The Lancet  
Nov 23, 2013  Volume 382  Number 9906  p1679 – 1756  e25
http://www.thelancet.com/journals/lancet/issue/current

Series
Bangladesh: Innovation for Universal Health Coverage
The Bangladesh paradox: exceptional health achievement despite economic poverty
A Mushtaque R Chowdhury, Abbas Bhuiya, Mahbub Elahi Chowdhury, Sabrina Rasheed, Zakir Hussain, Lincoln C Chen
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Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country’s success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households.

Bangladesh: Innovation for Universal Health Coverage
Harnessing pluralism for better health in Bangladesh
Syed Masud Ahmed, Timothy G Evans, Hilary Standing, Simeen Mahmud
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How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defined by the participation of a multiplicity of different stakeholders and agents and by ad hoc, diffused forms of management has contributed to these outcomes by creating conditions for rapid change.