Assessment and strategic issues.
Since independence more than 30 years ago, the Government of Bangladesh has invested substantially in the institutionalization and strengthening of health and family planning services, with special attention to rural areas, and the government is committed to HFA with PHC as the key approach. For the last 30 years, there has been a substantial improvement in the health status of the people. Life expectancy at birth has increased to 64.9 (2002), CDR has declined to 5.9 (2003), and TFR reduced from 6.34 (1975) to 3.0 (2004) (Sample and Vital Registration System, and Bangladesh Demographic and Health Survey 2004). The IMR was around 53 (2002) (Bangladesh Demographic and Health Survey 2004).
Despite these improvements, much remains still to be done. Mortalities rates, especially infant and maternal mortality, continue to be unacceptably high. The quality of life of the general population is still very low. Low calorie intake continues to result in malnutrition, particularly in women and children. Diarrhoeal disease continues to be a major killer. Communicable and poverty-related diseases that are preventable still dominate the top ten causes of morbidity. |
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Health Care System in Bangladesh.
The Health care system in Bangladesh falls under the control of the Ministry of Health and Family Planning. The government is responsible for building health facilities in urban and rural areas. For example, in the late 1980’s in Bangladesh, the rural health facilities that existed in the rural areas were mostly sub-district health centers, rural dispensaries and family welfare centers. Unfortunately, they were poorly administered. For example, a sub-district health center had only thirty hospital beds. Most of its services were useless because of staff problems like few medical professionals and because the hospitals had no support service.
Urban health centers also had problems with inadequate medical supplies. In many urban centers today, health services are provided by nongovernmental institutions. During dangerous months like monsoon season and other natural disasters, the Bangladesh health system isn’t capable of managing the number of victims.
In Bangladesh, the majority of the country’s population lives in rural areas, while the majority of health professionals work in urban centers. Also, the rapid growth of the private medical system meant that fewer professionals remained in the public sector to take care of the masses. Private systems are mostly out of reach for poor people who can barely afford to live day by day.
The health system in Bangladesh is supply-side financed, meaning that poor households can have access to medical treatments or at least to essential medical care. Still, there is a large gap because community financing programs are missing. Some NGO’s have started to offer micro-credit medical programs in order to help develop a national insurance program. One third of the national health system is publicly financed, meaning that the government pays for it from taxes and international subsidies. This means that the poor population is forced to pay for medical expenses while they can barely afford to put bread on the table because of the immense lack of jobs.
Futures vision in Health sector.
The government has formulated a perspective plan keeping in view the needs of the health sector for the future. The formulation of a national health policy would provide strategy directives on major health issues.
The future vision for the health sector would include universal access to basic healthcare and services of acceptable quality;
improvement in medical education; improvement in nutritional status, particularly of mothers and children; prevention and control of major communicable and non-communicable diseases;
strengthening planning and management capabilities; improvement in logistics of production/procurement, supply and distribution of essential drugs, vaccines and other diagnostics and therapeutic equipment; increase in overall life expectancy of the population; survival and healthy development of children;
the health and well being of women; protection and preservation of the environment; disability reduction; and the adoption and maintenance of healthy lifestyles.
Proposed strategies.
The Health and Population Sector Strategy (HPSS) introduced in 1998, which forms the basis for the future national health policy, is based on several key principles: greater orientation to client needs, especially those of women; improved quality, efficiency and equity of government health services; provision of a package of essential health services; expanded private sector role in providing health and population services; one-stop shopping via co-location of services; and expanded cost recovery and improved efficiency of resources by the public sector.
Some of the main objectives are:
- To allocate more resources to support services for poor, and vulnerable groups (women and children).
- Unifying the existing bifurcated health and family planning service delivery system.
- To achieve an appropriate balance between the public and private sectors in financing and provision of services.
- Decentralization of management through devolution of authority.
The following activities have been identified to achieve the above objectives:
- Deliver an Essential Services Package to the whole population with the aim of maximizing health benefits, relative to per capita expenditures. This is expected to meet the felt needs of the clients, strengthen service delivery, and improve system management.
- Service delivery mechanism should be unified, restructured and decentralized, both at the thana and hospitals.
- Other services, particularly hospital-level, are proposed to be provided through partnerships with or commissioning of services to NGOs and private not-for-profit hospitals. The public sector hospital services delivery will be improved through installing greater autonomy of management, local level accountability, cost-recovery, fee retention and utilization, and a drug revolving fund.
- Integrated support systems should be strengthened.
- Introducing a sector wide approach to manage the health sector, rather than having a series of projects with their own funding, management, implementation and reporting arrangements.
- In view of the potential resource gap between the sectoral resource envelope and projected sectoral expenditures, increased reliance on cost recovery for public sector services will be considered.
- Health insurance coverage in urban Bangladesh is proposed to be increased through development of a health insurance scheme for government employees and for employees of state-owned enterprises.
- At the centre, health will be more integrated and decentralization taken to lower levels.
- Hospital level services be focused and improved.
- Policy and regulatory framework be strengthened. Existing policies will be reviewed and revised for improving accessibility, affordability and quality of services and for further improvements in affordability, quality and safety of drugs and rational use of drugs. New policies on public and private sectoral mix and financing of services will be developed
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