𝗛𝗲𝗮𝗹𝘁𝗵 𝗕𝘂𝗱𝗴𝗲𝘁 𝗗𝗶𝘀𝗰𝘂𝘀𝘀𝗶𝗼𝗻 : 𝗘𝘅𝗽𝗲𝗰𝘁𝗮𝘁𝗶𝗼𝗻𝘀 𝗮𝗻𝗱 𝗢𝘂𝘁𝗰𝗼𝗺𝗲𝘀, 𝗣𝗮𝗿𝘁-𝟯

According to the World Health Organization, universal health coverage ensures that everyone has access to high-quality health services without facing financial difficulties, regardless of when and where they need them. Universal health coverage encompasses essential health services such as health promotion, prevention, treatment, rehabilitation, and palliative care. Primary health care is considered the most efficient and cost-effective means of achieving universal health coverage, as it provides integrated services tailored to the specific needs of individuals.

The primary focus of SDG-3 is Universal Health Coverage, and Bangladesh has made significant strides towards this goal in recent years. These advances include reductions in infant and under-5 mortality rates, maternity mortality rates, childhood undernutrition, and improvements in maternal and child care. Despite these accomplishments, disparities in access to healthcare persist in rural areas and among marginalized and disadvantaged populations, who still lack adequate and fair healthcare services. Bangladesh has set a target to achieve Universal Health Coverage by 2032 and is actively considering policy measures to enhance the quality and availability of healthcare services. Over the past four decades, Bangladesh has achieved progress in immunization and child health, such as the elimination of neonatal tetanus in 2008, earned a polio-free certification in 2014, and a 73% decrease in under-5 mortality. The country aims to expand immunization services through 140000 vaccine administration points and has established approximately 14,000 community clinics to provide primary healthcare.

The allocation of funds in the health budget significantly influences the attainment of Universal Health Coverage. Analysis of the FY 2024-2025 health budget reveals that the government has prioritized investments in the establishment of 90 UH and FWC, as well as the reconstruction of 60 Union Sub Centers. Moreover, the budget allocates resources for the construction of three 10-bed and two 20-bed hospitals to enhance the availability of health services, indicating a greater emphasis compared to the previous health budget of FY 2023. Notably, there is a concerted effort to enhance primary health care by expanding the number of union sub-centers, aligning with the integrated approach to achieving Universal Health Coverage through primary health care. Community clinics have increased from 13,783 to 14,275, operating nationwide. Plans to establish burn and plastic surgery facilities at five medical colleges (Sylhet, Barishal, Rangpur, Rajshahi, Faridpur) are in the pipeline but are yet to be implemented. In the FY 2024-2025 development plan, the aim is to improve access and availability of health care services. While the government has augmented its development budget, there has been a decrease in operating expenditures. This reduction may impact the quality of services provided by medical professionals. With a potential decrease in new doctor and nurse recruitment, accessibility may diminish, the workload will increase which will lead to poorer service delivery, thus affecting the efficiency of administration and maintenance levels. Furthermore, the decrease in operating expenditure may lead to reduced supplies of essential drugs and medical equipment. Well equipped facilities, sufficient health care workers are necessary to achieve UHC. Budget cuts on operating expenditures can hinders the progress as it decreases the accessibility and quality of health services.

The government has not allocated any budget for health insurance, causing out-of-pocket expenditures to remain high. As a result, many people are unable to access necessary healthcare without facing financial strain. The health budget as a percentage of total GDP continues to decrease annually, with no specific allocation to reduce out-of-pocket expenses through affordability schemes or insurance. This situation poses a significant challenge to achieving Universal Health Coverage. Furthermore, the ongoing development efforts aimed at improving healthcare services will require considerable time for implementation, adding to the complexity of the issue. Notably, the poorest 20% of the population have only half the access to healthcare services compared to the richest 20%.

𝗥𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗮𝘁𝗶𝗼𝗻𝘀:

1. The primary healthcare must be affordable and accessible for all citizens of Bangladesh, including the construction of more primary healthcare centers in rural areas.

2. In order to mitigate out-of-pocket expenditures, universal health insurance coverage is imperative. Encompassing a comprehensive demographic will lead to a reduction in insurance costs. Subsidies for health insurance premium can increase coverage among the poor people which will ensure the equitable access.

3. It is crucial to raise public health spending and allocate more budget towards healthcare. In order to enhance efficiency in health care spending rigorous audit and monitoring system should be implemented by the regulatory authorities.

4. Expansion of access to crucial health services and the effective provision of maternal health vouchers to 20 additional upazilas than originally planned are underway. This scheme has already been implemented in 55 upazilas, demonstrating significant progress in extending essential maternal health support.

5. In order to incentivize doctors and nurses to deliver high-quality services, it is imperative to augment the budget allocated for operational expenses.

6. Investing in community health workers through training is one of the effective way to ensure access to health care. They can contribute to extend the primary health care in the rural areas.