Moving towards the goal of Universal Health Coverage (UHC) in Bangladesh

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Moving towards the goal of Universal Health
Coverage (UHC) in Bangladesh

• Md. Ashadul Islam
• Director General
• Health Economics Unit
• Ministry of Health and Family Welfare

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Health Sector of BangladeshA Story of
Achievements

• Bangladesh over the years have achieved
  remarkable progress
• Through the government agenda the country has
  been on track with the health MDGs
• The country has the highest EPI coverage (82)
  amongst neighboring countries

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Reduced Mortality and Increased Life Expectancy
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Progressive improvement in child health over the
years
Sources Measure DHS- Demographic and Health
Survey URL http//www.statcompiler.com/
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Reduced Fertility Rate andincreased
Contraceptive Prevalence Rate
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Health gains achieved with relatively low level
of resources
Source WHO-NHA Data-base
THE is 3.7 of GDP but public spending is only
1.4 of GDP
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Health Care Financing Features

• We have a HCF system as part of the national
  financial management system.
• Main Features
• Share in the national budget --- 4.27
  (2013-14)1
• Public spending as of GDP --- around 1.41
• Per capita Health expenditure---US 27 (2011)1
• Out-of-pocket---64 of Total health
  expenditure(THE)2
• Coverage of insurance --- lt1 of THE2
• Government is financer and provider of services
• Budget norms follow civil service and budgetary
  regulations and codes.

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Total Health Expenditureis increasing over time,
it has increased from 48,000 million taka in 1996
to 300,000 million taka in 2011 (almost 6 times
in 15 years)
Million Taka
Source WHO-NHA Data-base
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So the increase in THE means most of the spending
is coming from households
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Source WHO-NHA Data-base
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Health Financing in Bangladesh(2006-2007)
Million Taka Taka 69 1 US
Source BNHA 1997-2007
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Comparison of health expenditure - 2011
Country Per capita total health spending (US ) THE as of GDP Public HE as of GDP Per capita govt spending (US )
Bangladesh 27 3.7 1.4 9.7
India 59 3.9 1.2 18.3
Nepal 33 5.4 2.1 13.0
Pakistan 30 2.5 0.7 8.0
Sri Lanka 97 3.4 1.5 43.1
Indonesia 95 2.7 0.94 33
Vietnam 96 6.9 2.7 38
Source WHO-NHA Data-base
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increase in National and Health Budget - a
comparison
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Challenges in Bangladesh

• Inadequate funding for the whole health system.
• -Government budget is 1.4 of GDP, Total Health
  Expenditure (THE) is 3.7 of GDP.
• Inequity in financing and utilization
• -main source of financing for health care is
  out-of-pocket payment (64 of THE)
• Inefficient use of resources
• -due to absence of proper resource allocation
  formula, shortage of health workers, vacant posts
  (44) in public health facilities, lack of
  provider autonomy, no purchaser-provider split,
  duplication of programs and insufficient
  coordination leading to wastage

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Common concerns across the globe

• Increasing health care cost
• Protect people from financial consequences of
  health care payment
• Expand fiscal space in spite of macro-economic
  constraints
• Use of available resources efficiently and
  equitably
• For all these, Health care financing is moving
  towards
• Universal Health Coverage (UHC)

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Whats next?
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Universal Health Coverage
Ensuring that all people can use the promotive,
preventive, curative and rehabilitative health
services they need, of sufficient quality to be
effective, while also ensuring that the use of
these services does not expose the user to
financial hardship (WHO)
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Moving towards the UHC Goal

• UHC is a continuous journey
• No single model of universal coverage
  successful programs vary and the starting point
  is the country context
• But relevant to all (rich and poor) countries,
  because all want to
• Reduce the gap between need and utilization
• Improve quality
• Improve financial protection

Source Kutzin, J. (WHO) Presentation Kenya June
2013
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Bangladesh Steps toward UHC

• Renewed Commitment through Health Policy 2011
• Revitalized and established nearly 13000
  community clinics and improved hospital services
• Increased health manpower for hospitals and
  health centres to provide health care services
• Increased efficiencies in procurement,
  distribution and utilization of essential
  medicines and equipment
• Expanded demand side financing for ante-natal
  care and deliveries attended by skilled birth
  attendants
• Adoption of the HEALTH CARE FINANCING STRATEGY

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What needs to be done?
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Who will benefit from UHC?
Poor 48 million
Formal Sector 18.8 million
Informal Sector 85.7 million
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What is planned to attain UHC?
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Supporting the move towards UHC
SSK Pilot Implementation Other coverage programs
formal and informal sector
Development of legal, regulatory and financial
framework
National Social Health Protection Scheme
Strong political leadership and commitment
Advocacy and multi-sectoral support for UHC
Capacity building on Health Care Financing at
all levels
Strengthening the health system building blocks
Monitoring progress and Evidence-based policies
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Role of Health Economics Unit
Universal Health Coverage
Equitable Financial Access to Essential Quality
Health Services
Evidence Based Policy Development
HCFS Implementation
Coordination and Steering
UHC monitoring National Health Accounts
Legal Framework Development
Equity, Efficiency, Economy, Effectiveness
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Thank you