The health ministry has proposed doubling health sector allocation to bring down out-of-pocket expenditure to a bearable level by sharing the cost of treatment of patients in private hospitals alongside building a strong urban primary health care system. This plan will help the government achieve universal health coverage, part of the UN Sustainable Development Goal 2030.
The health ministry's recommendations are based on a draft report prepared by London-based think tank Chatham House with financial assistance from Unicef.
The health ministry last week wrote to the finance ministry, seeking the political decision of the government to implement the recommendations.
In its letter sent to the finance ministry last week, the health ministry said, "The basic principle of universal health coverage is to ensure all necessary services within the financial capacity of all the people of the country. This is a challenging target for a developing country like ours."
Health Secretary Dr Anwar Hossain Hawlader told The Business Standard that Bangladesh has to achieve universal health coverage by 2030 as per the conditions of SDGs. Chatham House will provide us with technical support on what strategy will be useful for our country to achieve this. They have provided technical support to different countries of the world.
"The think tank will let us know how it will work with us. After that, we will decide when the work will start. We will start working after reviewing the strategy they offer us."
The policy institute's report "Achieving Universal Health Coverage in Bangladesh: An Exploration for Policy Options" was prepared after analysing the current status of the health sector and the current trend of economic progress, and reviewing successful initiatives of other developing countries.
Chatham House, also known as the Royal Institute of International Affairs, in its report recommended raising budgetary allocations for the health sector in Bangladesh to 2% of the country's GDP, which stands at 0.83% in the current fiscal 2022-23.
Highlighting the successful initiatives of Vietnam, the Philippines, Sri Lanka, India, and Bhutan, the independent policy institute identified a number of areas to work on for ensuring quality healthcare and reducing out-of-pocket expenditure in Bangladesh.
The ministry is planning to build separate urban health centres named "Subarna Rekha" in major cities including Dhaka to provide 16 essential health services emulating the "Mohalla Clinic" model in India based on Chatham House's recommendations.
The draft report includes enhancing the quality of services in public hospitals and ensuring government participation in meeting patients' out-of-pocket expenditures and providing financial assistance to private facilities in the purchase of medical equipment.
It has also recommended taking effective measures to boost investment and improve management in the basic foundations (building blocks) of the health system, such as manpower, drugs and supplies, and infrastructures.
Officials concerned told TBS that the health ministry will finalise the report after discussing and seeking opinions about the recommendations of other stakeholders on the draft report and reviewing the actual situation of the health sector.
Chatham House and Unicef have reached an agreement to work in Bangladesh to support the government in taking forward this important agenda.
A three-member delegation of Chatham House visited Bangladesh on 11-15 September this year. During the visit, they attended a workshop with stakeholders and held meetings with high-level government officials and policymakers.
In Bangladesh, there is a large disparity in the uptake of services across different socio-economic classes and primary health care coverage in urban areas is much lower than needed.
Out-of-pocket expenditure on healthcare services among recipients is very high in the country. Currently, Bangladeshis have to pay 68.50% of their total treatment costs out of their own pockets, the report mentions.
The urban poor and those in lower economic groups have very few affordable options for health services both for maternal, reproductive, or child health-related diseases and complications arising from non-communicable diseases.
Due to inadequate affordable health services in urban areas, the poor and even middle-income people also cannot access very expensive private treatment facilities.
Thrust on following right strategy to achieve universal health coverage
Universal health coverage means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.
When people have to pay most of the cost for health services out of their own pockets, the poor are often unable to obtain many of the services they need, and even the rich may be exposed to financial hardship in the event of severe or long-term illness. Pooling funds from compulsory funding sources can spread the financial risks of illness across a population.
Universal health coverage is a target set by the United Nations in its Sustainable Development Goals 2030. The health ministry stated that the government, especially the prime minister, has a strong commitment to achieving this target.
The health ministry told the finance ministry that the coverage of essential healthcare services in Bangladesh is 52%, noting that there are challenges in two key aspects of universal health coverage – service coverage and financial coverage.
It stressed giving more importance to primary healthcare service by increasing the allocation to this area and suggested making efforts to implement universal health coverage based on primary health care similar to many developed countries. The health ministry considers this relatively easier and cost-effective for Bangladesh.
"These activities can play a far-reaching role in boosting people's confidence in the government and in socio-economic development," the health ministry told the finance ministry.
Dr Abu Jamil Faisal, a public health expert and a member of the Public Health Advisory Committee of the Directorate General of Health Services, told TBS that the first thing that is considered in universal health coverage is to keep out-of-pocket expenses as low as possible. Its aim is not to provide free treatment to all, but to bring health coverage to all. And the government, private sector, donors as well as the people of the country will have a role to play in this regard."
Need for streamlining primary healthcare system
The "Mohalla Clinic" initiative by the Aam Aadmi Party government in Delhi has been conceptualised as a mechanism to provide quality primary health care services accessible within the communities in Delhi at their doorsteps.
Bangladesh also has urban health service centres, which are under the Ministry of Local Government, but they do not have adequate health services. The health ministry has long been showing interest in taking over these centres, but the local government ministry is reluctant to give them up. In this context, the health ministry is planning to develop an effective urban healthcare centre system independently.
The health secretary said very few patients go to primary healthcare centres in the country. "People go to hospitals when they are sick. Therefore, the Ministry of Health will independently develop the urban health care system. Urban primary health care will be incorporated in the operation plan in the next Five-year Plan.
"If this can be done, the pressure on secondary and tertiary healthcare facilities will go down. It will also help to bring down out-of-pocket expenditure, and the number of people going abroad for treatment will come down as well."
How other countries achieved universal health coverage
History shows that many of the world's universal health systems emerged from public health emergencies, financial crises, or major conflicts. This includes New Zealand after the Great Depression, the UK after World War II, Thailand after the Asian Financial Crisis, and the re-socializing of China's health financing system after the SARS epidemic.
In 2018, India allocated $1.54 billion for the scheme, with insurance payments to be shared between the central and state governments. The programme would allow people to visit the country's network of secondary and tertiary level private hospitals and facilities for care ranging from hip replacements to cancer treatment.
According to health ministry officials, Unicef is committed to supporting the Bangladesh government in achieving universal health coverage through strengthening primary healthcare both in urban and rural areas as a cost-efficient and equitable approach.
On the other hand, the Chatham House Centre for Universal Health supports governments on the political economy of universal health coverage, with a focus on advising political leaders and governments on how to plan, finance and implement national UHC reforms.
Recently, Chatham House formed the Commission for Universal Health, co-chaired by Helen Clark, former New Zealand Prime minister, and Jakaya Kikwete former president of Tanzania, with global leaders to work jointly with countries to accelerate universal health coverage and stimulate learning across countries.
Saima Wazed, autism activist, WHO goodwill ambassador for autism, and daughter of Prime Minister Sheikh Hasina, is one of the members of the commission.