The document discusses a proposal to reposition the Health Economics Unit (HEU) within the Ministry of Health and Family Welfare in Bangladesh. The proposal aims to clarify and focus the HEU's mandate on supporting universal healthcare through health economics analysis and policy guidance. It recommends refocusing the HEU's activities, limiting its scope by relocating certain units, renaming it the Directorate General of Health Economics and Policy, and establishing four new technical units. It also addresses staffing limitations and the need to strengthen collaboration to effectively implement the proposed changes.

1. Repositioning the Health Economics Unit
Health Economics Unit (HEU), Ministry of Health and Family Welfare (MOHFW)
© 2012 Meagan Harrison, Courtesy of Photoshare

2. Overview of the presentation
▪ Context and objectives of the activity
▪ Methodology
▪ HEU’s current situation
▪ Proposed repositioning plan.
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3. Overview of the Presentation
▪ Context and objectives of the activity
▪ Methodology
▪ HEU’s current situation
▪ Proposed repositioning plan.
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4. Context of the Activity
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▪ Expansion of HEU’s mandate in the context of universal
health coverage (UHC), HCFS, and the 4th HPNSP.
▪ Staffing constraints, limitations imposed by civil service
recruitment rules, and the absence of career paths for
technical staff.
▪ High staff turnover and the absence of effective knowledge
management systems.

5. Objectives of the Activity
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▪ Conduct an organizational review and develop a plan for
repositioning the HEU to strengthen its role in advancing
UHC.
▪ Assess the need for creation of a dedicated costing unit at
the repositioned HEU.

6. Overview of the Presentation
▪ Context and objectives of the activity
▪ Methodology
▪ HEU’s current situation
▪ Proposed repositioning plan.
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7. Assessment Methodology
▪ Organizational assessment conducted by a team from the Health
Finance and Governance (HFG) project and MaMoni Health
Systems Strengthening (HSS) project in July 2017.
▪ Questions covered by the assessment:
▪ How is the mandate of the HEU currently defined?
▪ Is staffing sufficient to carry out the work and to fulfill the mandate?
▪ Can the work, as presently defined, be performed effectively by the
HEU?
▪ Is the HEU positioned most effectively for realization of its mandate? If
not, how should the HEU be re-positioned to advance UHC?
▪ Results of the assessment formed the basis for development of a
repositioning plan.
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8. Methods used:
▪ Document review.
▪ Interviews.
▪ Workshops.
▪ Group discussions.
▪ HEU staff.
▪ Current and former MOHFW
officers.
▪ Implementing partner
representatives.
▪ Donors.
Key informants/
stakeholders reached:

9. Types and Numbers of Interviews Conducted
Type of Stakeholder
Type and Number of
Interviews
Number of
Participants
Government
Group (7) 17
Individual (13) 13
Technical partners
Group (5) 12
Individual (4) 4
Development partners
Group (5) 13
Individual (3) 3
Total 59
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10. Overview of the Presentation
▪ Context and objectives of the activity
▪ Methodology
▪ HEU’s current situation
▪ Proposed repositioning plan.
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11. HEU’s Current Mandate
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To improve the performance of the health, population,
and nutrition sector for increased provision of quality
services for the entire population, especially the poor,
women, and the disadvantaged, through use of
resources in an economically efficient manner with a
focus on equity and participation.*
*http://heu.gov.bd

12. HEU’s Current Objective
• Attain sustainable health financing
to achieve UHC and a more
responsive health sector in
Bangladesh.

13. Current Organogram
Director
General
Administrative and
Support Staff (22)
Director (1)
Deputy
Director (1)
Deputy
Director (1)
Director (1)
Deputy
Director (1)
Deputy
Director (1)
Director (1)
GNSPU
Deputy
Director (1)
Deputy
Director (1)
10 Medical Officers deputed from DGHS
7 seconded staff from different agencies
~ 10 seconded staff at field sites for QIS activities
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14. Horizontal and Vertical Scopes
Health
Economics
(Costing,
BNHA,
PER)
Health
Care
Financing
Strategy
(HCFS)
Quality
Improvement
Secretariat
(QIS)
Shasthyo
Suroksha
Karmasuchi
(SSK)
Gender
NGO and
Stakeholder
Participation
(GNSP)
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15. HEU Successes
▪ Successfully institutionalized and completed five rounds of Bangladesh
National Health Accounts (BNHA).
▪ Led, with multiple partners, the development of Bangladesh’s first
HCFS, which focused on achieving UHC.
▪ Energized the QIS, developing multiple standards and protocols.
▪ Led the development of Bangladesh’s first Gender Equity Strategy for
the health sector and related action plan, and leads training on gender in
the health sector across MOHFW.
▪ Led and supported multiple costings of health services, including costing
the first and later version of the Essential Service Package (ESP),
including the latest ESP.
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16. Challenges Faced by HEU
▪ The scope of activities is broad due to:
▪ Number and variety of activities.
▪ Staffing limitations - high staff turnover due to:
▪ Lack of qualified technical personnel;
▪ Limited number of allocated positions;
▪ Limitations imposed by recruitment regulations; and
▪ Absence of a defined career path for technical staff.
▪ Absence of an effective knowledge management system.
▪ Not all activities undertaken by HEU contribute to its mandate.
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17. Overview of the Presentation
▪ Context and objectives of the activity
▪ Methodology
▪ HEU’s current situation
▪ Proposed repositioning plan.
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18. 1. Clarify the mandate of
HEU in relation to UHC:
To achieve UHC and a more
responsive health sector in
Bangladesh, HEU will
support sustainable health
financing approaches and
policy formulation through
the generation and support of
health economics data and
analysis.
© 2012 Amelia Rutter, Courtesy of Photoshare
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19. 2. Refocus HEU activities:
▪ Activities on data analysis and use of data and evidence.
▪ Advocacy and policy guidance (to support policy
formulation).
▪ HEU might be involved in the design and monitoring of
proofs of concept pilots:
▪ Will not be involved in direct implementation.
© 2012 Amelia Rutter, Courtesy of Photoshare
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20. 3. Limit the breadth of activities:
▪ Relocate the QIS.
▪ Relocate the gender component of the GNSPU.
▪ More discussion is required:
▪ Where to relocate?
▪ When to relocate?
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21. 4. Relocate QIS and the gender component of
the GNSPU:
▪ Will require initiating a participatory process:
▪ Defining the Terms of Reference for these units; and
▪ Reaching agreement on the most appropriate placement
within the MOHFW.
 Over a period of 2.5 to 5 years (2018-2022) during 4th
HPNSP.
© 2012 Amelia Rutter, Courtesy of Photoshare
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22. 5. Rename the HEU:
Directorate General of
Health Economics and
Policy (DGHEP)
▪ Place it within the
MOHFW.
© 2012 Amelia Rutter, Courtesy of Photoshare
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23. 6. Form four technical units:
▪ To focus on analysis, advocacy, and policy
guidance.
▪ With the necessary number of staff who are
qualified to do the work.
© 2012 Amelia Rutter, Courtesy of Photoshare
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24. Proposed Structure of DGHEP
Equity & Gender,
Voice and Stakeholder
Participation (EGVSP)
External Partners
Situated outside
DGHEP
New
Units
Research and
collaboration
Directorate General of Health Economics and Policy (DGHEP)*
QISPolicy & Universal
Health Coverage Unit
(UHCU)
NGO Engagement &
Public Private
Partnerships Unit
(PPPU)
Proposed
outside of re-
positioned
HEU
*Proposed new name for re-positioned HEU
Economic Analysis &
Costing Unit (EACU)
Health Expenditure
Tracking Unit (HETU)
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25. Functions of Proposed Units
1. Economic Analysis and Costing Unit (EACU)
2. Health Expenditure Tracking Unit (HETU)
3. Policy and Universal Health Coverage Unit (UHCU)
4. NGO Engagement and Public Private Partnerships
Unit (PPPU)
© 2012 Amelia Rutter, Courtesy of Photoshare
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26. Proposed Organogram
To support the
new
organogram:
▪ Develop new
recruitment
rule.
▪ Define
career paths
for staff.
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27. 7. Address the existing staffing limitations:
▪ Improve DGHEP’s ability to recruit and retain qualified
personnel.
▪ Define a career path for technical staff.
8. Strengthen multidisciplinary collaboration:
▪ Between the new DGHEP and other units in the MOHFW.
▪ Improve design, implementation, and uptake of research
activities.
9. Implement the proposed repositioning in close
collaboration with key partners and stakeholders:
▪ With a clear timeline.
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28. Thank You! Follow us!
On the web at www.HFGproject.org
On Twitter at @HFGproject
On Facebook at www.facebook.com/hfgproject
The HFG project is funded by USAID under cooperative agreement No. OAA-A-12-00080. The author's views expressed in this
presentation do not necessarily reflect the views of the United States Agency for International Development or the U.S.
government.
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