On the march towards UHC in Bangladesh!

We are aware about the recent laudable performance of Bangladesh in achieving the health related MDGs in the country, despite the existence of a health system frequently characterized as ‘weak, fragmented and poorly resourced.’ During the last decade, Bangladesh has managed to expand health service coverage, reduce disease burdens, and improve overall population health outcomes, at a ‘low cost’ compared to its neighbours of comparable socioeconomic conditions. Key to these changes has been sustained commitment for health sector over the years in situations of political unrest, economic crises, and natural disasters. Consistent and coordinated policy and programme inputs in the health sector, investments enhancing women’s empowerment (e.g., girls’ education, microcredit, and garments manufacturing), interventions for WASH and poverty reduction, improving nutrition and food security, and infrastructure development (e.g., roads and highways improving accessibility) played key roles in attaining such achievements.

Activities facilitating UHC in Bangladesh has gained new momentum following the commitment of the Prime Minister in the 64th World Health Assembly in May 2011 to achieve universal health coverage (UHC) by 2032. Some strategic initiatives undertaken since then include the formulation of the Health Care Financing Strategy 2012-2032, Communication strategy for UHC 2014-2016, and Bangladesh National Health Accounts 2015. Further, the National Health Policy which was first promulgated in 2000 has been revised in 2013/14 incorporating the principle of the ‘right to health’ for all. Besides, the Health Workforce Strategy 2015 and the Health Protection Act 2014 are finalized for implementation.

The support of the Rockefeller Foundation through its Transforming Health Systems (THS 2010) initiative in 2009 (RF) (to facilitate UHC in LMICs countries like Bangladesh through a ‘multi-pronged’ approach) was crucial in taking up the above initiatives. A recently published Working paper delineates how investments in strategic areas of health sector in the initial stages can generate a momentum for UHC in a LMIC like Bangladesh. To further catalyse the process, RF funded the establishment of the Centre of Excellence for Universal Health Coverage (www.coe-uhc.org) in 2011 at the JPGSPH, BRAC University. The centre works to generate essential evidence on UHC in the context of Bangladesh, develop core competencies for implementing UHC, and provide a forum for disseminating and sharing knowledge, experiences and best practices around UHC and related issues.

During 2016-'17, an advocacy programme on raising UHC awareness (on core concepts of UHC, its scope and components, opportunities and challenges of implementation etc.), was undertaken by the CoE-UHC with support from the USAIDS/HFG, in collaboration with HEU of the MoHFW and Abt Associates. The idea was to develop a critical mass of professionals in the public, private and NGO sectors who can carry forward the UHC agenda in Bangladesh. Activities under the project included organizing customized orientation sessions for different sections of the stakeholders, short courses on UHC, and policy dialogues with practitioners and experts. An end-of-project evaluation found it successful in building a certain level of awareness, interest and consensus on UHC among the policy makers and practitioners for informed, pro-active engagement in their respective field of work. The programme also gave us an idea about their (top level stakeholders at policy and implementation levels) gaps in understanding about UHC, and their felt needs for further information/knowledge/training etc. on UHC, which will guide us in future UHC related research and advocacy activities.

Bangladesh Health Watch, a civil society advocacy initiative since 2006 has been producing analytical reports on different issues that deserve priority attention of the government as well as non-government stakeholders who are committed to improve the health condition and health system of Bangladesh. So far six reports have been published: the fourth report was on universal health coverage (“Moving Towards Universal Health Coverage”, 2012). In 2015, an international conference on “Realsing UHC goals: Bangladesh realities and way forward” was held in Dhaka by PPRC with support from RF where experts from home and abroad discussed the various paths which Bangladesh need to follow, and overcome the obstacles strategically, in achieving UHC by 2032. The CoE-UHC partnered with PPRC to organise some of the sessions in this conference.

In brief, it can be said that the inception activities have successfully placed UHC high up in the national health agenda...now the next big push is needed to start the ball rolling!