This document provides an overview of Bangladesh's health system. It discusses the key building blocks of the health system including service delivery, human resources, health financing, and challenges. Some of the main points covered are: - Bangladesh has a pluralistic health system consisting of public, private, NGO, and informal sectors. - The main challenges include an overall shortage and skill imbalance of human resources, as well as low motivation and absenteeism in rural areas. Initiatives are underway to address these challenges through new training programs and incentives. - Government health expenditure is about 1% of GDP and 4.45% of the national budget. Out-of-pocket expenses account for 63% of total health spending.

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. 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. 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. Organisations under MoHFW

5. Service Delivery structure in govt sector

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. 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. 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. 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. Health Expenditure &
Financing Features
Case of no pocket

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. 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. 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. 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. 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. 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. 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. 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. Thank You ….end of part one !