A New Health Care Financing Strategy in Bangladesh
Bangladesh, one of the most densely populated countries in the world, recently showed its political and programmatic commitment to achieving health-related Millennium Development Goals (MDGs) through a three-day workshop, held from October 2nd to 4th, with the goal of preparing a health care financing strategy to target the poor and underserved. The workshop, led by the Health Economics Unit of the Ministry of Health and Family Planning, was attended by both the Health Minister, Prof. AFM Ruhul Haque, and Health Secretary, Mr. Humayun Kabir. The Health Minister helped guide a range of participants, including health economists, health system specialists, academicians, and program implementers, in developing a strategic document to help solve the problem of lack of financing for health care for the poor and vulnerable.
Bangladesh is in desperate need of a new health financing strategy for the poor. Recent analyses show that out-of-pocket expenditure on health is as high as 63%. In addition, to achieve the health-related MDG targets by 2015, Bangladesh will need to increase its spending per capita on helath from US$16 (BNHA 1997-2007) to US$36 (MDG Needs Assessment and Costing 2009-2015, GOB and UNDP, 2009).
To start the workshop off, Mr. Abdo Yazbeck, a health economist from the World Bank gave an overview of the global and South Asian context for health care financing, providing several key guidelines for the development of a health financing strategy:
- Underlying demographic, epidemiological, and economic situations determine ‘needs’ and the ability to meet those needs.
- Reforms must be tailored to individual countries' socioeconomic, political, and geographic circumstances – no magic bullets or one-size-fits-all solutions exist.
- Governments should design policies consonant with the economic principles of equity, efficiency, affordability and sustainability, which underlie the revenue collection, risk pooling, and purchasing functions of health financing.
- Policy instruments must line up with the objectives to be achieved, but policy reforms are often more politically, rather than technically, driven.
- Financing reforms must also be accommodated within a country’s current and future ‘fiscal space.'
- Financing changes must be coordinated with all other health systems reform efforts.
Others gave their insights, such as Mr. Joseph Kutzin from the World Health Organization (WHO), who described the WHO’s framework for health care financing. The participants from India, Sri Lanka and Thailand also shared their country experiences with health care financing and different models of financing.
The participants discussed a number of goals, including improving equity, reducing private spending and increasing public spending on health, increasing (allocative and technical) efficiency, and mobilizing more resources. At the end of the workshop, a road-map was developed to finalize the strategy paper and to pilot this initiative by mid-year 2012. As a participant in this workshop, I feel that the government and the development partners are taking key steps in the right direction. I look forward to seeing the implementation of this strategy to ensure health for the poor.