Key themes discussed in the orientation sessions for top policy makers, health managers, academia, professional bodies of doctors and non-doctors, and journalists under the Building Awareness for Universal Health Coverage (UHC) in Bangladesh: Advancing the Agenda Forward in 2016

These included the followings:

Level of commitment and awareness varies among different groups of stakeholders

          “We need commitment for UHC first and it has to be within our capacity, affordability and limited budget.” [DGHS, 3 Oct 2016]

          “We blindly can’t follow other countries path… we need to understand our situation and based on our country context create our own path for UHC.” [DGHS, 3 Oct 2016]

          “ We feel shy to interact and discuss because of limited orientation in this regard… but we need to come out of our shyness and participate” [Professional Bodies of Doctors, 6 Sep 2016]

          “Journalists are aware about UHC, mostly through different programs arranged by PIB. We expected to learn new thing through this session…specific and updated data on related issues can be helpful for health reporting.”  [Journalists, 24 Oct 2016]

Health system preparedness in the context of epidemiological and disease transition

          “Medicine provided from the government sector are mainly for communicable diseases but we need to think about the burden arising from the NCDs also...” [DGFP, 16 Aug 2016]

          “…the government facilities are not well prepared to address people’s need. As an alternative, the care seekers are moving towards private facilities.”  [DGHS, 3 Oct 2016]

          “Health services are mostly focusing on curative care but less on preventive care…Government of Bangladesh should do the other way round, e.g., initiating mass awareness program on preventive care in our country.”  [Journalists, 24 Oct 2016]

Health workforce motivation, career prospect, relationship between health and allied professionals

“We need to have highly motivated health workforce and it is mainly their responsibility to take forward UHC..” [Senior government official, 11 Aug 2016]

     “Career planning for professionals need to be specified in the public sector. Career prospect of allied medical professionals in the private sector is not clear…” [Professional Bodies of Non-Doctors, 27 Sep 2016]

     “Mutual respect among health professionals such as between doctor-nurses, doctor-physiotherapists ,etc., could help to achieve UHC.” [Professional Bodies of Non-Doctors, 27 Sep 2016]

Allocation and optimum use of resources, and service package

        “We can create health insurance fund like collaborative fund in government sector for financial resource mobilization. For private sector this can be made mandatory.”  [Senior government official, 11 Aug 2016]

      “We spend 27 US$ per person per year and do not have much scope to increase this. We need to be strategic in maximizing the  use of existing resources.” [Professional Bodies-Doctor, 6 Sep 2016]

      “We need no more medical colleges, no more hospitals… rather better use of what we have” [Senior government official, 11 Aug 2016]

     “The service package can be divided into two parts. There will be one basic part which will include the cost of basic services like lab/diagnostic, medicine, operation. The second part will cover the other costs like room rent.” [DGHS, 3 Oct 2016]

Efficiency of providers, responsiveness, timely delivery of needed services, & appropriate referral

     “If the doctor has to see 500 patients in one working day obviously the quality of service will be hampered and there will be hardly any client satisfaction.” [DGHS, 3 Oct 2016]

    

     “We may see that doctors are referring patients to upper-level hospitals without examining him or her. Behavior of doctors is also an important factor to implement UHC in Bangladesh.” [Journalists, 24 Oct 2016]

       “Minimum quality of doctors for proving services should be standardized and provision for upgrading doctors’ quality should be ensured.” [DGFP, 16 Aug 2016]

Governance and regulation

       “UHC can be implemented if all the services are being provided by the government sector, where a huge private market is doing their business. Formulation of laws is necessary to have a control over the private sector.” [Journalist, 24 Oct 2016]

       “Capitalist approach does have some benefits but we failed to ensure good governance, transparency in health sector. Media is playing a role by covering service news, corruptions and we can discuss more about the role of journalists.” [Journalist, 24 Oct 2016]

    

       “The private sector has to be regulated.  A complete package of common diseases/ healthcare services can be fixed such as a complete package for appendectomy (operation cost, bed rent, diagnosis, drugs including all costs) as per government hospital cost.” [DGHS, 3 Oct 2016]

Pharmaceutical sector regulation

       “The health sector of Bangladesh needs strong regulation, especially in pharmaceutical sector. Drug price has to be controlled to check high out-of-pocket expenditures.” [Professional Bodies of Non-Doctors, 27 Sep 2016]

   

       “Streamlining the regulations both for government and non-government sector will increase efficiency of human resource for health.” [Professional Bodies of Non-Doctors, 27 Sep 2016]

  

       “By opening a drug shop people are prescribing even acting as a doctor and we do need a strong regulation to stop this in our country. If we failed to do this, all the efforts will be wastage of resources as a total generation is growing up with drug intolerance and this is like a ticking time bomb for our future.” [DGFP, 16 Aug 2016]

Inter-ministerial collaboration

“We need a separate entity that will work on target based preventive initiatives, inter- ministerial coordination, safe drinking water, food contamination and relevant concerns” [Senior government officials, 11 Aug 2016]

     “To avoid fragmentation, duplication and wastage, awareness and sensitization of both public and private sector is necessary. We can do it block wise, different ministries can work on different blocks.”  [Senior government officials, 11 Aug 2016]

    “There are 105 safety net programme under National Social Security Strategy.  In 5 clusters Ministry of Finance, banking sector and others are working for the programme. In our country, many other ministries are spending on health. We can bring them all under the same umbrella.” [DGFP, 16 Aug 2016]

Data & information system

     “In Bangladesh there are no records of doctors’ professional activities, quality improvement or any disputes…no clinical record available to rectify or improve. Data in this regards is essential to maintain high standard.”

       [Professional Bodies of Doctors, 6 Sep 2016]

       “We took different initiatives through community clinics, we are  providing free drugs, both cash and kind to reduce OOP and we need to get updated data on recent OOP status in the country to formulate our strategy accordingly.”

       [DGFP, 16 Aug 2016]