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  • 1
    Language: English
    Pages: 1 Online-Ressource
    Series Statement: Health, Nutrition and Population (HNP) Discussion Papers
    Abstract: Bangladesh allocates a much smaller share of the government budget to health than countries of similar income level. Reallocation is politically challenging but could offer the biggest potential source of fiscal space for health, larger than the space that economic growth can bring. How those additional resources are used, is also important to improve financial protection. Improving the readiness of the public health care network to provide quality care, particularly at primary health care level, could reduce the use of alternative providers, thereby reducing the need for OOP payments. Ensuring the functionality of community clinics, union level facilities, and upazila health complexes, including a revision of their opening hours would also contribute towards this goal. Ensuring access to pharmaceutical products, particularly for essential NCD-related drugs, at affordable prices could also contribute to a reduction in households OOP payments. In addition to these supply-side interventions, the government could consider demand-side programs where resources follow the patient. For instance, given the large needs and the little resources available, an important pathway to reduce OOP payments while decreasing inequalities would be better targeting public subsidies to the poor and vulnerable. Finally, improving public financial management, policies, and governance will also contribute to the effective use of existing and any additional resources for health
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  • 2
    Language: English
    Pages: 1 Online-Ressource
    Series Statement: World Bank E-Library Archive
    Series Statement: UNICO Studies Series
    Abstract: This case study describes Bangladesh's success story using the standardized approach used by the Universal Health Coverage Studies Series (UNICO Studies Series) to provide a balanced account of the key pillars that lay behind the success of pluralism in the health system of Bangladesh. The aim is to recognize the contributions of the different actors (including the Government and the informal sector, which in the past have not been sufficiently recognized) and the strengths and weaknesses of these pillars as the needs and opportunities evolve due to emerging health issues. This lack of knowledge is an impediment to policy formulation and implementation aimed at maintaining the success of Bangladesh in the health sector. The case study suggests that there were four pillars to the successful pluralism that characterized Bangladesh: (a) effective prioritization of public financing on highly cost-effective interventions, (b) effective alignment of government and DP financing based on the mechanism of the SWAp, (c) extensive use of female CHWs and innovative NGOs, and (d) a large informal private sector that functions as a retailer of an unusually large and competitive domestic pharmaceutical industry. It should be acknowledged that determinants such as significant poverty reduction, education of girls, female labor force participation, and water and sanitation interventions outside the health sector also played a significant role in achieving better health outcomes
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  • 3
    Language: English
    Pages: 1 Online-Ressource
    Series Statement: World Bank E-Library Archive
    Series Statement: Health, Nutrition and Population (HNP) Discussion Papers
    Abstract: Robust public financial management (PFM) systems are crucial to ensure the efficacy and integrity of public health spending, thereby contributing to improved service coverage and financial protection, as required for achieving universal health coverage. A weak PFM system has impeded implementation of the Bangladesh health care financing strategy 2012-2032. This paper aims to identify and document major PFM challenges in relation to the interventions outlined in this strategy document, on the grounds that relaxing these constraints will strengthen implementation. Further, the study examines PFM barriers in service delivery, such as delays in fund availability and procurement and the lack of operational funds at the facility level. The paper points to a number of obstacles, including the absence of a legal framework for implementing a social health protection scheme, no laws to retain user fees at health facilities or to change financial rules to introduce flexible cash at facilities, district health managers without delegated financial power, noncompliance with audit observations, and need for PFM capacity strengthening. Short-, medium- and long-term actions are presented to address these PFM issues. Removing these barriers will not require significant additional resources, but will offer the potential to significantly enhance value for money for Bangladesh's government health budget
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