Recently, a colleague pointed out to me that in Bangladesh, the Government provides free healthcare through public facilities, yet she has never sought any health services at these facilities. What caught my attention was her concern about the high cost of care at private health facilities and unreliability in the quality of services provided; she seemed to reflect a widespread distress among people regarding access to affordable and quality healthcare in the country.
According to the Health Economic Unit of the Ministry of Health and Family Welfare, about 10 per cent of households spend more than one fourth of what is meant to be resources for food costs on healthcare instead. It was also found that cost for healthcare pushed 18 per cent of households into poverty in Bangladesh. Another study demonstrated that poor quality health services, high expenses and a corrupt health system compels many Bangladeshis to travel to neighboring countries such as India, Malaysia, Thailand, and Singapore for medical treatment. These statistics shed light on the need to tackle healthcare costs and improve the quality of services in the country.
To overcome these challenges, we must advocate for greater policies around universal health coverage (UHC). There are several concerns, myths and confusion that revolve around UHC and access to affordable health services. The Centre of Excellence for Universal Health Coverage at JPGSPH has been striving to clarify these concepts and advocate for UHC since 2011. Two main activities of the Centre have been generating evidence by conducting research on facilitating UHC, as well as building the capacity and knowledge of health professionals and policymakers working in this field.
Based on first hand experiences, in partnership with USAID’s Health Finance and Governance Project, the Centre coordinated a programme titled Building Awareness on Universal Health Coverage: Advancing the agenda in Bangladesh. For the first year, the objective of the programme was to raise awareness among practitioners and policymakers. This would eventually aid in the development of a critical group of public and private sectors players who can facilitate and move the UHC agenda forward.
To achieve this goal, a series of orientation sessions were offered, targeting government officials and different professional bodies. The aim was to build consensus, mobilize stakeholders, define and discuss the role of different stakeholders and above all, raise awareness. Participants included government officials, medical and allied health professionals, health journalists and senior academics of community medicine and public health department from public and private medical colleges.
Following these orientation sessions, the Centre designed a short course to continue building on the experience and provide other public health practitioners with such critical information. Over the past seven times the course has been offered since 2015, we have heard participant raise several questions and concerns regarding the current state of healthcare financing, workforce, governance, quality and cross-sectoral collaboration.
However, our leaders and champions remain hopeful. Even the Director General of the Directorate General of Health Services has mentioned, “The Honourable Prime Minister of the Government of Bangladesh has already expressed the highest commitment, but we are yet to lift up our collective voices for moving towards UHC.”
During the second stage of the program, we engaged stakeholders to exchange their experiences and opinions, to define their respective roles and activities, and to debate the next steps for advancing UHC in the country. We organized a live talk show on a popular TV channel and roundtable policy dialogue with a daily newspaper to address these issues.
Such activities have enriched the Centre’s knowledge and experience towards advancing UHC in Bangladesh. We are hopeful that someday we will be able to respond to all the queries made by our colleagues, peers, course participants and eventually the service recipients. As stated by the Health Minister, “We need cooperation from all sectors including the media to achieve our UHC targets.”
This blog is written by Nadia Ishrat Alamgir, a senior research fellow at the Centre for Universal Health Coverage at James P Grant School of Public Health.