Ensuring the wellbeing of all citizens
Universal health coverage (UHC) ensures that all citizens -- regardless of their status -- can access high-quality health care services without compromising their financial wellbeing. The definition of UHC spans three ideals: Equity in access to health care services, quality of health care, and financial risk protection.
UHC is also key to achieving the World Bank Group’s (WBG) twin goals of ending extreme poverty and increasing equity and shared prosperity, and as such it is the driving force behind all of the WBG’s health and nutrition investments.
It is also an essential part of the Sustainable Development Goals. In recent years, the UHC movement has gained global momentum, with the World Health Assembly and the United Nations General Assembly calling on countries to “urgently and significantly scale up efforts to accelerate the transition towards universal access to affordable and quality health care services.”
Low and middle-income countries have made considerable gains in maternal health, child survival and nutrition, and management of communicable diseases. Even so, inequities persist between and within countries.
There is a lack of fairness regarding how people of different economic status receive health care -- those with the greatest need in Bangladesh, particularly the poor, are most likely to receive the least benefit. Socio-economically disadvantaged people most often cannot access services from privately-owned health care providers resulting in inequity in overall health care benefits.
The country’s health system is struggling to meet basic standards for quality of care because of a shortage of skilled health workers, the large number of unregulated private service providers, irregular supplies of drugs, inadequate public financing, high out-of-pocket expenses, and lack of proper monitoring, and supervision mechanisms.
Further complicating the situation is the increasing burden of non-communicable diseases and the absence of any pre-payment risk pooling mechanisms. Bangladesh faces a daunting challenge in achieving the goal of UHC.
A new agenda for health care in Bangladesh should be defined to encourage the second generation of health care system innovations under the clarion call of UHC. This agenda should draw on the experience of the first generation of innovations that underlie the country’s impressive health care achievements and creatively address future health care challenges.
Central to the reform process will be the development of a multi-pronged strategic approach that responds to existing demands in a way that assures affordable, equitable, high-quality health care from a pluralistic system; anticipates health care needs in a period of rapid health and social transition; and addresses underlying structural issues that otherwise might hamper progress.
A pragmatic reform agenda for achieving UHC in Bangladesh should include development of a long-term national human resources policy and action plan, establishment of a national insurance system, building of an interoperable electronic health information system, investment to strengthen the capacity of the Ministry of Health and Family Welfare, and creation of a supra-ministerial council on health.
It is expected that Bangladesh will overcome its challenges and provide affordable health care for all. Poverty must be addressed. Making health care available to all socio-economic groups is one of the main UHC goals which must be addressed into the implementation of any health care projects.
In Bangladesh, achieving optimum health care outcome and reducing inequalities will require broader and more inclusive cross-sector interventions, with policy-makers playing a key leadership role. It is imperative to assess current gaps in service availability, service utilization by people of different socio-economic groups and living in marginalized communities, resource availability, cost and financing, policy, and governance.
Reliable data is directly linked to an effective, efficient, and economical health care service. In recent years, there has been a general increase in media coverage about UHC and efforts to learn from neighbouring countries, which has contributed to a policy-level dialogue on UHC in Bangladesh.
So it is also necessary to establish a learning platform for UHC through which the international as well as the national success stories and improved techniques would be analyzed and applied to the areas of greater need of UHC in a viable and financially sustainable manner.
Bangladesh needs to assess progress through a well-defined monitoring and evaluation framework to make UHC a reality. This means using a set of indicators that are comparable with other countries to track health care financing, the density of the health care workforce, supplies of essential medicines, the availability and functionality of key instruments, and the use of the health information system.
The government should continue to measure coverage of priority public-health interventions and include those for non-communicable diseases for all ages and genders. The country will also need continuous feedback about whether efforts towards achieving UHC are contributing to the progressive realization of the equity goals.
The UHC monitoring and evaluation framework must be established through inclusive policy dialogue and effectively reflect the country’s disease burden profile, health system capacity, and level of economic development.
The government needs to introduce mandatory pre-payment schemes for formal sector employees and subsidized schemes for the poor population as planned in the health financing strategy.
Strengthening the civil vital registration system is almost as urgent as the need to strengthen the routine health care information system.
It would also be important to strengthen the Ministry of Health and Family Welfare’s stewardship capacity so that information from the private sector is collected in the future through the information system. It is expected that the country will make effectively and reliably tracking progress towards achieving UHC the highest priority.
The effective and financially sustainable implementation of UHC is based on a resilient and responsive health care system that provides comprehensive primary health care services, with extensive geographical coverage, including in remote and rural areas, and with a special emphasis on access to populations most in need, and has an adequate skilled, well-trained and motivated workforce, as well as capacities for broad public health measures, health protection, and addressing determinants of health through policies across sectors, including promoting the health literacy of the population.
Tanvir Ahmad is an urban planner.