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Universal health coverage in Bangladesh: activities, challenges and recommendations

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Document pages: 13 pages

Abstract: Catastrophic health spending forced 5.7 million Bangladeshis into poverty. Inequality exists in most health indicators of social, economic and demographic parameters. This study explores the existing health policy environment and current activities to promote the progress of universal health coverage (UHC), as well as the challenges faced in these efforts. This qualitative study involved document review (n = 22) and key informant interview (Kii, n = 15). Subject analysis of text using manual coding techniques (subject: activities around UHC, implementation obstacles, suggestions). We found that Bangladesh has a comprehensive set of universal health insurance policies, such as health financing strategy and phased recommendations to pool funds to create national health insurancecheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

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