**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).