impacts, which have been largely overlooked to
date. By making their social and economic impacts visible, health systems will benefit from a
stronger position in local and national development plans and investment strategies. This will
also make a significant contribution to shifting the debate from health systems being perceived as
only representing a cost, to them being understood as mechanisms that drive economic stability,
and as essential partners for achieving social and economic well-being.
IN a developing country context like Bangladesh where GDP has hit 7% growth rate per annum,
it is often said that infrastructure-megaprojects are crucial drivers for accelerating economic
growth. For these developing economies, the benchmark of 7% economic growth is usually
required both for capital accumulation to fund the mega projects and to reap the benefits of these
projects for boosting the growth rate to the magical two digit number. The Asian story of grand
success has shown the economists and practitioners alike that sustaining a two-digit growth rate
for at least 10-15 years is the key in pulling a miracle for economic transformation.

In the early days of development in the so called East Asian Tiger economies, the mega-
infrastructure projects evidently played a crucial role in accelerating economic growth. Even under the
Sustainable Development Goals framework, it is estimated that the world economies need to
spend about $57 trillion on infrastructure by 2030 to enable the anticipated levels of GDP growth
globally. Of that, about two-thirds will be required in developing countries like Bangladesh.

Even before the ‘Agenda 2030’was adopted, the present government in Bangladesh under the
leadership of Sheikh Hasina envisaged implementing a few mega projects in Bangladesh to
deliver the economic and social goods for millions of people in different parts of Bangladesh and

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to create the economic growth that will benefit the population. It is expected that these large
infrastructural undertakings and mega projects would transform the country's communications,
transportation, ports and energy scenario by 2030 and help the country to achieve high mid-
income country status by 2041

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RECOMMENDATION
Bangladesh might be one of only two ASEAN and South Asian economies to register positive
growth in 2020 when the world is almost certainly bound to a devastating recession caused by
the coronavirus pandemic.
By working together across the board, we can leverage our solid economic fundamentals and the
innate resilience of our communities to quickly regain lost ground, and achieve all our ambitions
and aspirations for our nation.

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