A Case Study On

Hazaribag Tannery Industries

Prepared by: Aslam Khayer ID:

Prepared for:

Dr. Tanvir

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THE SCENARIO IN HEALTH-CARE SYSTEM IN BANGLADESH

( WITH ESPECIAL EMPHASIS ON HEALTH WORKFORCE RESOURCES OF BANGLADESH )

Over the last two decades or so there has been quite an outstanding improvement in the health sectors. But at this juncture, it seems that inadequacy of health human resources are already a big concern for our policy-makers. In Bangladesh, we are severely in need of skilled workers in the places where they are needed the most. Moreover, the need for a vibrant health system supporting the health workers cannot be overemphasized. A healthcare system largely depends on the efficiency of its four broad factors capital, workforce, utilizations, and financing. Among these, capital and workforce are the most important ones. Lack of adequate capital invested can be clearly reflected on hospitals and health-forces. Acute shortage of qualified health care practitioners in Bangladesh is a part of the day-today reality. Bangladesh has shortages of over 60,000 doctors, 280,000 nurses and 483,000
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technologists. There are large vacancies against allotted posts in government health facilities. Not only the scarcity of health workers is a challenge, the unjustified mix of physicians, nurses, midwives, and health technologists raises major concerns. . Bangladesh has fairly distributed hospitals across its geographic regions (divisions). Although Bangladesh has 0.400 hospital beds per 1,000 populations, the under-utilization of theses hospital beds remains a big concern. The poor quality of services in such hospitals is partly responsible for the under-utilization. It is not only the supply that can guarantee equitable or efficient utilization of services but other factors such as lack of education and awareness among patients can also trigger under-utilization of services. Moreover the rural people who constitute 74 percent of total population usually live far away from these existing public hospitals. Most private hospitals are concentrated in the urban areas. Moreover, as private sector health-care facilities are highly dependent on out-of-pocket payments, unfortunately they work as barriers to healthcare access and remain a factor for catastrophic economic burden to the poor. The Out-of-Pocket (OOP) expenditure in health for a private person is about 64.3%of the total health expenditure, whereas the Government bears 35.7% of the total cost. In Bangladesh health services are mostly obtained through out-of-pocket (OOP) payments at point of service. With very high cost of healthcare, income erosion through health shocks and catastrophic illnesses leads to impoverishment and further poverty. Unfortunately Bangladesh has one of the highest rates of catastrophic illnesses and with an OOP of 64.3%, almost 5.7 million people plunges into poverty every year. In order to save the mostly poor population, the government can share the lion share of the total health cost. Revenue collected by the government is the most important source for financing the health-care sector. With a rather small revenue base, Bangladesh always finds it difficult to generate the adequate revenue to run a well-functioning health-care system. The other sectors such as education; national defense, agriculture etc. are always competing with the health sector for budget allocation.

MY OPINION
Given the existing scenario, Bangladesh need to invest heavily on its health care system to provide quality service to its citizens based on equity and social justice. With a rather small tax base, the prospect of raising that huge amount of money is almost impossible. Imposition of indirect taxes such as value-added tax, fuel tax is not good options for generating extra revenue

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as this mostly affects the poor. Still we need to find a way out that will allow us to manage that extra money which will be spent to address most of the factors that are hindering the progress of our health system to move into a better functioning and equitable health-care system. Although figuring out on what needs to be done is not the real challenge, the real challenge is to manage that astronomical amount of money that will be needed for a well-functioning health-care system for a population of 160 million. Once the money is there all the needed actions of training personnel and infrastructural development work can be undertaken.

THE WAY OUT

Although some form of weak pre-payment system already exist in Bangladesh, but we definitely do not have the one that will give results. This pre-payment system will be a kind of social/community based health-insurance scheme that will be phased in through stages. To start with, the public and private formal sector employees can be integrated into the pilot schemes and later the informal sector can be covered. The very large pool of informal sector workers, who represent 88% of the total workforce in Bangladesh, will be assimilated into the health-insurance system in stages. By sharing health risk across themselves, all these people the formal and the informal sector workers can be covered under the umbrella of a comprehensive universal healthcare coverage scheme. The umbrella of coverage of this health insurance scheme can be further expanded through using cross-subsidization and by doing that the ultra-poor, the students, the disabled and the elderly who lack the ability to pay the premium can be brought under the coverage of the system. Many of the indicators of Bangladesh Health sector suggest that Bangladesh should make the move towards attaining a Universal Health Coverage (UHC) for its people. The UHC assures a better way of paying for health services against the regressive Out-of-Pocket methods. Taking care of not burdening the poor and the sick, UHC shares the costs more equitably across all population.

THE WAY FORWARD

Once we have put Universal Health Care System in place, we can be assured that the system will generate the sum of money that will allow us to work out the details that will lead us towards a more efficient, equitable and effective Health Care system for Bangladesh.

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Considering the challenges the healthcare system of Bangladesh are facing, I can recommend the following goals : More hospitals need to be established and more medical personnel as well as the optimal mix will ensure quality, equitable, and effective health service for all.

Although we dont consider the informal non-State sector as a part of our Health Care System, this sector constitute 95% of all the health care providers and addressing to the health care need of 80 percent of the population, particularly the poor and the women. This sector need to be brought under investment scheme and trained/utilized accordingly.

Keeping the gross imbalance in the skill-mix of the formally trained providers in mind, we need to train necessary number of professionals so that we can keep the ratios among physicians, nurses, technologists in line with WHO suggested norms.

.Under- and over-utilization of hospital beds should be investigated corrective measures should be taken to remedy those and equity needs to be established in respect of geographic areas, gender and socioeconomic groups.

The possibility for creating incentives for private investment in rural areas needs to be investigated so that the distribution of hospitals in urban and rural areas can ensure physical access to hospital based healthcare. Moreover, provision of additional incentives (monetaory and in kind) to doctors and other public sector providers can be arranged in order to provide service in rural areas.

We need to put mechanisms into place where incentives will be created for private investment in rural areas so the urban bias in health-care facilities are not maintained any more.

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For an efficient resource allocation in the public hospitals as well as reimbursement to the private ones, it is important to estimate the disease-specific treatment cost and case-mix of patients in different hospitals.

Disease-specific treatment cost and case-mix of patients in different hospitals must be properly analyzed so that efficient resource allocation in the private hospitals as well as reimbursement to the private ones can be arranged.

Overall, we need to critically study both supply and demand sides and find out the most effective ways to finance healthcare through pre-payment mechanism. Moreover a model should be developed to ensure efficient and equitable resource allocation so that need-based universal health coverage can be established in Bangladesh within foreseeable future.

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