Just one look at the healthcare budget allocations each year is enough to understand how appalling our indifference to our healthcare sector is. There has been a decline in budget allocation as a percentage of GDP, which has fallen to 0.83 percent in the current fiscal year. But according to the World Health Organization (WHO), it should be at least five percent. Bangladesh ranks last in South Asia in terms of health allocation relative to GDP. We currently have to pay 72 percent of our medical expenses out of our own pockets.
WHO has committed all member states to ensure Universal Health Coverage (UHC), which means that everyone has access to quality healthcare as needed, regardless of financial constraints. Global health insurance is a key regulator in achieving UHC. Many countries around the world are or have been on the way to achieving UHC through private optional health insurance, community-based health insurance, compulsory payroll-based social health insurance, and so on. It took Germany and France more than 100 years to cover 100 percent of their population through social security. Many low- and middle-income countries in Asia, Africa and Latin America have been trying to introduce labor tax-based compulsory social health insurance for decades.
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But the idea of universal healthcare or its implementation is completely absent in Bangladesh. While the ruling government has pledged to formulate and implement UHC in the country, little progress has been made in this regard. Despite Covid-19 and the ongoing Russia-Ukraine war, our economy has not been badly affected. In terms of macroeconomic indicators, Bangladesh should be able to increase the health sector budget without disrupting the dynamics of the economy.
Are our politicians aware that sustainable development is not possible without investments in the health sector? Investing in healthcare isn’t just about spending; it strengthens the economy in many ways and helps alleviate poverty and inequality. Investing in the health sector will lead to improved labor availability, better contribution to schooling, employment opportunities for women and higher productivity in the economy.
Funding for healthcare in Bangladesh comes entirely from the government’s general taxation system. There is an opportunity to significantly increase funding by expanding the tax base margin, consolidating and reallocating the fragmented funding system, and reallocating priorities. Tax evasion, corruption and harassment should be prevented. Funding the health sector is easier to achieve by expanding the narrow tax system than by trying to collect health insurance premiums from poor and informal communities.
The need to increase the state budget for our healthcare sector is beyond question today. In the next state budget, health allocations are therefore to be increased to two percent of GDP. The Treasury Secretary should think about how he will allocate this money. The WHO recommends allocating at least five percent of GDP or 15 percent of the budget to the health sector. An increase in healthcare spending per percent of GDP would save 0.13 percent of the population from financial disaster.
The challenges of health care are mainly twofold: financing and service delivery. Corruption in the healthcare system, misconduct by doctors and a lack of capacity to implement the budget are the highlights of the topics. Prioritizing cost management should be done by accepting the reality of the healthcare financial crisis. Priority should be given to maximizing the involvement of poor and vulnerable groups, and consideration should be given to the services that can be provided. Corruption should be resolutely opposed. Expenditure and results in the health sector should be presented to the population in a transparent manner. A government survey found that medicines accounted for 63 percent of an individual’s out-of-pocket expenses. A strong primary health care system plays the most cost-effective role in achieving universal health coverage.
Public health programs should be implemented through comprehensive disease prevention initiatives. The government should develop a flawless structure capable of reaching a fair understanding with the manufacturers of medicines and medical devices for the procurement and supply of medicines, medical supplies and new technologies. The development of non-profit private health care should be supported. Differences in service quality and costs between public and private healthcare systems should be reduced, if not eliminated. Alongside public and private health care, NGOs should be able to work as a complementary body with the self-sacrificing attitude and ability to engage in health care. The government must also invest in improving the quality of life for healthcare workers.
Universal health coverage is not achieved by an overnight miracle. Bangladesh should learn from the experiences of the last 50 years in low- and middle-income countries and develop a health system that takes into account the historical development of these health systems, cultural acceptance and political-economic reality. Measuring progress towards UHC requires an integrated national health database. The UHC structure should be built by analyzing the information gathered there, making plans and implementing new decisions from the lessons of success and failure. The countries that have achieved UHC have always had high budget allocations for health care high on their political agenda. Strong political commitment is needed to extend health care to the poor and vulnerable and to prioritize the voice of marginalized people over opportunist groups.
Our Constitution mentions the promise to establish a state based on equality. A basic human aspiration is that the individual or family is not left destitute or reduced to further poverty while seeking medical treatment. Otherwise, our Constitution will not be able to play a regulatory role to protect the health and life of the people of this country.
dr Rakib Al Hasan is a doctor, author, activist and youth leader. His Twitter handle is @rakibalhasan_bd