Roll out universal health coverage: Experts

Highlights: 

• Experts' recommendations for govt: 
• Allocate more funds to the health sector
• Establish a National Health Security Office
• Reduce out-of-pocket costs
• Update health policy

To ensure healthcare for all citizens, the interim government should implement Universal Health Coverage (UHC), with increased funding focused on improving primary healthcare services and reducing urban-rural service disparities, said health experts.

Due to a low health sector budget, many people fall below the poverty line due to out-of-pocket healthcare expenses, leading to societal inequality, they said at a roundtable titled "Ensuring Health through Universal Health Care in Bangladesh," organised by the Centre for Policy Dialogue (CPD) and The Business Standard.

Political commitment is crucial to achieving UHC. To develop the health sector, experts stressed the need to swiftly establish a National Health Security Office, reduce out-of-pocket costs by providing free medications, implement the Shasthyo Shurokhsha Karmasuchi (SSK) programme in every police station, and update the 1990 health policy to reflect current realities.

Chaired by CPD Executive Director Dr Fahmida Khatun and moderated by TBS Deputy Editor Sazzadur Rahman, the event took place at the TBS office in the capital's Eskaton Garden area today.

Fahmida Khatun said, "The health sector is often overlooked, with costs being shouldered by individuals through out-of-pocket expenses. Public spending on health from domestic sources is only 0.4%, and increasing out-of-pocket expenditures are contributing to rising poverty."

"Although our budget size and GDP are growing, we are becoming poorer due to health-related expenses. Out-of-pocket healthcare costs pushed 3.74% of the population below the poverty line in 2020, up from 3.11% in 2016," she said.

"Financial struggles to cover healthcare costs can be passed down through generations. Ensuring UFC would be a significant step forward for individuals and the state," she stated.

Currently, Bangladeshis have to pay 68.50% of their total treatment costs out of their own pockets, patients spend a whopping 64% of their health expenses on drugs, and only 3% of patients receive medication from government hospitals, according to data from the Health Economics Unit of the Ministry of Health and Family Welfare.

The interim government should provide free medications to lower out-of-pocket expenses, said Dr Mushtaque Raza Chowdhury, convenor of Bangladesh Health Watch – a consortium of health experts and professionals aimed at promoting public health.

He said, "Any mass movement can yield positive results. We hope this interim government will remain in office for another year and a half, during which they can achieve significant developments in the health sector — such as establishing a Health Security Office, forming a Permanent Health Commission and implementing the Shasthyo Shurokhsha Karmasuchi (SSK) in every police station, along with necessary policy revisions."

Dr Syed Abdul Hamid, a professor at the Institute of Health Economics at the University of Dhaka, said, "The SSK, which was launched in 2015 in Tangail as a pilot project, can be expanded. It initially offered a package of Tk50,000, but the current government could increase that to Tk100,000. This initiative should not only target the poor but all people."

"Investing Tk4000-Tk5000 crores could be a game-changer for the health sector. This funding is already within our budget and can be allocated accordingly. If implemented, it could also facilitate the introduction of a referral system," he added.

A referral system in healthcare is a structured process that guides patients from primary care providers to specialised services or higher levels of care when needed.

Dr AM Zakir Hussain, chairman of the Community Clinic Health Support Trust, said that poor service quality results from several factors, including a lack of resources, insufficient technology, low motivation among health workers, inadequate prioritisation, a weak system, and poor pricing assessment and procurement skills. 

He emphasised that the basic requirements for successful UHC include effective healthcare delivery, efficient health system management, essential resources, and equitable distribution. This encompasses the input-process-output/outcome model, access to essential technologies, and a fair and justified approach to service provision.

Dr Lelin Choudhury, a public health expert and chairman of Health and Hope Hospital, said, "As per government estimates, around 18% of the population lives below the poverty line. Therefore, those individuals should be integrated into government services, and health cards should be issued to ensure they do not miss out on necessary care."

"People seeking treatment in government hospitals often feel helpless, and this mindset needs to change. We must set a standard for service across all public and private hospitals. Healthcare must be equitable, and experts should be entrusted with responsibilities," he added.

Dr Dibalok Singha, executive director of Dushtha Shasthya Kendra (DSK), emphasised that the government must demonstrate a commitment to improving the health sector. 

"With approximately 400 million people living in extreme poverty in the country, we can learn from successful examples of universal health coverage in Rwanda, Vietnam, Brazil, and Thailand, tailoring those lessons to our own needs," he said.

"Currently, Bangladesh allocates only 0.74% of its GDP for health, which should be increased by an additional 1%. It is essential to prioritise what the government will implement in the short, medium, and long term for the health sector," Dibalok concluded.

Dr Mahbub Elahi Khan Chowdhury, a scientist in the Health Systems and Population Studies Division at icddr,b, said that out-of-pocket expenditures would decrease if health services were made more accessible at government health centres.

Dr Khondaker A. Mamun, the founder of CMED Health Ltd, said, "Each year, Bangladeshis spend approximately $10 billion on healthcare, with about $5 billion going to neighbouring countries for treatment. Therefore, we must focus on enhancing the quality of healthcare within our own borders. By doing so, we can keep this money in the country."

The roundtable was attended by Professor Liakat Ali, former vice chancellor of  Bangladesh University of Health Sciences, Dr Sohana Shafique, assistant scientist of icddr,b, Dr Nahitun Naher, assistant director at the Centre of Excellence for Health Systems and Universal Health Coverage, Dr Mohib Ullah Khondoker, director of Gonoshasthaya Kendra, Dr Md Aminul Hasan, former director of Hospital, DGHS Consultant, Ministry of Health and Family Welfare, Prof Rashed E Mahbub, former president of Bangladesh Medical Association (BMA),  Dr Subrata Paul, Focal point, UHC and National Health Accounts at Health Economics Unit, and Dr Md Monzur Hossain, programme manager at the Ministry of Health and Family Welfare.