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Supporting the piloting of social health protection in Bangladesh

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Mike Naylor Rashid Zaman Tomas Lievens Alex Manu A0039

We led a consortium, contracted by the Health Economics Unit (HEU) of the Government of Bangladesh, to assist the piloting of a health protection scheme, known locally as ‘Shastho Surokhsma Karmasuchi’ (SSK). The programme’s primary objective was to stimulate the use of health facilities, increasing the treatment of insured diseases within the poor population of the pilot region. In the longer-term, the scheme’s impact spread beyond this area, as the programme’s demand-side approach influenced the structure of health financing on an institutional level. The successful implementation of the piloting provided the basis for a mixed system of healthcare financing models and approaches, constituting a major step towards achieving universal health coverage (UHC) in Bangladesh. 

The objectives of this piloting was to help promote the adoption of pro-poor health financing mechanisms in Bangladesh, supporting more equitable and accessible health service delivery throughout the country. The scheme was first piloted in a limited geographical area of Bangladesh, with the potential for expansion following successful implementation.

Challenges

The critical challenges facing health financing in Bangladesh can be broadly categorised into three groups: inadequate funding, inequity in the provision and utilisation of funds and services, and inefficient use of existing resources. The National Health Care Financing Strategy 2012-32 aims to ensure financial protection against such adverse health expenditures, principally amongst the poor. Funds have been and will be raised from a combination of tax-based budgets, donor aid, social health protection schemes, and prepayment schemes.

The Social Health Protection Act, drafted by the Ministry of Health and Family Welfare (MoHFW) in Bangladesh, provides a legal framework to underpin Universal Health Coverage targets. As part of this, SSK was developed by MoHFW to support the process of building a scalable social health protection model.

Our approach

We worked closely with the Health Economics Unit (HEU) of the MoHFW to successfully implement the pilot of SSK. Our partners for the project were Institute of Health Economics (IHE) of the University of Dhaka, Management for Health (m4h), and AOK Consult. Our team included experts in the fields of public health, law, procurement, IT, communication, insurance economics, health economics, and infrastructure.

The technical support provided covered a wide range of areas, including:

  • developing clinical guidelines;
  • finalising accreditation standards;
  • developing payment schemes;
  • supporting registration of the participating households;
  • implementing a fraud-proofing strategy;
  • establishing financial management systems;
  • carrying out training;
  • strengthening management capacities;
  • introducing monitoring and evaluation systems; and
  • giving recommendations for future scale up.

Outcomes

The piloting of the social health protection programme provided important insights on the design and implementation aspects of social health insurance in Bangladesh. It provided the basis for a mixed system of healthcare financing models and approaches, constituting a major step towards achieving UHC in Bangladesh.

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