Md Billal Hossen :
Enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The right to health for all people means that everyone should have access to the health services they need, when and where they need them, without suffering financial hardship. No one should get sick and die just because they are poor, or because they cannot access the health services they need. Good health is also clearly determined by other basic human rights including access to safe drinking water and sanitation, nutritious foods, adequate housing, education and safe working conditions. The right to health also means that everyone should be entitled to control their own health and body, including having access to sexual and reproductive information and services, free from violence and discrimination. In Bangladesh, the out-of-pocket (OOP) health expenditure is 67 percent of the total health expenditure, which is much higher than that of the world average of 32 percent whereas maximum 20 percent out-of-pocket health expenditure is recommended. Furthermore, Bangladesh has a shortage of approximately 100,000 doctors and approximately 800,000 healthcare providers compared to the global standard.In this year the budget allocation for health sector is only 4.9 percent of the total budget whereas minimum 15 percent is recommended for ensuring adequate access to health. From the aforesaid statistics it is crystal clear that the allocated amount is very low for improving the health sector. So what’s the solution? The solution lies in the Universal Health Coverage (UHC).
Bangladesh has agreed to achieve the UHC by 2030. According to World Health Organization (WHO) “Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care”. Currently, at least half of the people in the world do not receive the health services they need. About 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health. This must change. Good health systems are rooted in the communities they serve. They focus not only on preventing and treating disease and illness, but also on helping to improve well-being and quality of life.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. This requires a strong, efficient, well-run health system; a system for financing health services; access to essential medicines and technologies; a sufficient capacity of well-trained, motivated health workers.
In the context of Bangladesh following steps should be taken to ensure universal health care for all.
Increase government expenditure on primary healthcare as a priority for achieving UHC: Public ?nancing is the most reliable source of health ?nancing. Bangladesh should increase government expenditure on primary healthcare to the levels recommended by national costing’s for the Essential Service Package ($8.5 per capita) to 5% of GDP or at least $86 per capita, per year in accordance with WHO recommendations for achieving UHC.
Invest to improve ?nancial protection for households: Bangladesh must reduce reliance on out-of-pocket payments to end catastrophic healthcare expenditure. This can be achieved by:
o Ensuring user fees are not charged and policy directives to provide free basic healthcare are complied with.
o Expanding piloted health insurance to reduce out-of-pocket payments through cross-subsidized pre-payments.
o Increasing government investment in primary healthcare services to ensure quality services are available and patients are not forced to pay for private sector care.
Address inequity in health outcomes and access to services:
Policy and investment should speci?cally address barriers to access faced by marginalized groups and those located in hard-to-reach areas. Attention should be given to ensuring sustainability of this work currently funded by external donors through government buy-in and transfer of responsibility.
Increase ?scal space through health ?nancing reform: This should include:
o Reduced inef?ciencies through improved governance and regulation and improved health service management.
o Financing reform to increase ?exibility in use of funds and giving greater autonomy to sub-national health management for improved responsiveness in a decentralized system.
Create greater demand for UHC and quality primary healthcare, including through support for civil society: Improving quality of services is key to increasing trust and demand for services this could be achieved through the introduction and enforcement of a code of conduct for service providers, improved regulation, inter-sectoral collaboration and increased involvement of civil society in decision-making and community monitoring of service quality. Empowerment of people to improve health-seeking behavior through better health promotion and support, including capacity building, for civil society to engage in advocacy activities.
The principal of the SDGs is to “leave no one behind.” That’s exactly what UHC aims to do. We must ensure that the poorest and most vulnerable people-including those in the remotest areas and those living in emergency settings-enjoy the same access to services as the wealthiest in big cities.We cannot tolerate a world in which people are forced to choose between wellbeing and financial stability. The world is moving towards this important achievement. And we need to play our role. Let’s make promise to change the lives of millions of people across the world. Health coverage that is universal. Health coverage that is for everyone, everywhere and leaves no one behind.
( Md Billal Hossen is a MS student of Applied Nutrition and Food Technology).
