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

Health Sector of Bangladesh A Story of Achievements ❶ Bangladesh over the years have achieved remarkable progress ❷ Through the government agenda the country has been on track with the health MDGs ❸ The country has the highest EPI coverage (82%) amongst neighboring countries

Reduced Mortality and Increased Life Expectancy 3

Progressive improvement in child health over the years Sources: Measure DHS- Demographic and Health Survey URL: 4

Reduced Fertility Rate and increased Contraceptive Prevalence Rate 5

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

Health Care Financing Features We have a HCF system as part of the national financial management system. Main Features ❶ Share in the national budget % ( ) 1 ❷ Public spending as % of GDP --- around 1.4% 1 ❸ Per capita Health expenditure---US$ 27 (2011) 1 ❹ Out-of-pocket---64% of Total health expenditure(THE) 2 ❺ Coverage of insurance --- <1% of THE 2 ❻ Government is financer and provider of services ❼ Budget norms follow civil service and budgetary regulations and codes. 7

Total Health Expenditure is 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 8

So the increase in THE means most of the spending is coming from households Source: WHO-NHA Data-base 9

Health Financing in Bangladesh ( ) Million Taka Taka 69 = 1 US $ Source: BNHA

Comparison of health expenditure Country Per capita total health spending (US $) THE as % of GDP Public HE as % of GDP Per capita govt spending (US $) Bangladesh India Nepal Pakistan Sri Lanka Indonesia Vietnam Source: WHO-NHA Data-base 11

% increase in National and Health Budget - a comparison

Challenges in Bangladesh ❶ Inadequate funding for the whole health system. -Government budget is 1.4% of GDP, Total Health Expenditure (THE) is 3.7% of GDP. ❷ Inequity in financing and utilization -main source of financing for health care is out-of-pocket payment (64% of THE) ❸ 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

Common concerns across the globe ❶ Increasing health care cost ❷ Protect people from financial consequences of health care payment ❸ Expand fiscal space in spite of macro-economic constraints ❹ Use of available resources efficiently and equitably For all these, Health care financing is moving towards Universal Health Coverage (UHC) 14

What’s next?

Universal Health Coverage 16 | 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)

Moving towards the UHC Goal… ❶ UHC is a continuous journey ❷ No single model of universal coverage – successful programs vary and the starting point is the country context ❸ 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

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

What needs to be done?

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Who will benefit from UHC?

What is planned to attain “UHC”?

23 SSK PilotImplementationOther coverageprograms – formaland informal sector National SocialHealthProtectionScheme Advocacy and multi-sectoral support for UHC Outcomes Improved access to health services Financial protection from health care cost Promoting equity in health distribution Improvement of quality of care Development of legal, regulatory and financial framework Capacity building on Health Care Financing at all levels Supporting the move towards UHC Strong political leadership and commitment Strengthening the health system building blocks Monitoring progress and Evidence-based policies

Role of Health Economics Unit Equitable Financial Access to Essential Quality Health Services Evidence Based Policy Development Coordination and Steering HCFS Implementation UHC monitoring National Health Accounts Legal Framework Development Equity, Efficiency, Economy, Effectiveness