Health is recognized as a human right by at least 140 countries through their constitutions. And Bangladesh is one of them. Article 15 of the constitution of Bangladesh requires the state to ensure people’s provision of medical care and it is regarded as a basic necessity of life. However, 52 years since adopting the constitution, the majority of Bangladesh's population is still not fully covered by essential health services. Universal health coverage (UHC) can be a good tool to bring every citizen of the country under the coverage of essential health services.
The sustainable development goals (SDGs) outlined UHC as the main strategy for achieving sustainable health goals for 2030. The SDG target 3.8 is stated as “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” The two core components of UHC are: Ensuring all people have access to essential health services and financial protection from catastrophic health spending.
Bangladesh is committed to achieving universal health coverage by 2032. In the UHC service coverage index, Bangladesh scored 52 on a scale of 100 in 2021. A research article published in the Lancet Global Health in 2018 analyzed the trends in the indicators of UHC and projected that the goal of achieving 80% service coverage would not be possible for eight out of 13 indicators by 2030. Moreover, impoverishment and catastrophic health expenditures were projected to increase from 4% and 17% in 2015 to 9% and 20% by 2030.
High expense, no backing
Bangladesh has the highest catastrophic out-of-pocket expenditure in South Asia. According to a WHO estimate, almost 25% of the population faces catastrophic health expenditure and more than 5 million people face heavy healthcare costs every year in Bangladesh. Despite Bangladesh's impressive economic growth, with a remarkable 7.1% yearly increase in GDP (2022), the country's healthcare sector suffers from chronic underfunding.
In 2020, Bangladesh National Health Accounts (BNHA) estimated total health expenditure from all sources for 1997-2020. They found that government spending on health was only 0.66% of the total GDP of Bangladesh in 2020. This is at odds with the global trend that shows public health spending is rising as a percentage of GDP as per capita income increases. To achieve the aim stated in the Government of Bangladesh's Eighth Five-Year Plan 2020-2025, it is necessary to raise government expenditure on health to a minimum of 2% of the GDP.
Systems of hierarchy and profit
Bangladesh has a hierarchical health system where patients with minor health conditions go to primary healthcare institutions and patients with severe conditions go to specialized and tertiary healthcare institutions for diagnosis and treatment. A hierarchical health system is considered as an ideal model of a health system.
However, these numbers are not sufficient considering the huge population of this small country. Bangladesh cannot utilize this system at its fullest, mainly due to a lack of health workforce, infrastructure, technology, and financing. Reforming such a health system to unveil its full potential can be an important instrument for achieving universal health coverage.
On the other hand, Bangladesh consists of a pluralistic health system. There are multiple actors in this sector: Government, for-profit private sector, not-for-profit private sector (mainly NGOs), and international development organizations. Many NGOs are efficiently contributing to developing the health sector of Bangladesh. However, the for-profit private sector in Bangladesh is known to be very expensive, amplifying the burden of health expenses. Regulating the private sector and supporting the NGOs, along with fostering collaboration between the government and non-government sector can have a crucial impact on achieving universal health coverage.
Among other activities, policy reformation, increased investment in healthcare infrastructure, targeted interventions to reach marginalized communities, decentralizing tertiary healthcare institutions, enhancing the availability of essential medicines, educating people about their health, and promoting preventive healthcare measures are pivotal steps towards realizing the vision of universal health coverage in Bangladesh. As we move towards a sustainable Bangladesh, we must ensure that every citizen in the country knows and gets their health rights.
Md Jahirul Islam and Mahebub Hasan are students of Department of Population Sciences at University of Dhaka.