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Bangladesh Health System Review Health Sy Health Systems in Transition Vol. 5 No. 3 2015 s t ems in T r ansition V ol. 5 No. 3 2015 Bangladesh Health System Review The Asia Pacific Observatory on Health Systems and Policies (the APO) is a collaborative partnership of interested governments, international agencies, foundations, and researchers that promotes Bangladesh Health System Review evidence-informed health system policy regionally and in all countries in the Asia Pacific region. The APO collaboratively identifies priority health system issues across the Asia Pacific region; develops and synthesizes relevant research to support and inform countries’ evidence-based policy development; and builds country and regional health systems research and evidence-informed policy capacity. OF THE C PHIL LI IP B P U IN P E E S R D* * E H P T F LI L LO U R OP A EAT S P R SALUBRITA A T E M OF H ENT Health Systems in Transition Vol. 5 No. 3 2015 Bangladesh Health System Review Written by: Syed Masud Ahmed, icddr,b and JPGSPH Bushra Binte Alam, World Bank Iqbal Anwar, icddr,b Tahmina Begum, World Bank Rumana Huque, Dhaka University Jahangir AM Khan, icddr,b Herfina Nababan, JPGSPH Ferdaus Arfina Osman,Dhaka University Edited by: Aliya Naheed, icddr,b; Nossal Institute for Global Health, University of Melborne Krishna Hort, Nossal Institute for Global Health, University of Melborne Asia Pacific Observatory on Public Health Systems and Policies i WHO Library Cataloguing-in-Publication Data Bangladesh health system review (Health Systems in Transition, Vol. 5 No. 3 2015) 1. Delivery of healthcare. 2. Health care economics and organization. 3. Health care reform. 5. Health system plans – organization and administration. 7. Bangladesh. I. Asia Pacific Observatory on Health Systems and Policies. II. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 705 1 (NLM Classification: WA 540 JB2) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications–whether for sale or for non-commercial distribution–should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines (fax: +632 521 1036, email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The named authors alone are responsible for the views expressed in this publication. ii Contents Preface ................................................................................................................ viii Acknowledgements ............................................................................................. x List of abbreviations ........................................................................................... xi Abstract ............................................................................................................... xvi Executive summary ......................................................................................... xvii 1 Introduction ................................................................................................. 1 Chapter summary ................................................................................................. 1 1.1 Geography and demography ...................................................................... 1 1.2 Socioeconomic context ............................................................................... 3 1.3 Political context ........................................................................................... 5 1.4 Health status ................................................................................................ 6 2 Organization and governance ................................................................ 24 Chapter summary ............................................................................................... 24 2.1 Overview of the health system ................................................................ 25 2.2 Historical background .............................................................................. 27 2.3 Health system organization in Bangladesh .......................................... 29 2.5 Planning ..................................................................................................... 36 2.6 Intersectorality ........................................................................................... 38 2.7 Health information management ........................................................... 39 2.8 Regulation ................................................................................................... 42 2.9 Patient empowerment and accountability ............................................ 48 3 Financing .................................................................................................... 54 Chapter summary .............................................................................................. 54 3.1 Health expenditure ................................................................................... 55 3.2 Sources of revenue and financial flows ................................................ 61 3.3 Overview of the statutory financing system ....................................... 66 3.4 Out-of-pocket payments ......................................................................... 70 3.5 Private (Voluntary) health insurance ...................................................... 73 3.6 Other financing .......................................................................................... 76 3.7 Payment mechanisms ............................................................................. 78 iii 4 Physical and human resources .............................................................. 82 Chapter summary ............................................................................................... 82 4.1 Physical resources .................................................................................... 83 4.2 Human resources ...................................................................................... 90 5 Provision of services ..............................................................................102 Chapter summary ............................................................................................. 102 5.1 Public health ............................................................................................ 103 5.2 Patient pathways .................................................................................... 109 5.3 Primary/ambulatory care ....................................................................... 110 5.4 Inpatient care ........................................................................................... 113 5.5 Emergency care ....................................................................................... 114 5.6 Pharmaceutical care ............................................................................... 115 5.7 Rehabilitation/intermediate care .......................................................... 118 5.8 Long-term care ........................................................................................ 119 5.9 Services for informal carers .................................................................. 119 5.10 Palliative care ........................................................................................... 120 5.11 Mental health care .................................................................................. 120 5.12 Dental care ............................................................................................... 122 5.13 Complementary and Alternative Medicine (CAM) and Traditional Medicine .................................................................................................... 123 5.14 Health services for specific populations ............................................. 123 6 Principal health reforms .......................................................................125 Chapter summary ............................................................................................. 125 6.1 Analysis of recent major reforms in Bangladesh .............................. 126 6.2 Future developments .............................................................................. 141 7 Assessment of the health system
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