Syed M. Ahmed, Professor and Director of the Centre of Excellence for Universal Health Coverage in Dhaka, Bangladesh speaks with Timothy Grant Evans, Senior Director of Health, Nutrition and Population Global Practice at the World Bank
Despite the characterization as a “weak, fragmented and poorly resourced” health system, Bangladesh demonstrated spectacular progress toward health-related UN Millennium Development Goals. During the last decade, Bangladesh has managed to expand health service coverage, reduce disease burden and improve overall population health outcomes—all at a low cost compared to its neighbors of comparable socioeconomic conditions.
Key to these achievements has been the sustained commitment of Bangladesh’s health sector over the years, even in situations of political unrest, economic crises and natural disasters. Consistent and coordinated policy and program inputs in the health sector, investments enhancing women 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) have all contributed to these achievements.
The below initiatives highlight the factors contributing to the advances Bangladesh has made toward universal health coverage (UHC).
Milestone policy reforms
Policy reforms and efforts facilitating UHC in Bangladesh gained fresh momentum following the commitment of the Prime Minister of Bangladesh, Sheikh Hasina, in the 64th World Health Assembly in May 2011 to achieve 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 developed in 2000, has been revised in 2013-14 to incorporate the principle of the right to health for all. In tandem, Bangladesh government finalized the Health Workforce Strategy 2015 and the Health Protection Act 2014 for implementation.
Early investments and support
The support of the Rockefeller Foundation through its Transforming Health Systems initiative launched in 2009, has been crucial for low and middle income countries like Bangladesh to implement reforms on the path toward UHC. Funding the establishment of the Centre of Excellence for Universal Health Coverage (CoE-UHC) in 2011 at BRAC University has further catalyzed the UHC movement in Bangladesh.
The Center’s recently published working paper delineates how investments in strategic areas of health sector in the initial stages have generated a momentum for UHC in a low and middle income country like Bangladesh. The CoE-UHC 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.
UHC awareness program
During 2016-17, an advocacy program on raising UHC awareness was undertaken by the CoE-UHC with support from the USAID-funded HFG Project in collaboration with the Ministry of Health and Family Welfare and Abt Associates. The campaign aimed 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 program included organizing customized orientation sessions for different stakeholders, short courses on UHC, and policy dialogues with practitioners and experts. An end-of-project evaluation found the initiative successful in building a certain level of awareness, interest and consensus among the policymakers and practitioners for informed, proactive engagement in their respective field of work. The program also gave insights on gaps in understanding of the top-level decision-makers and the needs for further information and/or training, which could guide future UHC related research and advocacy activities.
Role of civil society and nonprofits
Bangladesh Health Watch, a civil society advocacy initiative launched in 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 with one of them focused on UHC (“Moving Towards Universal Health Coverage”, 2012).
In 2015, an international conference on “Realising UHC goals: Bangladesh Realities and Way Forward” was held in Dhaka by the Power and Participation Research Centre with support from the Rockefeller Foundation and the World Bank, where national and international experts discussed challenges and potential solutions for Bangladesh in pursuit of its UHC goals by 2032.
Global practitioner-to-practitioner learning
Seeking to learn best practices from other countries, Bangladesh joined the Joint Learning Network for Universal Health Coverage (JLN) in early 2015. The JLN learning exchanges are enabling Bangladeshi policymakers and practitioners to engage with their counterparts from other JLN member countries on similar challenges and jointly solve problems to implementing UHC reforms.
Currently, Bangladesh is engaged with the JLN’s member countries on a learning exchange on stakeholder communications, sharing lessons and co-producing global knowledge on how to effectively reach diverse stakeholders of UHC to support reform efforts within countries. Bangladesh is also engaged in a learning exchange on leveraging existing resources as part of the Efficiency collaborative , where members are initially focusing on measurement of efficiency and systematic priority setting for efficient use of resources for health.
In conclusion, we are excited about the many developments in Bangladesh and look forward to interacting and engaging with peers, especially from the low- and middle-income countries, who face similar challenges in moving toward UHC under situations of both resource and human constraints.
Bangladesh recently became a full member of the JLN, represented by the Health Economics Unit of the Ministry of Health and Family Welfare. Read an interview with Dr. Ashadul Islam, Director General in the Ministry of Health and Family Welfare and Bangladesh representative on the JLN’s Steering Group.