1 NATIONAL HEALTH ACCOUNTS INSTITUTIONALIZATION: BANGLADESH DRAFT WORK PLAN Prasanta Bhushan Barua Joint Chief (Joint Secretary) Health Economics Unit Ministry of Health and Family Welfare Government of Bangladesh
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NATIONAL HEALTH ACCOUNTS INSTITUTIONALIZATION:
BANGLADESHDRAFT WORK PLAN
Prasanta Bhushan BaruaJoint Chief (Joint Secretary)
Health Economics UnitMinistry of Health and Family Welfare
Government of Bangladesh
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Outlines of the Presentation
• Introduction
• Basic Health Information
• Health Financing in Bangladesh
• Bangladesh National Health Accounts (BNHA) Institutionalization: Draft Work Plan
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Bangladesh
•
Surrounded by India, Myanmar and Bay of Bengal
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Bangladesh
World’s Longest Sea Beach at Cox’s Bazar
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Bangladesh
World’s Largest Mangrove Forest in SunderbanUNESCO declared World Heritage.
Demographic Information
Area : 147570 sq.km
Density : 993/sq. km.
Sex Ratio(M/F) : 105: 100
Average HH size : 4.8 persons
Population : 146 million.
Annual growth rate (in 2008) : 1.39%
Total fertility rate (TFR) : 2.7
Urban/Rural population Ratio : 1:3
Source:(BBS, 2009) 6
Guiding Principles in Health Sector Constitution :
Article 15(a) ….. ensure basic necessities of life including medical care to its citizens.
Article 18(1)….. raise the level of nutritional status and improve public health.
MDGs: achieve MDGs by 2015 MDG 4: Reduce Child Mortality MDG 5: Improve Maternal Health. MDG 6: Combat HIV/AIDS, Malaria and other Diseases
HNPSP: Sustainable improvement in health, nutrition and family welfare.
Health Policy: Ensure quality health, nutrition and family welfare services which is affordable, attainable and acceptable to its citizens.
Vision 2021: Welfare of the people, Life expectancy target 70 years.
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Basic Health InformationIndicators Base year
(1990 – 1991)Current Status
(2009)MDG Target
(2015)Under -5 mortality Rate /1000 LB
146 53.8 48
Infant Mortality Rate /1000 LB
92 41.3 31
Proportion of 1 yr. children immunized against measles
54 82.3 100
Maternal mortality rate/ 100,000 LB
574 348 144
Proportion of births attended by skilled health personnel, %
5.0 24 50
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Basic Health Information contd.
Indicators Base year(1990 – 1991)
Current Status (2009)
MDG Target (2015)
Antenatal care coverage (at least one visit)
27.5 60 100
Antenatal care coverage (at least four visits)
5.5 21.0 100
Total Fertility Rate (TFR) 3.0 (2004) 2.7 (2007) 2.2 (2011)
Prevalence of Malaria/100,000 population
776.9 (2008) 586 Halting
Prevalence of TB/100,000 pop.
264 225 (2008) Halting
TB Detection rate under DOTS, %
21 70 Sustain
TB cure rate under DOTS, %
73 92 Sustain
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Health Financing in Bangladesh(2006-2007)
Sources of Fund Exp.(Million Taka)
%
Public Sector 41,318 26Rest of the World 12,391 8NGOs 2,092 1
Household OOP 103,459 64
Private Firms 1,325 .8
Private Insurance 314 .2
Total Health Exp. 160,899 100
Health Financing in Bangladesh2006 - 2007
11Source: BNHA 1997-2007
Tota l Hea l th Expend i tu re by F inanc ing Agents 1997 - 2007
12Source: BNHA 1997-2007
Total Health Expenditure by Providers1997 - 2007
Source: BNHA 1997-2007
Total Health Expenditure by Functions1997 - 2007
Source: BNHA 1997-2007
Total Health Expenditure 1997-2007
Source: BNHA 1997-2007
Per capita Health Expenditure and per capita GDP (Taka)
Source: BNHA 1997-2007
Share of Public and Private Financing in %
Source: BNHA 1997-2007
Total Health Expenditure : BNHA I, BNHA II, BNHA III
1992-1997
1992-1997
1992-2001
1998-2001
1997 2000 2005 2006 2009
NHA3
NHA2
NHA1
Year
2002-2007
Chronological History - BNHA
BNHA I – (1996/97) - 1998 : Draft SHA Consultedwith the support from ADB
BNHA II – (1996/97 – 2001/02) -2003 : Comparable ICHA Classifications for BNHA developed
with the assistance from DfID
BNHA III – (1996/97– 2006/07) – 2010 : Capacity to Report all SHA tables
with the support from GtZ
Institutionalization of BNHA
Issue arises 1998 after BNHA I Incorporated in the Terms of Reference (ToR)
during BNHA II During BNHA III issue of Regular Updating
raised by HEU
HEU-GTZ Work-plan Initiated the process
World Bank came forward with GSAP
Achievements Acceptance of Ministry of Health and Family Welfare to
produce NHA regularly by HEU Established a dual reporting system for Bangladesh as
well as globally comparable standard In each round new estimates along with revised estimates Started thinking of institutionalization within Government
-GTZ supported through expert advice and consultation with integration in HEU-GTZ work plan
Senior Policy Makers of MoHFW (Minister, Secretary) stressed the need and role of HEU in institutionalization
Constraints
Not sure how to organize Uncertainty of funding support for successive
rounds Lack of trained/experienced human resources Lack of mechanism to retain knowledge/memory Retention of trained/experienced professionals High cost of production –
-- each time have to start from zero
Way Forward
Capacity development/building of HEU HEU to be strengthened to able to handle NHA
process as a part of its overall health economics work
Incremental approach for regular NHA production Task shifting – collaborative work of IHE & BBS Out sourcing some technical work (survey with
preliminary analysis) on the basis of PPP during transition
National Health Accounts Institutionalization Activities Work-plan
Vision – Role - Responsibility Vision
- Regular Production of NHA of internationally comparable standard
Role- Coordination among partner organizations - Updating BNHA framework adopting
international classifications- Coordination among DPs for funding support
Responsibility- Supporting policy formulation of government
based on BNHA findings- Translate BNHA data for evidenced based policy
suggestions -- Policy Briefs
ContentsActivities
Environment Resources Data Sources and Collection Data Management Information Products Quality and Validity Dissemination and Use Budget by Source Budget by Year Detailed Budget by Year and Source of Funding Aggregate Budget
Activities
Environment
Resources
Data Sources and Collection
Data Management
Information Products
Quality and Validity
Dissemination and Use
Budget by Source
Budget by Year
Detail Budget by Year and Source of Funding
contd.
Aggregate Budget
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