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HealthCarefinancing.md

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+**Health Financing and Programs in Bangladesh**
+
+**1\. Health Financing Overview**
+
+- **Household Out-of-Pocket (OOP) Expenditure**: Largest financing area, accounting for 68.5% of Total Health Expenditure (THE) in 2020.
+  - Majority spent at pharmacies/retail drug outlets (64.6%), followed by medical and diagnostic labs (11.7%).
+- **Total Health Expenditure (THE)**:
+  - BDT 777 billion in 2020 (2.8% of GDP).
+  - Per-capita THE: BDT 4,578 ($54).
+  - Current Health Expenditure (CHE): BDT 719 billion (2.6% of GDP), Per-capita CHE: BDT 4,239 ($50).
+  - Pharmaceutical Expenditure: BDT 389 billion (50% of THE).
+- **Bangladesh’s Health Budget**:
+  - FY 2023-2024: BDT 38,052 crore (5% of the national budget).
+  - Increment: 3.23% higher than the previous fiscal year.
+- **Trends in THE**:
+  - Per-capita THE increased from $10 to $54 over 20 years.
+  - Steady share of GDP: 2.8%-3% in the last decade.
+
+**2\. Disease-Specific Expenditures (2020)**
+
+- Total recurrent expenditure: BDT 69,000 crore.
+- **Top Disease Categories** (ICD-10 classification):
+    1. Diseases of musculoskeletal system: BDT 9,461 crore.
+    2. Digestive system: BDT 8,872 crore.
+    3. Circulatory system: BDT 8,865 crore.
+    4. Symptoms/signs not elsewhere classified: BDT 8,010 crore.
+    5. Respiratory system: BDT 5,395 crore.
+- These categories represent 65% of the total disease burden.
+
+**3\. Pharmaceutical Expenditure (2020)**
+
+- Household financing: 93.89% of total pharmaceutical expenditure.
+- Major contributors to expenditure:
+    1. Musculoskeletal diseases.
+    2. Circulatory diseases.
+    3. Digestive diseases.
+- Gender-based share:
+    1. Male: 39%
+    2. Female: 61%
+
+**4\. Bangladesh Essential Service Package (ESP)**
+
+- Total expenditure in 2020: BDT 380 billion (48.8% of THE).
+- Core services:
+    1. Maternal, neonatal, child, and adolescent health: 42% of ESP.
+    2. Non-communicable diseases: 25%.
+    3. Communicable diseases: 6%.
+    4. Family planning: 4%.
+    5. Nutrition: 3%.
+- Public vs Private Spending:
+    1. Public: 27%.
+    2. Private: 73%.
+- **Per-Capita ESP Spending (2020)**:
+    1. Public: BDT 593.
+    2. Private: BDT 1,642.
+
+**5\. Shasthyo Surokhsha Karmasuchi (SSK)**
+
+- Social health protection scheme for households below the poverty line (BPL).
+- Services provided via:
+  - Upazila health complexes.
+  - Urban hospitals (e.g., Mugda Medical College Hospital).
+- Innovations:
+  - Biometric SSK cards.
+  - IT integration for Electronic Health Records (EHR) and cashless transactions.
+- **Progress (till March 2024)**:
+  - Registered households: 307,593.
+  - IPD patients served: 54,056.
+
+**6\. Social Security Programs**
+
+- Share of government expenditure: 17.81% (2.65% of GDP).
+- Coverage:
+  - 50% of households benefited in 2022, up from 28.7% in 2016.
+- Programs include:
+  - Maternal and child health.
+  - Communicable and non-communicable disease control.
+  - Nutrition services.
+
+**7\. Historical Trends in Health Programs**
+
+- **4th Health, Population, and Nutrition Sector Program (HPNSP)** (2017-2022):
+  - Total allocation: BDT 2,633,893.5 lakh.
+  - Total expenditure: BDT 2,050,238.7 lakh.
+  - Yearly progress (2023-2024): 42.57% of allocation utilized.
+- Shift in financing:
+  - Increased demand-side financing for efficiency and equity.
+
+**8\. Key Challenges and Insights**
+
+- High reliance on OOP expenditure poses financial risks.
+- Significant gender disparities in disease-specific spending.
+- Slow increase in public health expenditure as a share of GDP.
+- Rising focus on IT-based solutions for healthcare delivery (e.g., SSK program).