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6.1 Realities of Health
Financing
6.1 Realities of Health
Financing
69%
Out-of-pocket payments
5.1%
Health sector stands at 5.14 percent of the total FY21 budget
6.2 Distribution of out-of-pocket expenditure on healthcare
6.2 Distribution of out-of-pocket expenditure on healthcare
65%
Drugs and Medicines
4%
Outpatient and
home-based services
22%
Curative Care
<1%
General government
administration of health
Consequences of excess OOP expending
Low utilization of formal healthcare due to excess OOP payments
Partial utilization of formal healthcare that may aggravate the disease condition, causing the disease to become a chronic condition.
Sale of household’s assets to manage the treatment costs, in turn making them poorer.
Malnourishment may increase due to excess health expenditures forcing households to ration their food items
Adverse impact on education, causing children to drop out of school.
OOP payments may mislead planners and policy makers to miscalculate poverty status.
6.3 Health Schemes and Insurance
6.3 Health Schemes and Insurance
Private health insurance
Private health insurance is either absent, or is present only in some pockets.
The middle class or third quintile possesses the highest share of private health insurance (79.4%).
Whereas, the poorest and the fourth quintiles have no private insurance and the richest quintile has only a 2.8% share.
Social health insurance
Social insurance coverage is negligible
Community-based health insurance scheme: little evidence on the impact of CBHI in terms of better access to health and health equity
Schemes are sometimes managed and developed by community groups (micro-insurance); as well as those developed by government, NGOs or other civil society organisations.
Impact on RMG workers- Evidence of limited increase in affordability, better health facilities, increase in health seeking behavior, and positive impact on ROI in health leading to increased productivity
Public health insurance
The Ministry of Health and Family Welfare has developed the Shasthyo Suroksha Karmasuchi (SSK) health protection scheme for the below-poverty line (BPL) population under the Health Care Financing Strategy 2012–2032 with a view to bringing all the citizens under the financial protection for healthcare by 2032.
The key actors in the scheme are HEU,contracted scheme operator and hospital.
Services include-- Inpatient care, hospital bed and food, transportation cost, medicines and diagnostics
6.4 Existing Health Schemes
6.4 Existing Health Schemes
Health and Education for All (HAEFA)
Health and Education for All (HAEFA)
HAEFA provides free, quality, and essential healthcare services to disadvantaged and displaced populations, including Rohingya refugees from Myanmar, industrial workers such as garment factory workers and rickshaw pullers, and hard-to-reach people who are underserved in Bangladesh.
Since July 2013, HAEFA has provided over 30,000 workplace screenings to ready-made garment (RMG) factory workers and rickshaw pullers across Bangladesh. HAEFA’s healthcare teams have brought efficient onsite screenings that fit into the RMG workers’ and rickshaw pullers’ schedules. These screenings check patients for non-communicable diseases such as: - hypertension - anemia - diabetes - tuberculosis - asthma - pregnancy complications - malnutrition
In 2018, HAEFA developed an on-site, single-visit See-and-Treat cervical cancer screening initiative and thermocoagulation treatment process for female workers.
APON: Alor Pothe Nobojatray Foundation
APON: Alor Pothe Nobojatray Foundation
One of their schemes aims to empower the workers of RMG manufacturing industry to increase their disposable income and build better, healthier lives by receiving subsidised health-care for their families, without forcing factory owners to increase worker pay. It does this by selling discounted consumer staples at a workers-only shop, where purchases earn the workers points toward a workplace benefits scheme.
APON sets up and independently manages the shop inside an RMG factory, selling packaged food, hygienic products and other disposables to the employees at a slight discount - about 8% to 10% below market retail. Each purchase from the shop earns a worker points that accumulate on their APON account.
After accumulating a certain number of points, the worker gains access to APON’s zero-cash health coverage, allowing them to get free medical diagnoses and prescriptions from a doctor.
Urban Primary Health Care Project (UPHCP)
Urban Primary Health Care Project (UPHCP)
The Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership.
The objectives include :
Improve accessibility (financial and physical) to PHC services in the urban areas covered by the project
Ensure the delivery of quality PHC services to urban populations-the project will ensure essential service delivery package (ESD+) focused maternal and child health in urban areas, particularly for the poor
Increase the utilization of PHC services by the urban poor, especially women, new-born and children
Strengthen institutional arrangements for the delivery of PHC services in urban areas
Increase capacity of the Urban Local Bodies (ULBs) to ensure the delivery of PHC services, according to their mandate
Increase sustainability of the delivery of urban PHC services by strengthening ownership and commitment of the ULBs to ensure the delivery of PHC services particularly for the poor
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