Is Universal Health Coverage achievable for Bangladesh by 2032? – Kafil Uddin

After flunk of the declaration “Health for all by 2000” which was coined at Alma Ata in 1978 and known as Alma Ata declaration, the World Health Organization (WHO) further to achieve post Millennium Development Goals introduced the Universal Health Coverage (UHC) that is to ensure the needed quality health care for all without financial hardship at the point of services by 2030. Achieving Universal Health Coverage is one of the utmost appeals of the SDGs while almost half of the population of the world still does not have access to proper health care services. To promote and accelerate the theme of UHC, World Health Organization celebrates every year the “Universal Health Coverage Day” on 12 December globally.
In every year, catastrophic health expenses at the service points push almost 25 million people towards abject poverty across the globe. It is no different and much alarming that in Bangladesh 3.4% family fallen towards poverty only for the financial burden and catastrophic health expenses of the health care each year bearing themselves one of the highest out of pocket expenditure (67%) which is almost more than double of the WHO’s standard.
The Government of Bangladesh initiated sector wide approach in health sector for the better collaboration, to reduce duplication, lower the transaction cost in late 90s. To date, the government introduced 4th sector wide program that aims to ameliorate efficiency, equity and quality of health care for gradually moving towards achieving the Universal Health Coverage (UHC) as the government is mandated to its proclamation achieving it by 2032 declared at the 70th United Nations General Assembly in 2015.
With the mostly informal economy, less fiscal spaces for health sector and tremendous shortage of health workforce, Bangladesh has to undergo a plethora of challenges in achieving UHC in its stipulated timeframe. National Health Policy 2011,sector wide programs and other policies emphasized on more funds allocation in health sector and resource pooling thereby minimizing the risks of financial hardship. The “Health Care Financing Strategy 2012-32” is the most important policy document specifically focusing on UHC and it has identified the shortcomings of health care financing in Bangladesh stating inadequate financing, inequity and inefficiency in use of existing resources. Health Economics Unit, under the Ministry of Health and Family Welfare(MOHFW) piloted a social health protection (SSK) scheme for the below poverty line financed by the government which offers health care services for the card-holders completely free at the service points under three Upazila of Tangail district. Thus pooling resources, depending on tax based financing, reducing the financial burden and ensuring quality of services, stretching the scheme across the above poverty line (APL) will smooth the journey of government’s mandate towards perpetrating Universal Health Coverage. Government plans to encompass the all the Below Poverty Line (BPL) people in the country under the social protection scheme after successfully piloting SSK in Tangail thus government will ensure Essential Service Package(ESP) for them without any financial hardship. Gradual inclusion of the formal sector under contributory health protection scheme and community based health insurance initiatives, micro health insurance and finally, gradual move towards social health protection scheme for the largest informal sector will facilitate the country’s proclamation.
Provision of health care and strong health care financing are inevitable but in a pluralistic health system and existing supply based budgeting it is difficult to alter separately the health sector financing for the finance ministry. On the other hand, poor management of the health workforce, skill mix imbalance, scrappy training and low motivation are vacillating. Health care providers do not feel comfortable to provide services at primary level for the lack of proper facilities and security. Sometimes, the concerned authority exacerbate the shortage of the manpower by their defective monitoring mechanism as the service providers have scopes to get rid of their assigned duties by offering bribes or practicing political power. There is also a pervasive cultural and religious hindrance for the insurance based health system in the country’s perspective and this is evident from some fraudulent activities by the so called insurance company. Hence, strategically Health Economics Unit under MOHFWnamed after the social protection scheme as Shastho Surokkha Kormosuchi (SSK) to get around the public distrust. Still there remain a huge gap in understanding the term UHC because of the less media coverage and dissemination among mass people, some think this is nothing different but mere an insurance.
Bangladesh has already achieved notable fruition in preventive care through Expanded Program on Immunization (EPI) and has evolved from being a “basket case” to a swatch of “good health at lower cost”. As the economy evolving faster, purchasing power is also increasing and disease pattern is also shifting to chronic non communicable diseases. Hence, strengthening capacity in term of infrastructure and health workforce development, procurement of supply are inevitable to confront the undefined circumstances. As per the current state, while still we have to cover the BPL people under the protection scheme it will be much difficult for Bangladesh to cover the vast informal and formal sector as well. . The financial burden reduction through resource pooling, emphasizing on social health protection (SSK), strengthening the primary level health care facilities can be the key factors. Redesigning the public finance, improving the implementing mechanism, inter-sector collaboration, special attention to hard to reach areas, demand based financing, conspicuous monitoring mechanism, educating mass people through awareness and disseminating the idea of UHC among them, strengthening health insurance mechanism and strong political mandate and good will only can bring the success in achieving the UHC for Bangladesh. 

The Writer is studying at Institute of Health Economics, University of Dhaka.