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Health system in bangladesh for interns

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Health system in bangladesh for interns

  1. 1. Introducing health system to the Interns Prof Abdul Hanif Tablu Pediatric Surgery Dhaka Medical College June 1, 2015 1 Health System in Bangladesh
  2. 2. What is health system ? WHO defines health system as Six building blocks and their interconnectedness Which block is most important? Service delivery is the main function Other blocks are support functions SYSTEMS THINKING for Health Systems Strengthening – WHO & Alliance for Health Policy and Systems Research
  3. 3. Health system in Bangladesh  Pluralistic  Government – Country-wide network  Growing Private (for profit) sector  Large informal sector  NGO providers  Shrinking charitable section  Home and community care
  4. 4. Organisations under MoHFW
  5. 5. Service Delivery structure in govt sector
  6. 6. Human Resources in HPN Sector  HPN is a provider-intensive sector  <55% of budget spent for pay and allowances  Total personnel 162,927
  7. 7. Issues, Challenges and initiatives Human Resources ❶ Overall shortage ❷ Skill imbalance (fewer nurses, anesthetists, technologists than physicians) ❸ Low motivation ❹ Vacancies & absenteeism in rural areas ❺ Quality
  8. 8. Initiatives to address challenges New Human Resource plan and management  Recruitment of additional providers  Rules, regulations and incentives for serving in the rural areas  Special training program for anesthesia  Task shifting and partnerships
  9. 9. Health financing  Govt. spends 1% of GDP & 4.45% of national budget  63% of the total health expenditure comes from out-of- pocket  We spend US $ 27 per capita per year (Govt + private)  15% of families face catastrophes  Inefficiency and wastage All these affects accessibility and utilization of health care especially by the poor
  10. 10. Health Expenditure & Financing Features Case of no pocket
  11. 11. Budget in Health Sector and National Budget Fiscal Year National Budget (in Crore) MoHFW Budget (in crore) MoHFW Budget as % of National Budget % Increase of MoHFW Budget as to Previous FY % Increase of Total Govt. Budget as to Previous FY 2013-14 2,22,491 9,495 4.27% 4.0% 17.5% 2012-13 1,89,326 9,130 4.8% 12.0% 17.4% 2011-12 1,61,213 8,150 5.1% 7.0% 24.0% 2010-11 1,30,011 7,617 5.9% 11.5% 17.6% 2009-10 1,10,523 6,833 6.2% 10.3% 17.4% 2014-15 2,50,516 11,146 4.45% 17.4% 12.6%
  12. 12. Successes and achievements • Bangladesh over the years have achieved remarkable progress • Through the government leadership, the country was able to meet the MDGs (4,5, & 6) pertaining to health • The country has the highest EPI coverage (82%-Lancet Series) amongst neighboring and peer countries
  13. 13. Health sector in Bangladesh Global appreciation  “The large number of women health workers has actually helped Bangladesh overtake India in every aspect of Human Development Index” - Amartya Sen, Jan 2013  “In respect of achievements in child mortality immunization and low birth weight, Bangladesh is advancing well ahead of India” - An Uncertain Glory by Amartya Sen and Jean Dreze in July, 2013
  14. 14. Global appreciation  Overseas Development Institute (ODI), London, put Bangladesh in the “Star” category among 24 nations for its achievement in Health sector  Bangladesh Paradox: exceptional health achievement despite economic poverty.  One of the great mysteries in global health  Unusual success -The Lancet Series Nov, 2013
  15. 15. Common challenges for health across the world  Increasing health care cost (more than 7 trillion USD)  Due to epidemiological change, new technology etc.  How to protect people (100 m people pushed into poverty)  from financial consequences of health care payment  How to generate more resources for health  amid macro-economic constraints  How to use available resources  effectively and efficiently  How to ensure equity in health care  Provide more to them who need most
  16. 16. How you can help?  In Many ways  Taking the “right to health” agenda forward  Determining the basic package of priority interventions  Setting standards of health care (effective & inexpensive)  Containing costs  Improving efficiency – better utilization of resources  Setting the balance between prevention, promotion and clinical care 16
  17. 17. 10 leading causes for inefficiency -WHO World Health Report 2010 1. Underuse of generics & higher-than- necessary priced medicines 2. Use of substandard & counterfeit medicines 3. Inappropriate & ineffective use of medicines 4. Oversuply & overuse of health care services & equipment 5. Inappropriate / costly mix of health workers
  18. 18. 10 leading causes for inefficiency 6. Inappropriate hospital admission & length of stay 7. Inappropriate hospital size 8. Medicine errors & suboptimal quality of care 9. Waste, corruption & fraud 10. Inefficient mix / inappropriate level of health care
  19. 19. Thank You ….end of part one !

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