Transcript The Goal of Universal Health Coverage in Bangladesh

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
❶Bangladesh over the years have
achieved remarkable progress
❷Through the government agenda
the country has been on track with
the health MDGs
❸The country has the highest EPI
coverage (82%) amongst
neighboring countries
700
80
600
70
60
Mortality rate
500
50
400
40
300
30
200
20
100
Life expectancy at birth
Reduced Mortality and Increased Life Expectancy
10
0
0
1970
1975
1980
1985
1990
1995
1997
2000
2004
2007
2010
MMR (per 100,000 live births)
U5MR (per 1,000 live births)
IMR (per 1,000 live births)
Life Expectancy at birth
3
Progressive improvement in
child health over the years
160
Per 1000 live births
140
120
100
Average annual rate
of reduction
80
60
-9.3% per year
40
-6.0% per year
-2.6% per year
20
0
1991-1992
1994-1995
Neonatal <1 month
1997-1998
2001-2002
2004-2005
Postnatal 1-12 months
2010
MDG Target
Child 13-60 months
Sources: Measure DHS- Demographic and Health Survey URL: http://www.statcompiler.com/
4
Reduced Fertility Rate and
increased Contraceptive Prevalence Rate
70
9
60
Total Fertility Rate
8
50
7
6
40
5
30
4
3
20
2
10
1
0
Contraceptive Prevalence Rate
10
0
1970 1975 1980 1985 1990 1995 1997 2000 2004 2007 2010
TFR (per woman)
CPR (per 1,000 population)
5
3.4%
3.3%
3.2%
3.1%
3.0%
3.0%
2.9%
2.8%
2.7%
2.7%
3%
2.7%
4%
3.7%
3.5%
4%
3.7%
3.7%
Health gains achieved with relatively
low level of resources
3%
1.4%
1.3%
2007
1.4%
1.2%
2006
1.3%
1.2%
2002
1.1%
2001
1.2%
2000
1.1%
1.1%
1999
1.2%
1.1%
1998
1.2%
1.1%
2%
1.2%
2%
1%
1%
0%
1997
2003
THE
2004
2005
Public spending
2008
2009
2010
2011
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 --- 4.27% (2013-14)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 THE2
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)
300,000
Million Taka
250,000
200,000
150,000
100,000
50,000
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: WHO-NHA Data-base
8
So the increase in THE means most of the spending
is coming from households
4
THE
Public health spending
HH health spending
3.5
3
%
2.5
2.8
2.7
2.8
2.8
3.0
3.1
3.0
3.1
3.2
1.5
1
1.6
1.6
1.6
1.7
1.8
1.2
1.2
2001
2002
1.2
1.1
1.1
1.1
1997
1998
1999
2000
1.8
1.8
1.1
1.2
2003
2004
2.0
1.1
3.7
3.7
3.5
2.2
2.2
2.3
2.3
2.3
1.2
1.2
1.3
1.4
1.3
1.4
2006
2007
2008
2009
2010
2011
3.4
2
1.5
3.7
3.5
2.1
0.5
0
2005
Source: WHO-NHA Data-base
9
Health Financing in Bangladesh
Million Taka
(2006-2007)
Taka 69 = 1 US $
Private Firms
Tk. 1,325, 0.8%
Private Insurance
Tk. 314; 0.2%
Public Sector
Tk. 41,318; 26%
Rest of the World
Tk. 12,391; 08%
Household OOP
Tk. 103,459; 64%
NGOs
Tk. 2,092; 0.1%
Source: BNHA 1997-2007
Comparison of health expenditure - 2011
Per capita
total health
spending
(US $)
THE
as % of GDP
Public HE
as % of GDP
Per capita
govt
spending
(US $)
Bangladesh
27
3.7
1.4
9.7
India
59
3.9
1.2
18.3
Nepal
33
5.4
2.1
13.0
Pakistan
30
2.5
0.7
8.0
Sri Lanka
97
3.4
1.5
43.1
Indonesia
95
2.7
0.94
33
Vietnam
96
6.9
2.7
38
Country
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)
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What’s next?
Universal Health Coverage
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)
16
|
Moving towards the UHC Goal…
❶ UHC
is a continuous journey
single model of universal coverage – successful programs
vary and the starting point is the country context
❷ No
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 13000 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?
Expanding Social Protection for Health:
Towards Universal Health Care Coverage
Health Care Financing Strategy 2012-2032
Bangladesh and UHC
Adoption of Health Care
Financing Strategy (HCFS)
More Funds
Equity
Efficiency
HIGHT Cost covered
• Zero co-payment
schemes for the poor
DEPTH Services covered
WIDTH Population covered
• Rapid expansion of
health protection fund
especially among the
poor
•
•
• Comprehensive
Inpatient & Outpatient
• Catastrophic benefit
packages
Decrease by half the share of household out of pocket payments to total
health expenditure
Expand pre-payments for health care from tax revenues, social health
insurance premiums and other pre-payment modalities
3
20
Who will benefit from UHC?
What is planned to attain “UHC”?
Supporting the move towards UHC
Development of
legal,
regulatory and
financial framework
SSK Pilot
Implementation
Other coverage
programs – formal
and informal sector
National Social
Health
Protection
Scheme
Strong political leadership and commitment
Outcomes

Improved access to
health services

Financial
protection from
health care cost

Promoting equity
in health
distribution

Improvement of
quality of care
Advocacy and multi-sectoral support for UHC
Capacity building on
Health Care Financing at all levels
Strengthening the health system building blocks
Monitoring progress and Evidence-based policies
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Role of Health Economics Unit
Equitable Financial Access to
Essential Quality Health Services
Evidence Based Policy Development
HCFS Implementation
Coordination and Steering
UHC monitoring
National Health Accounts
Legal Framework Development
Equity, Efficiency, Economy, Effectiveness