Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

Abstract

Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

Provider performance and facility readiness for managing infections in young infants in primary care facilities in rural Bangladesh

“…Bangladesh's MOHFW is responsible for policymaking, while implementation of those policies is the responsibility of different directorate generals-Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP) are the two most important ones in terms of service delivery [17,18,34]. The MOHFW maintains a three-tier system for delivering public healthcare services at all administrative levels and follows the IMCI protocol for management of sick children in primary health facilities [35,36].…”

“…In primary healthcare facilities, health services are highly subsidized by the government, requiring minimal or no payments from patients. [18,34] The SACMO is the designated provider for assessing, classifying and treating young infants according to the adapted WHO guidelines. Most often, there is only one SACMO posted and available to treat pediatric patients at the UH&FWC.…”

Caregiver acceptability of the guidelines for managing young infants with possible serious bacterial infections (PSBI) in primary care facilities in rural Bangladesh

“…Most village doctors have limited or no standard training and are connected to unlicensed pharmacies where they diagnose patients and sell prescription medicines [18,19]. Public healthcare is highly subsidized by the government, requiring minimal or no payments from clients, especially in the outpatient centers targeted for this intervention (i.e., Union Health & Family Welfare Centers [UH&FWC]; catchment area~25,000 persons) [24,25]. Despite adequate geographic distribution of these outpatient health centers, UH&FWCs have been largely under-utilized by the communities, and many were not fully functional due to staff shortages, insufficient equipment, poor infrastructure, unavailability of water and electricity, and perceived low quality of care [19,21,[26][27][28].…”

“…Despite adequate geographic distribution of these outpatient health centers, UH&FWCs have been largely under-utilized by the communities, and many were not fully functional due to staff shortages, insufficient equipment, poor infrastructure, unavailability of water and electricity, and perceived low quality of care [19,21,[26][27][28]. Families often prefer to seek care from the private sector, informal and formal, due to convenience and acceptability of services, but informal providers are highly unregulated and formal care comes at high out-of-pocket costs for families [18,19,24,29]. With the rollout of the new guidelines, there is an urgent need to strengthen existing public sector facilities to improve the quality of care and acceptability of health services for families of sick young infants.…”

Social Impact Bonds in Bangladesh: Saving a Million Life Years and Healthcare Costs

“…With a population of 166 million, Bangladesh has about 45 million poor people struggling to pay for healthcare. Currently, there is no Universal Health Coverage (UHC) in Bangladesh although an endeavor is being made to establish UHC in the country by 2030 [1]. In the meantime, Save a Million (SaM) project can help to reduce healthcare costs.…”