Understanding Health System and Healthcare financing

1. Healthcare System
and financing
Abdur Razzaque Sarker
MHE (Health Economics), MSS (Economics)
Health Economics and Financing Research, icddrb
and
PhD Fellow in Strathclyde University, UK
Email: razzaque.sarker@gmail.com
Abdur Razzaque Sarker
MHE (Health Economics), MSS (Economics)
Health Economics and Financing Research, icddrb
and
PhD Fellow in Strathclyde University, UK
Email: razzaque.sarker@gmail.com

2. 2
A good health system delivers quality services to all people, when and
where they need them
A system that includes “all the activities whose primary purpose is
to promote, restore or maintain health”
– Not just health care system: financing, governance and
provisioning measures
The objectives of a health system
– Contain costs
– Increase efficiency
– Maintain equity
– Improve quality
What is a health system?What is a health system?

3. 3
The WHO Health Systems FrameworkThe WHO Health Systems Framework

4. 4
Potential of health system and actual performance
– Given a list of priorities, and given one or more mechanisms for
rationing care, the way services are actually delivered – who
benefits from which interventions, how efficiently they are
provided, how responsive the system is – can still differ
markedly from one health system to another.
Tremendous variation in outcomes among countries with same
resources and possibilities
– Particular and unique regulation via organizations, institutions,
interventions, and incentives make up for this difference.
Why study Health Systems?Why study Health Systems?

5. The MOHFW delivers services through two separate executing
authorities under HPNSDP:
– Directorate General of Health Services (DGHS)
– Directorate General of Family Planning (DGFP)
Essential service delivery (ESD)/PHC services provides at ward level
through community health staff appointed by MOHFW
Non-government organizations (NGOs) also play important role in
providing services
5
Bangladesh Health Systems

6. 6
Director General (Health) Director General (FP)
Divisional Director (Health) Divisional Director (FP)
Civil Surgeon (CS) Deputy Director (DD-FP)
Upazila Health & Family Planning
Officer (UHFPO)
Family Planning Officer (FPO)
Medical Officer/Paramedics Paramedics/Field supervisors
Field staff (HA, AHI, HI) Field staff (FWA, FPI, FWV)
Dist.
64
Upa.
483
Div.
7
Union
4501
Ward
40,509
Ministry of Health and Family Welfare (MOHFW)
Bangladesh Health SystemsBangladesh Health Systems

7. Type of health facilities under the DGHS in different administrative
tiers
National Divisional District Upazila Union Ward
•Public Health
Institute
•Postgraduate
Medical Institute &
Hospital with
Nursing Institute
•Specialized Health
Centre
•Medical
College &
Hospital with
Nursing
Institute (in
some)
•General
Hospital with
Nursing
Institute (in
some)
• Infectious
Disease
Hospital
•Institute of
health
Technology
•District Hospital with
Nursing institute
•General Hospital
with Nursing Institute
(in some)
•Medical College &
Hospital with Nursing
Institute (in some)
•Chest Clinic (in
some)
•Leprosy Hospital (in
some)
•Medical Assistant’s
Training School
•Upazila Health
Complex
•TB Clinic (in
some)
•Rural Health
Centre (in some)
•Union sub-centre
(in some)
•Union Health &
Family Planning
Welfare Centre (in
some)
•Community
Clinic

8. Ministry of Local Government, Rural
Development & Co-operatives
Mayor Dhaka City
Corporation, North
Chief Executive Officer
Chief Health Officer
Deputy Chief Health
Officer
Health Officer
Assistant Health Officer
(Zonal level)
EPI
Supervisors
Sanitary
Inspectors
Mosquito
Supervisors
Birth & Death
Register Assistants
Vaccinators Sample
collectors
Spray
men/Crews
Mayor Dhaka City
Corporation, North
Chief Executive Officer
Chief Health Officer
Deputy Chief Health
Officer
Health Officer
Assistant Health Officer
(Zonal level)
EPI
Supervisors
Sanitary
Inspectors
Mosquito
Supervisors
Birth & Death
Register Assistants
Vaccinators Sample
collectors
Spray
men/Crews
Note: NGO activities are being monitored by UPHCP in collaboration with City Corporation (HQ and Zone offices)
Health systems (Urban)Health systems (Urban)

9. Health financing is concerned with how financial resources are
generated, allocated and used in health systems
The purpose of health financing is to make funding available, as well
as to set the right financial incentives for providers, to ensure that all
individuals have access to effective public health and personal health
care
– Purchasing is the process by which pooled funds are paid to
providers in order to deliver a specified or unspecified set of
health interventions
– Pooling is the main way to spread risks among participants
Health care financing

10.  The mechanisms for meeting the expenditure for
accessing healthcare
 It includes “collection of revenue” and
“purchasing of healthcare”
What does healthcare financing address?What does healthcare financing address?

11. 11
Ministry of health, usually heading a large network of public
providers organized as a national health service, relying on general
taxation
Social security organization mostly relying on salary-related
contributions
Community or provider based pooling organization
Private health insurance fund
Health financing organizationsHealth financing organizations

12. 12
Health financing organizations -Bangladesh

13. Thank you
Email: razzaque.sarker@gmail.com