Go-ahead for mega health projects
The government is embarking on the largest health sector programme, worth Tk 1,15,486 crore to be spent over the next five years, with special focus on diseases like cancer, heart ailments, diabetes, and improvements to health governance.
Yesterday, the Ecnec approved the fourth Health, Population and Nutrition Sector Programme (HPNSP) with a financial layout 126 percent higher than the third one implemented in 2011-2016 and cost Tk 51,082 crore.
The total cost of the second programme implemented between 2003 and 2011 was Tk 37,384 crore.
A surprising 84 percent of the fourth programme's money would come from the government's own budget while development partners, including the World Bank, would pay for the rest, Tk 18,847 crore.
The planning ministry informed the Ecnec that the contribution of the development partners might increase and in that case the programme expenditure could go up Tk 20,000 crore more.
Non-communicable diseases (NCDs), which the programme would have special focus on, account for 59 percent of total deaths in the country, according to the World Health Organisation's NCD Country Profile 2014.
At least 17 percent of total deaths in the country are caused by cardiovascular diseases, while chronic respiratory diseases, cancers, accidents and diabetes cause 11, 10, 9 and 3 percent of the deaths.
More cases of NCDs could be attributed to the increased life expectancy, now 72 years, an ageing population, tobacco consumption, food habits, the environment, and sedentary lifestyle amid growing urbanisation.
The WHO in a 2015 report estimated that 21,316 die in the country every year due to traffic related accidents. Some three times this number face serious injuries leading to physical disabilities.
The health ministry, moving away from the sector-wise approach initiated in the first five-year programme in 1998, started better-planned delivery of health, population and nutrition services in Bangladesh in the second five-year programme in 2003.
“Bangladesh has made remarkable progress in achieving the health-related Millennium Development Goals. We have not, however, focused much on non-communicable diseases,” said Prof Abul Kalam Azad, director general of the Directorate General of Health Services (DGHS).
While increasing the number of expert doctors and diagnostic facilities was important, the authorities would expand preventive care and nutrition services, two components crucial for reducing the burden of NCDs, he said.
ESSENTIAL SERVICE PACKAGE
The government has been providing primary healthcare services, mostly in maternal, childcare and family welfare services, but the new plan includes screening for diseases in health facilities, from community clinics to upazila health complexes.
The testing would include blood sugar, pressure, cancer, Prof Azad said, adding, “This will require purchase of logistics as well as training and recruiting new health personnel. We will do it in phases.”
At least 29 types of essential drugs would also be provided to all citizens in these facilities, he said, adding, “This is part of our goal to ensure all have access to affordable healthcare.”
COMMUNITY PARTICIPATION
The Health Sector Programme (HSP) 2017-2022 includes a new approach to local planning in which hospitals would maintain records to generate data that would be used for better decision-making, Prof Azad said.
According to the HSP, hospitals, in the new approach, would involve local authorities and elites for improving health services and make it more accountable.
“If hospital staff are sincere and provide quality services, clients will come to the hospital to seek services even though the problem of limited resources remains,” it said.
NEW CONDITIONS FOR FUNDING
Development partners have tagged a new funding mechanism for the HSP to improve performance and efficiency.
The fund, pooled by the World Bank and other partners, would be disbursed based on results known as “Programme-for-Results (PforR)”, which was agreed to by the government.
Under this mechanism, fund would be disbursed upon achievement of some preset disbursement linked indicators (DLIs), which are tangible, transparent and verifiable performance indicators, said Ashadul Islam, director general of health economics unit of the health ministry.
MULTI-SECTOR APPROACH
Work of other ministries has influence on health and nutrition. For example, improving nutrition is not possible without the help of agriculture, food, fish and livestock ministries that work on producing and manage food and ensuring food safety, officials said.
The HSP covers these aspects, said a health ministry official.
Prof Syed Masud Ahmed, of the Centre of Excellence for Universal Health Coverage at Brac University, said the programme meant was quite comprehensive.
“Effective implementation is crucial, however. Improving governance is a major challenge.”
According to a World Bank report, Bangladesh's Health Sector Programme is one of the largest in the world. The programme has been drawn on the basis of lessons learnt from previous programmes.
The programme has made good progress in improving health outcomes, which include reductions in infant and child mortality rates; a sharp decline in maternal mortality ratio; and declining fertility rates, the WB report said.
In terms of health services delivery, child immunisation coverage has been above 80 percent while antenatal care visits increased from 54.6 percent in 2010 to 63.9 percent in 2014. Deliveries by medically trained providers rose from 26 percent in 2010 to 42.1 percent in 2014.
This increase in skilled birth attendance was predominantly due to a rise in facility-based deliveries, from 23.7 percent to 37.4 percent over the period.
The WB report said even though progress has been achieved in the sector, significant health challenges remain.
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