JLN Country Corner: Spotlight on Bangladesh Apr 10, 2015

JLN Country Corner: Spotlight on Bangladesh

In January, the Joint Learning Network for Universal Health Coverage (JLN) welcomed 13 new associate member countries to our expanding network of universal health coverage (UHC) policymakers and practitioners. Each of these countries, across six regions, joins the JLN with a unique story to tell.

We recently chatted with our colleague, Dr. Ashadul Islam, who represents one new associate member countryBangladesh. Dr. Islam is the Director General of the Health Economics Unit at the Bangladesh Ministry of Health and Family Welfare. 

Make sure to continue reading our interview below to learn more about Bangladesh's vision for achieving UHCkey successes and challenges, and why Bangladesh joined the JLN.

In recent years, Bangladesh has received much praise for its efforts to boost healthcare reform. Through effective governance, the country has been on track with its health Millennium Development Goals, while using relatively few resources. But with high out-of-pocket (OOP) payment, the country still has a long way to go.  

To speak more about Bangladesh’s successes and challenges, we spoke to Dr. Ashadul Islam, who is the Director General, Health Economics Unit at the Ministry of Health and Family Welfare.

Question: Welcome to the Joint Learning Network! We are very excited to have Bangladesh join our network. I’m sure our readers are very curious to learn more about why Bangladesh decided to apply for membership in the JLN.

Islam: It is a pleasure to work with the JLN because this is the largest forum for Universal Health Coverage. We need to learn from the experiences of other countries because [joint learning is a] very new approach for us. We need to learn and develop ourselves. Also, I find it very interesting to know that we can customize some of the learnings and experiences from other countries through this collaboration.

Question: How do you think your involvement with the JLN can affect other members of the network?

Islam: We have taken different initiatives based on the context of Bangladesh. We have developed different tools on UHC, especially around resource allocation formula. We also developed monitoring tools to measure the progress towards UHC. We also developed strategic directions and plans for improving quality because this is an important part of UHC. So the groundwork that we have been working on may be something that other countries might like to know.

Question: Could you describe your UHC landscape in more detail? I’m sure our readers would like to learn more about your background.

Islam: The main direction for UHC is our 20 years-long health care financing strategy, so we’ll be implementing it in phases. We categorized the population into three groups—below the poverty line, the formal sector (who meet regular income levels), and the informal group. For the first group—those who are below the poverty line—we have developed a health protection scheme for the poor and we will start the pilot this year. There is much work going on, which we would be happy to share with other countries in the JLN.

Question: Are there any specific countries in the network you are curious to learn from and who might share similar challenges?

Islam: Countries like Indonesia, India, Philippines, and other neighboring countries—we share some of the common challenges in the health systems and services. These countries’ experiences will be helpful for us.

Question: I would like to probe more into Bangladesh’s history with UHC reform. When did this issue become a prominent topic area in your country?

Islam: We can claim [that the interest in UHC] is as old as when Bangladesh was born because our Constitution provides the obligation for state to insure the population. But formally, this wave of UHC started with the healthcare financing strategy developed in 2012.”

Question: What are some of the successes and challenges that you have faced along the way?

Islam: We have been trying this insuring health for all through different schemes and programs for the last 15 years. The successes that we have been encountering for a long time are the expenses of the allocation and efficiency in financing, and the protection of the poor. However, the issue is we need more resources and we also need to efficiently use our scarce resources. We need to lessen out-of-pocket payments and enable people to recover from health shocks.

Question: How much coverage of the population have you achieved so far and what are you doing as far as providing healthcare access for the uninsured?

Islam: There are multiple methods that Bangladesh is pursuing [to provide healthcare access]. Our public healthcare facilities are free of cost. Anybody can access health, although there are some initial out-of-pocket costs involved.

Question: What are some next steps for Bangladesh? You mentioned that you will be piloting a health protection scheme for the poor?

Islam: Yes. We are trying to develop the health card. After the piloting experience, it will be deployed to the whole country. There’s a strong commitment from the government that those families identified as poor through the national criteria will be given the card and some sort of benefits package.

Question: You sound like you’re optimistic that Bangladesh will ultimately achieve UHC!

Islam: Yes. It could be achieved by 2032 [as outlined in our healthcare financing strategy]. Hopefully we can achieve it, or at least make some substantial progress before that. At the end of the day, UHC is a very challenging sort of thing. I have been here for two years, and every time I face challenges. But we believe the JLN can help us learn best practices from around the world.