Bangladesh: Moving Towards Universal Healthcare?

February 22, 2012
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The launch of the Bangladesh Health Watch Report for 2011 was held at BRAC Centre Inn on February 20, 2012. The Hon’able Minister of Finance, Mr. Abul Maal Abdul Muhith was the Chief guest along with the Hon’ble Minister of Health and Family Welfare Prof Dr. A. F. M. Ruhal Haq. Nobel Laureate Prof Amartya Sen was the Guest of honour.

The launch of the Bangladesh Health Watch Report for 2011 was held at BRAC Centre Inn on February 20, 2012. The Hon’able Minister of Finance, Mr. Abul Maal Abdul Muhith was the Chief guest along with the Hon’ble Minister of Health and Family Welfare Prof Dr. A. F. M. Ruhal Haq. Nobel Laureate Prof Amartya Sen was the Guest of honour. Representatives of the Bangladesh Health Watch Prof Rounaq Jahan, Dr. Faruque Ahmed, Dr Syed Masud Ahmed and Dr Ahmed Al Sabir also spoke at the occasion. A large audience of relevant policy makers and professionals attended the ceremony. This year’s report is titled “Moving towards Universal Health Coverage”.
This was the fourth report of the Bangladesh Health Watch, an effort in 2006 as a civil society initiative to monitor the progress of good health for all in Bangladesh. The earlier reports covered areas such as health equity (2007), health human resources (2008) and governance of the health sector (2009-10).
The Constitution of Bangladesh recognizes health as a fundamental right of its citizens although ensuring this right has been a challenge for the State. Access to quality health services in the country is limited to those economically well-off while the majority of the nation does not possess the financial means. Health care cost has been on the rise with very high out of pocket cost and quite often it results in monetarily devastating entire families. Universal Coverage is one of the strategies to ensure health rights of the citizens by addressing the healthcare financing challenges. Universal health coverage (UHC) requires all people to have access to needed health services – prevention, promotion, treatment and rehabilitation – without the risk of financial hardship or ruin associated with accessing services. Among the neighboring countries, Thailand has achieved Universal Coverage for all its citizens.
Member States of the World Health Organization (WHO) through resolutions in the World Health Assembly of 2005 and 2011 have set themselves the target of developing their health financing systems in order to accelerate and sustain progress towards universal coverage. As the movement for Universal Health Coverage intensifies globally, there is an imperative to prepare Bangladesh for it. This year’s report of Bangladesh Health Watch makes a persuasive case for Universal Coverage, identified challenges, and made specific recommendations. According to the report, UHC is ethically correct, financially viable and politically timely.
Of the challenges, affordability, level of political and public commitment to health, and the inadequate level and quality of healthcare services for people who are worse off – either because they are poor or ill – are the most important ones.
Tackling these challenges would require a) raising more funds for health and/or diversifying funding sources – making health a higher priority in existing government spending; making revenue collection more efficient; diversifying sources of revenue using innovative domestic financing; saving on inefficient spending; increasing external support; b) Providing or maintaining an adequate level of financial risk protection by relying largely on forms of prepayment (e.g. insurance and/or taxes) to raise funds, then pooling them to ensure access and spread financial risks. This will help minimize reliance on direct, out-of-pocket payments; and c) Improving efficiency and equity in the way funds are used by ensuring that people do not pay too much for medicines and using them more appropriately as well as improving quality control, improving hospital efficiency, choosing the right services, finding incentives that work, avoiding fragmentation, and creating accountability by separating the service purchasing functions of MoHFW from the service provisioning functions.
BRAC established its health programme in the early seventies. Among many other Health care interventions , BRAC Healthcare Innovations Programme is an innovative and comprehensive health protection scheme that can be a pathfinder for 21st century NGOs, seeking to offer Universal Health Coverage (UHC).The James P. Grant School of Public Health at BRAC University (SPH) in collaboration with BRAC Health Programme is exploring the strategy and design of BRAC Healthcare Innovations Programme (B-HIP), that intends to offer health insurance products to the people at the ‘base of pyramid’ in Bangladesh. B-HIP is primarily focusing on financing and service provisioning at primary, secondary, tertiary and catastrophic levels.
The goal of Universal Healthcare is a highly politically charged and revolutionary change for a society to undertake. Even developed nations, such as the United States of America, have failed to establish a system due to decades of privatization and well established lobbyist efforts. The goal however, is not an unreachable one. Moreover, if the Government of Bangladesh seeks to move forward with this massive overhaul of the healthcare system, it is likely that BRAC will be an essential partner.
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