chatbot-knowledge/HealthCarefinancing.md

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).