WEALTH FOR HEALTH

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By Rashna Mahzabin

Where do we stand?

In the time of the pandemic, questions of healthcare coverage and quality of healthcare all over the country have come under scrutiny. One question has been rising continuously if healthcare is seen as valuable as economic growth by the country leaders.

Countries must increase spending on primary healthcare by at least 1% of their gross domestic product (GDP) if the world is to close glaring coverage gaps and meet health targets agreed in 2015, says a new report from the World Health Organization and partners on the eve of a UN General Assembly high-level meeting on Universal Health Coverage. They must also intensify efforts to expand services countrywide.

The world will need to double health coverage between now and 2030, according to the Universal Health Coverage Monitoring Report. It warns that if current trends continue, up to 5 billion people will still be unable to access health care in 2030 – the deadline world leaders have set for achieving universal health coverage. Most of those people are poor and already disadvantaged.

WHO has also claimed to invest an additional USD200 billion a year on scaling up primary health care across low and middle-income countries would potentially save 60 million lives, increase average life expectancy by 3.7 years by 2030, and contribute significantly to socio-economic development. It would represent about a 3% increase on the USD7.5 trillion already spent on health globally each year.

Countries must also renew efforts to scale up service coverage countrywide. Although coverage has increased steadily since 2000, progress has slowed down in recent years. Most increases have occurred in lower-income countries, but these countries are still lagging behind. The biggest health service gaps are in the poorest countries and those affected by conflict.

Trends of Global Health Spending:
In 2016, the world spent US$ 7.5 trillion on health, representing close to 10% of global GDP. The average per capita health expenditure was US$ 1,000, but half of the world’s countries spent less than US$ 350 per person. The patterns and trends identified in last year’s report are confirmed by the 2016 data published in WHO’s Global Health Expenditure Database. As described in section 1, health spending is growing faster than the overall economy globally as well as in most countries, particularly in low and middle-income countries. Despite the growth in low-income countries, the gap across country income groups remains wide. The share of spending from prepaid sources is also growing, with a concomitant smaller share coming from direct out-of-pocket payments made at the point of use — both welcome trends.

At the aggregate level, external aid is a small share (less than 1%) of global health spending, and it has declined as a percentage of health spending in middle-income countries. However, its share of health spending in low-income countries is increasing. As in last year’s report, the data suggest fungibility between external aid and public spending on health from domestic sources, particularly in low-income countries, where aid was considerable. While aid per capita for health more than doubled across low-income countries over 2000–2016, from US$4 to US$10, public spending on health increased only slightly (by about US$3 per capita), and the share of health in overall domestic public spending declined.

Public spending on health has been growing globally, both in level and as a share of the total health spending. This trend has been driven mainly by growth in real per capita GDP and an increase in overall public spending as a share of that increasing GDP. The prioritization of health in overall domestic public spending was less responsible for these changes, and growth patterns differed across income groups. In low-income countries, this share was lower in 2016 (6.8% on average) than it was in 2000 (7.9%), with aid fungibility as a potential cause. This decline in low-income countries was an important contributor to the slower growth, on average, in their public spending on health relative to spending in other country income groups. There was a slight increase (about 1%) in domestic health prioritization in lower-middle-income countries, a larger increase in upper-middle-income countries (about 2%) and the largest increase in high-income countries (3.3%). On average, public spending on health increased in high-income countries. Immediately after the economic crisis of 2008– 2009 faster than overall public spending and certainly faster than GDP, suggesting that countercyclical spending policies were in effect. Of course, for this finding and the other points made above, the averages mask considerable cross-country variation.

Bangladesh & Healthcare Budget Allocation:
According to a 2018 news report of a daily, for the last 10 years, the budgetary allocation for health has been constantly around five percent of the total budget. If at least 3 percent of the GDP could be spent on health, it could have a major impact. Generally, the government provides allocation to public hospitals based on the number of beds. The amount allocated for each bed is very small. But as the number of people seeking treatment is much higher than the number of beds available, these extra people do not get any portion of the budgetary allocation.

Needless to say, the healthcare services in Bangladesh are not affordable to the general people and the quality of healthcare is also questionable. The government’s view regarding the health sector is also not clear. But if the government wants the private sector to take responsibility for the health sector, it needs to ensure that there is a regulatory mechanism in place, which is not there at present.

When it comes to COVID-19, Bangladesh is no better than other affected countries in preventing the coronavirus pandemic. The existing healthcare infrastructure and the available medical equipment are not adequate even in ordinary situations, let alone in facing the ominous outbreak. The COVID-19 pandemic has put our health sector to the ultimate test. Medicare facilities for common citizens are extremely limited. According to the Bangladesh Bureau of Statistics (BBS), as of 2017, there was one hospital bed for every 1,196 individuals in the country (BBS, 2019). Data from the Bangladesh Health Facility Survey 2017 shows that among the healthcare facilities in Bangladesh, 5.1 percent had emergency transport, 21.5 percent had alcohol-based disinfectants, 27.5 percent had medical masks, 28 percent had all basic equipment, 34.5 percent had lab facilities, 43.1 percent had regular electricity, 55.1 percent had soap and water, 83.7 percent had paracetamol oral suspension, 86.3 percent had a thermometer, and 90.1 percent had improved water source, as of 2017. Apart from the lack of infrastructure and equipment, healthcare facilities in Bangladesh are also not staffed with adequate numbers of healthcare service providers. As of 2018, there was one registered physician for every 1,581 individuals in the country (BBS, 2019). The Bangladesh Health Facility Survey 2017 also shows that among the healthcare facilities in Bangladesh, 28 percent had specialists, 59.1 percent had general practitioners or medical officers, and 79.7 percent had nurses, as of 2017.

There are many community clinics in the country at the village level, but due to a lack of professional health workers, these clinics remain largely underutilised. Many of them are only capable of providing patients with primary health-related information and occasionally prescribe over-the-counter drugs. If these community clinics could be made fully operational by appointing skilled doctors and staff, the basic healthcare needs of local communities could be easily met. Also, there are many government-approved private medical college hospitals in the country which remain underutilised. If the government can make these facilities fully operational through a public-private partnership, the poor and the extreme poor can have access to health services at low cost.

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