Health is wealth for both an individual and a nation. Health is a basic right for every human being. “Universal health coverage” – a central theme in today’s global health arena, is based on the concept of equitable health service provision. It is all the more important for the developing world, where one’s body is the only asset one possesses for maintaining livelihood.
However, increasing costs are hindering access to quality healthcare around the world, and Bangladesh is not an exception.
Very few in Bangladesh can access quality healthcare in time due to a lack of money and the absence of quality services near where people live. It is more of a concern for the poor. Currently, the per capita expenditure on healthcare in Bangladesh is $27, which is far less than what is recommended or required.
Unfortunately, with this low level of expenditure, the people of Bangladesh have to spend the most out of their pockets for healthcare compared to other Asian countries.
The government of Bangladesh bears only 26% of the national health expenses. The other 64% comes from the people themselves, with about 10% from private companies, NGOs, and insurance companies (for profit).
Inadequate number of health human resources (HHR), insufficient fund allocation in the national health budget, inadequate government health service provision, catastrophic healthcare costs, and an expensive and largely unregulated and questionable quality of care at private clinics are the most important issues hindering universal access to quality healthcare services. Catastrophic healthcare costs in Bangladesh pushes 4% of the people into poverty every year.
Thus, Bangladesh needs to take a close look at the existing system to find ways to improve the quality and reach of these services and remove economic and other barriers. Community health insurance is one such tool that can pave the path towards achieving universal health coverage for Bangladesh.
Community health insurance is not driven by financial profit but by the consideration of ensuring access to healthcare by removing financial barriers and protecting people from catastrophic expenditure.
The ICDDR,B has been implementing a project on community health insurance in Chakaria, a remote rural area in Cox’s Bazaar district of Chittagong division, since 2012.
This project is locally known as “Amader Shasthya,” meaning “our health.” Amader Shasthya believes that “a burden shared is a burden halved” and thereby encourages solidarity among villagers.
The scheme runs two packages: Indoor and outdoor. The premium for the outdoor package is set at Tk500 per household per year, which entitles each household member to free consultation with paramedics, doctors, access to medicine, and diagnostic services at a discounted price.
This package has a special rate for the poor, which is set at Tk200 and provides the same set of services. The maximum benefit under this package is fixed at Tk5,000 per individual per year, and Tk30,000 per household per year.
The indoor package, on the other hand, charges Tk1,200 per household per year as a premium and provides services including consultation with paramedics, doctors, hospital admission, diagnostic services, medicine, and operation costs.
The maximum benefit each household can claim is set at Tk54,000 for this package, and for an individual, this amount is set at Tk9,000 per year.
Although the concept of health provision through Amader Shasthya is new to the villagers of Chakaria, it is becoming increasingly popular every day. Amader Shasthya has incited renewed hope in gaining access to quality healthcare for the poor people in Chakaria, reducing out-of-pocket costs, and protecting them from catastrophic healthcare costs.
As of now, nearly 30% of the households in their area of operation have been enrolled in the scheme and the benefit received by the clients is worth Tk70 lakh to date.
Community health insurance has played a major role towards achieving universal health coverage in countries like India, Cambodia, and Thailand. Bangladesh can also benefit from such financing tools.
The government of Bangladesh is currently focusing on ensuring universal health coverage, which is the constitutional right of its citizens. The Chakaria experience of Amader Shasthya sets a promising example of community health insurance, which can help the government achieve its dual target of ensuring healthcare for all and lowering out-of-pocket expenses.
