This document analyzes reproductive, maternal, newborn, and child health (RMNCH) expenditures in Bangladesh using data from the Bangladesh National Health Accounts. It estimates expenditures for 2012 by public and private healthcare providers and financing schemes. Key findings include reproductive healthcare expenditures of $134 million, maternal and newborn expenditures of $44 million, and child healthcare expenditures of $83 million. The analysis provides a breakdown of RMNCH spending by provider, function, and financing source to understand where resources are being allocated. It aims to inform policies to improve funding and access to critical maternal and child health services.
Hôpital Universitaire de Mirebalais (HUM) Costing StudyHFG Project
The Health Finance and Governance Project (HFG), funded by USAID, was asked by to work with Partners in Health and its sister organization in Haiti, Zanmi Lasante, (PIH/ZL) to conduct a costing study of the recently opened Hôpital Universitaire de Mirebalais (HUM). The objective of the study is to provide data and information that will support the development of a financial sustainability plan for HUM.
Health Financing in Botswana: A Landscape AnalysisHFG Project
The government of Botswana is committed to achieving universal health coverage and assuming a higher share of HIV/AIDS and other health spending, even though long-term economic growth prospects are less optimistic than in the past. To guide its path, the government is developing a health financing strategy that will increase efficiency, ensure financial sustainability, and promote an effective mix of public and private mechanisms for health financing and service provision. The government created a multi-stakeholder Health Financing Technical Working Group (HFTWG) to lead the development of the strategy and requested support from the Health Finance and Government Project (HFG), a global initiative funded by the United States Agency for International Development (USAID). HFG conducted this landscape analysis to inform the process by compiling the findings of previous studies, providing information on Botswana’s fiscal space for health, health expenditures, funding gap for health, and health system performance, and outlining policy initiatives for addressing the priorities of the HFTWG.
Landscape of Prepaid Health Schemes in BangladeshHFG Project
This landscape study is part of a series of studies and analysis, undertaken by HFG on behalf of USAID/Bangladesh to determine the feasibility of NGO provider-based prepayment schemes. This paper describes, based on available documents, published and gray literature, and key informant and expert interviews, the landscape of prepaid health schemes in Bangladesh giving particular focus on provider based prepayment schemes. Bangladesh has extensive networks of NGO providers, some such as the Smiling Sun NGO networks have been supported through external funding. This paper reviews existing or recently completed prepaid schemes as a first step to determine the feasibility of provider-based prepaid schemes to increase the NGO providers’ sustainability.
Income, expenditures, health facility utilization, and health insurance statu...HFG Project
The primary objective of this study is to estimate the average income and general expenditures of people living with HIV/AIDS (PLWHA). The null hypothesis is that income among PLWHA is the same as that of the general population.
Additionally, this study will help to inform estimates of the potential liability faced by Vietnam’s Social Health Insurance scheme if it assumes responsibility for paying for HIV/AIDS treatment. VAAC is also seeking answers to questions about why patients are not enrolling in the insurance scheme and how to increase the enrollment rate.
Hôpital Universitaire de Mirebalais (HUM) Costing StudyHFG Project
The Health Finance and Governance Project (HFG), funded by USAID, was asked by to work with Partners in Health and its sister organization in Haiti, Zanmi Lasante, (PIH/ZL) to conduct a costing study of the recently opened Hôpital Universitaire de Mirebalais (HUM). The objective of the study is to provide data and information that will support the development of a financial sustainability plan for HUM.
Health Financing in Botswana: A Landscape AnalysisHFG Project
The government of Botswana is committed to achieving universal health coverage and assuming a higher share of HIV/AIDS and other health spending, even though long-term economic growth prospects are less optimistic than in the past. To guide its path, the government is developing a health financing strategy that will increase efficiency, ensure financial sustainability, and promote an effective mix of public and private mechanisms for health financing and service provision. The government created a multi-stakeholder Health Financing Technical Working Group (HFTWG) to lead the development of the strategy and requested support from the Health Finance and Government Project (HFG), a global initiative funded by the United States Agency for International Development (USAID). HFG conducted this landscape analysis to inform the process by compiling the findings of previous studies, providing information on Botswana’s fiscal space for health, health expenditures, funding gap for health, and health system performance, and outlining policy initiatives for addressing the priorities of the HFTWG.
Landscape of Prepaid Health Schemes in BangladeshHFG Project
This landscape study is part of a series of studies and analysis, undertaken by HFG on behalf of USAID/Bangladesh to determine the feasibility of NGO provider-based prepayment schemes. This paper describes, based on available documents, published and gray literature, and key informant and expert interviews, the landscape of prepaid health schemes in Bangladesh giving particular focus on provider based prepayment schemes. Bangladesh has extensive networks of NGO providers, some such as the Smiling Sun NGO networks have been supported through external funding. This paper reviews existing or recently completed prepaid schemes as a first step to determine the feasibility of provider-based prepaid schemes to increase the NGO providers’ sustainability.
Income, expenditures, health facility utilization, and health insurance statu...HFG Project
The primary objective of this study is to estimate the average income and general expenditures of people living with HIV/AIDS (PLWHA). The null hypothesis is that income among PLWHA is the same as that of the general population.
Additionally, this study will help to inform estimates of the potential liability faced by Vietnam’s Social Health Insurance scheme if it assumes responsibility for paying for HIV/AIDS treatment. VAAC is also seeking answers to questions about why patients are not enrolling in the insurance scheme and how to increase the enrollment rate.
Understanding District-Level Variation in Fertility Rates in High-Focus India...HFG Project
The Government of India (GoI) under the Mission Parivar Vikas (MPV) programme focuses investments in 146 districts in 7 states, which have the highest levels of fertility in India. The strategy aims to accelerate the supply of high quality family planning (FP) services in order to bring fertility of these states to replacement level by 2025. Young couples in the 15-24 year age group constitute the most important opportunity for this investment as they have the highest unmet need for modern contraception (22 percent) and are the largest contributor to fertility (54 percent combined). National Family Health Survey, Round 4 (NFHS-4) data was used to understand patterns and variations in contraceptive use and unmet need among women in this age group including women with low parity (parity at 0 & 1) across the four high focus states of Bihar, Madhya Pradesh (MP), Rajasthan and Uttar Pradesh (UP) in MPV and non-MPV districts.
The purpose of the USAID HFG TB Strategic Purchasing Activity is to identify and recommend small improvements in TB purchasing/provider payment and related public finance management (PFM) mechanism to better target country health budgets towards priority TB services for the poor in USAID TB priority countries. This technical report summarizes the rapid assessment findings, conclusions, recommendations, and possible next steps from stakeholder consultations held in Malawi from May 18-29.
The three health financing functions are revenue collection, pooling and purchasing. Revenue collection is the source/level of funds, pooling is the accumulation of prepaid revenues on behalf of a population and purchasing is the transfer of pooled funds to providers on behalf of a population. The main focus of the HFG/TB Activity is the health purchasing function, specifically provider payment systems and PFM mechanisms. This rapid assessment focuses more on domestic revenue health purchasing and PFM at the district level as other USAID investments are supporting NTP and Global Fund grant implementation. This assessment emphasizes public funding as public funding is critical to pro-poor priority public health services especially TB.
This rapid assessment is not intended to be a literature review or formal study. Stakeholder consultations are the main vehicle for identifying and recommending small TB purchasing and PFM improvement steps for possible further in-depth analysis and implementation. The rapid assessment technical report is organized into five sections: 1) introduction; 2) TB continuum of care gaps; 3) overall strategy and sequencing; 4) shorter-term TB purchasing and PFM steps; and 5) relationship between shorter-term steps and longer-term public service and health reforms.
Performance Based Incentives to Strengthen Primary Health Care in Haryana Sta...HFG Project
Authors: Susan Gigli, Jenna Wright, Francis Raj and Mudeit Agarwa
Published: February 28, 2015
The Government of Haryana is interested in adopting a performance-based incentive (PBI) scheme aimed at strengthening primary health care results. In December 2014, the HFG project conducted a qualitative investigation among 10 public health facilities in two Blocks in Haryana in order to understand the existing incentive and operating environments and to inform the design of a PBI scheme. This report presents the findings of the formative investigation and relevant contextual information on the health system in the selected districts with a view toward supporting an effective PBI scheme in Haryana. The findings and considerations fed into a stakeholder PBI design workshop in early 2015.
The study suggested strongly that a PBI scheme—communicated clearly and perceived as fair—could lead to a change in the overall work culture from one that inadvertently encourages passivity to one that promotes teamwork, engagement, initiative, transparency and accountability.
Estimating Bangladesh Urban Healthcare Expenditure Under the System of Health...HFG Project
Bangladesh is a densely populated country with 23 % people residing in urban areas and with a 3.5% annual growth of urban population. Bangladesh Bureau of Statistics divided into seven administrative divisions: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Rangpur, and Sylhet. Each division is divided into zilas, and each zila into upazilas. Each urban area in an upazila is divided into wards, which are further subdivided into mohallas. A rural area in an upazila is divided into union parishads (UPs) and, within UPs, into mouzas. The people who are living in wards were considered as urban population and the Ups’ population was considered as rural. However, the division between urban and rural health care is not so distinct and it is difficult to create an urban and rural demarcation of health expenditure. According to BDHS 2014, the urban population has more access to facility delivery, qualified doctors and less unmet need for contraception. This raises the question whether there is more health expenditure by urban population than the rural.
This study aims to estimate the health expenditures of the urban population in terms of provider, financing agents and functions by analyzing the data of National health accounts, which will eventually give a specific direction to identify the gaps and way of addressing those issues.
Association between starting methadone maintenance therapy and changes in inc...HFG Project
The primary objective of this survey is to estimate the change in average income and general expenditures of methadone maintenance therapy (MMT) clients associated with starting MMT care. The null hypothesis is that income among MMT clients is the same before and after they started MMT.
Additionally, this survey will provide data to help to inform estimates of changes in job status associated with enrollment in MMT. This survey also serves to supplement a second survey assessing the income of people living with HIV/AIDS (PLWHA).
Expanding Coverage to Informal Workers: A Study of EPCMD Countries’ Efforts t...HFG Project
For many low- and middle-income countries (LMICs), expanding health coverage to informal workers is one of the most common, yet complex challenges requiring action. Informal workers are, by definition, not provided with legal or social protections through their employment, and are vulnerable to health and economic shocks. They also account for a large percentage of the population in LMICs. Expanding or deepening health coverage to informal workers is thus an area of interest for stakeholders pursuing universal health coverage (UHC): the goal that the entire population can access needed good-quality care without risk of impoverishment. Pro-poor coverage schemes that rely on prepayment – payment delinked from the time of care seeking – are a key financing strategy for UHC (WHO 2010). However, including informal workers in such schemes is challenging given that informal workers are not typically registered in taxation systems and social protection systems, nor covered by labor laws and regulations, making them less visible to the government and other stakeholders (Rockefeller Foundation 2013).
This report complements existing literature on how health reforms can improve the welfare of informal workers, focusing on the 25 countries prioritized for development assistance by the United States Agency for International Development (USAID) as part of its Ending Preventable Child and Maternal Deaths (EPCMD) initiative. Given the strong interest in these questions among EPCMD countries, USAID commissioned the Health Finance and Governance project (HFG) to conduct this research and provide recommendations relevant to UHC policy discussions in these countries.
Universal Health Coverage in Haryana: Setting Priorities for Health and Healt...HFG Project
In India, the reach of the public health system is limited; many people avoid seeking formal care because of its high cost or cultural barriers. As a result, they delay seeking care until they are seriously ill, which means higher costs when they seek care, high morbidity, and sometimes mortality that would have been preventable had care been sought earlier in the course of illness. This report provides Haryana a five-year road map for moving toward universal health coverage (UHC). It identifies key inputs that the state will need to effectively expand coverage of primary and secondary care by 2019/20 and estimates the cost of these inputs, in addition to other government-mandated increases.
The Funding Gap in the Dominican Republic’s National HIV/AIDS ResponseHFG Project
HFG conducted a gap analysis to calculate the increase in resources required to fully fund the National HIV and AIDS Response in the medium-term, including different investment scenarios. This report includes the methodology used, the estimate of funding gaps under different scenarios, and a section of analysis and conclusions that presents some alternatives to increase the efficiency of the distribution of resources to control the epidemic.
Guide for the Monitoring and Evaluation of the Transition of Health ProgramsHFG Project
This guide looks at three different transition experiences (funding, technical assistance, and services) to demonstrate variations in the type of transition undertaken, and the corresponding need for M&E. The authors draw upon experience of monitoring and evaluating transition to clarify key elements and dimensions of transition and how they relate to the longer-term goal of program sustainability and to present possible indicators, relevant to different health programs and transition arrangements that can help track transition and offer suggestions on how to select appropriate indicators. This document provides a conceptual framework to guide thinking around the M&E of transitions and will be amended as experience grows.
Measuring Technical Efficiency of the Provision of Antiretroviral Therapy Amo...HFG Project
Botswana has made great strides in combating the HIV epidemic. Deaths due to AIDS have declined dramatically since 2005 (UNAIDS 2014; 2016) and the country is on its way to achieving its 90-90-90 targets. As Botswana implements its ambitious Treat All Strategy and expands treatment to nearly 330,000 people living with HIV, the country will need to critically assess its efficient use of all available resources to sustain gains and continue progress towards an AIDS-free generation. To support the Ministry of Health with evidence regarding the efficiency of antiretroviral therapy (ART) service delivery, the USAID-funded Health Finance and Governance project estimated the overall and component-specific costs and utilization figures of adult outpatient ART care at Botswana’s public health facilities.
Benchmarking Costs for Non-Clinical Services in Botswana’s Public HospitalsHFG Project
Authors: Peter Stegman, Elizabeth Ohadi, Heather Cogswell, Carlos Avila and Mompati Buzwani
Published: April 30, 2015
Botswana’s health sector has embarked on a broad program of reforms and, to this end, the Ministry of Health (MOH) has developed the Health Services Outsourcing Strategy and Programme 2011-2016. This planning document emerges from major strategic thrusts outlined in the National Development Plan 10 and the revised National Health Policy. Decision makers at the MOH, as well as hospital managers and others involved in implementing the outsourcing strategy at the facility level, need to know, among other things, how much the provision of non-clinical services is already costing the government under the existing arrangements. The study described here intended to support the implementation of the outsourcing plan by generating actual costs for the delivery of four non-clinical services that are, or will be, the focus of future outsourcing efforts: cleaning, laundry, catering, and grounds maintenance. The study looked at costs in five public sector hospitals: Athlone District Hospital, Deborah Retief Memorial Hospital, Gumare Primary Hospital, Goodhope Primary Hospital, and Mahalapye District Hospital.
An analysis of the costs and cost drivers of delivering non-clinical services in hospitals that are not currently outsourcing service delivery provides a cost benchmark. This will enable MOH decision makers and implementers to better understand the costs and cost drivers of non-clinical services and to compare current costs with estimated private sector costs, effectively negotiate contracts, and move toward greater efficiency and cost-savings. Further, cost benchmarks will provide hospitals with the critical data needed to understand not only the cost foundation of outsourced services but also more about what they can expect to receive for that cost, such as the type, quantity, and quality of service or product they are purchasing.
Understanding Client Preferences to Guide the Prioritization of Interventions...Md. Tarek Hossain
To summarize, the main findings were:
1. The availability of brand drugs is an important factor in determining which facilities are utilized in this population – more so than any other attribute explored in the study for child health services.
2. Provider attitude is also a key determinant of health facility choice and facilities would benefit from further exploration to define specifically how they can improve this client population's perception of their providers’ attitude.
3. This population, though generally poor, does not have a strong preference for free services (over moderately priced services).
4. Although this population expressed (as expected) strong preferences for a continuum of care that includes effective referral services, higher preference scores for provider attitudes and the availability of brand drugs were observed, suggesting that these should be considered for prioritization.
Understanding District-Level Variation in Fertility Rates in High-Focus India...HFG Project
The Government of India (GoI) under the Mission Parivar Vikas (MPV) programme focuses investments in 146 districts in 7 states, which have the highest levels of fertility in India. The strategy aims to accelerate the supply of high quality family planning (FP) services in order to bring fertility of these states to replacement level by 2025. Young couples in the 15-24 year age group constitute the most important opportunity for this investment as they have the highest unmet need for modern contraception (22 percent) and are the largest contributor to fertility (54 percent combined). National Family Health Survey, Round 4 (NFHS-4) data was used to understand patterns and variations in contraceptive use and unmet need among women in this age group including women with low parity (parity at 0 & 1) across the four high focus states of Bihar, Madhya Pradesh (MP), Rajasthan and Uttar Pradesh (UP) in MPV and non-MPV districts.
The purpose of the USAID HFG TB Strategic Purchasing Activity is to identify and recommend small improvements in TB purchasing/provider payment and related public finance management (PFM) mechanism to better target country health budgets towards priority TB services for the poor in USAID TB priority countries. This technical report summarizes the rapid assessment findings, conclusions, recommendations, and possible next steps from stakeholder consultations held in Malawi from May 18-29.
The three health financing functions are revenue collection, pooling and purchasing. Revenue collection is the source/level of funds, pooling is the accumulation of prepaid revenues on behalf of a population and purchasing is the transfer of pooled funds to providers on behalf of a population. The main focus of the HFG/TB Activity is the health purchasing function, specifically provider payment systems and PFM mechanisms. This rapid assessment focuses more on domestic revenue health purchasing and PFM at the district level as other USAID investments are supporting NTP and Global Fund grant implementation. This assessment emphasizes public funding as public funding is critical to pro-poor priority public health services especially TB.
This rapid assessment is not intended to be a literature review or formal study. Stakeholder consultations are the main vehicle for identifying and recommending small TB purchasing and PFM improvement steps for possible further in-depth analysis and implementation. The rapid assessment technical report is organized into five sections: 1) introduction; 2) TB continuum of care gaps; 3) overall strategy and sequencing; 4) shorter-term TB purchasing and PFM steps; and 5) relationship between shorter-term steps and longer-term public service and health reforms.
Performance Based Incentives to Strengthen Primary Health Care in Haryana Sta...HFG Project
Authors: Susan Gigli, Jenna Wright, Francis Raj and Mudeit Agarwa
Published: February 28, 2015
The Government of Haryana is interested in adopting a performance-based incentive (PBI) scheme aimed at strengthening primary health care results. In December 2014, the HFG project conducted a qualitative investigation among 10 public health facilities in two Blocks in Haryana in order to understand the existing incentive and operating environments and to inform the design of a PBI scheme. This report presents the findings of the formative investigation and relevant contextual information on the health system in the selected districts with a view toward supporting an effective PBI scheme in Haryana. The findings and considerations fed into a stakeholder PBI design workshop in early 2015.
The study suggested strongly that a PBI scheme—communicated clearly and perceived as fair—could lead to a change in the overall work culture from one that inadvertently encourages passivity to one that promotes teamwork, engagement, initiative, transparency and accountability.
Estimating Bangladesh Urban Healthcare Expenditure Under the System of Health...HFG Project
Bangladesh is a densely populated country with 23 % people residing in urban areas and with a 3.5% annual growth of urban population. Bangladesh Bureau of Statistics divided into seven administrative divisions: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Rangpur, and Sylhet. Each division is divided into zilas, and each zila into upazilas. Each urban area in an upazila is divided into wards, which are further subdivided into mohallas. A rural area in an upazila is divided into union parishads (UPs) and, within UPs, into mouzas. The people who are living in wards were considered as urban population and the Ups’ population was considered as rural. However, the division between urban and rural health care is not so distinct and it is difficult to create an urban and rural demarcation of health expenditure. According to BDHS 2014, the urban population has more access to facility delivery, qualified doctors and less unmet need for contraception. This raises the question whether there is more health expenditure by urban population than the rural.
This study aims to estimate the health expenditures of the urban population in terms of provider, financing agents and functions by analyzing the data of National health accounts, which will eventually give a specific direction to identify the gaps and way of addressing those issues.
Association between starting methadone maintenance therapy and changes in inc...HFG Project
The primary objective of this survey is to estimate the change in average income and general expenditures of methadone maintenance therapy (MMT) clients associated with starting MMT care. The null hypothesis is that income among MMT clients is the same before and after they started MMT.
Additionally, this survey will provide data to help to inform estimates of changes in job status associated with enrollment in MMT. This survey also serves to supplement a second survey assessing the income of people living with HIV/AIDS (PLWHA).
Expanding Coverage to Informal Workers: A Study of EPCMD Countries’ Efforts t...HFG Project
For many low- and middle-income countries (LMICs), expanding health coverage to informal workers is one of the most common, yet complex challenges requiring action. Informal workers are, by definition, not provided with legal or social protections through their employment, and are vulnerable to health and economic shocks. They also account for a large percentage of the population in LMICs. Expanding or deepening health coverage to informal workers is thus an area of interest for stakeholders pursuing universal health coverage (UHC): the goal that the entire population can access needed good-quality care without risk of impoverishment. Pro-poor coverage schemes that rely on prepayment – payment delinked from the time of care seeking – are a key financing strategy for UHC (WHO 2010). However, including informal workers in such schemes is challenging given that informal workers are not typically registered in taxation systems and social protection systems, nor covered by labor laws and regulations, making them less visible to the government and other stakeholders (Rockefeller Foundation 2013).
This report complements existing literature on how health reforms can improve the welfare of informal workers, focusing on the 25 countries prioritized for development assistance by the United States Agency for International Development (USAID) as part of its Ending Preventable Child and Maternal Deaths (EPCMD) initiative. Given the strong interest in these questions among EPCMD countries, USAID commissioned the Health Finance and Governance project (HFG) to conduct this research and provide recommendations relevant to UHC policy discussions in these countries.
Universal Health Coverage in Haryana: Setting Priorities for Health and Healt...HFG Project
In India, the reach of the public health system is limited; many people avoid seeking formal care because of its high cost or cultural barriers. As a result, they delay seeking care until they are seriously ill, which means higher costs when they seek care, high morbidity, and sometimes mortality that would have been preventable had care been sought earlier in the course of illness. This report provides Haryana a five-year road map for moving toward universal health coverage (UHC). It identifies key inputs that the state will need to effectively expand coverage of primary and secondary care by 2019/20 and estimates the cost of these inputs, in addition to other government-mandated increases.
The Funding Gap in the Dominican Republic’s National HIV/AIDS ResponseHFG Project
HFG conducted a gap analysis to calculate the increase in resources required to fully fund the National HIV and AIDS Response in the medium-term, including different investment scenarios. This report includes the methodology used, the estimate of funding gaps under different scenarios, and a section of analysis and conclusions that presents some alternatives to increase the efficiency of the distribution of resources to control the epidemic.
Guide for the Monitoring and Evaluation of the Transition of Health ProgramsHFG Project
This guide looks at three different transition experiences (funding, technical assistance, and services) to demonstrate variations in the type of transition undertaken, and the corresponding need for M&E. The authors draw upon experience of monitoring and evaluating transition to clarify key elements and dimensions of transition and how they relate to the longer-term goal of program sustainability and to present possible indicators, relevant to different health programs and transition arrangements that can help track transition and offer suggestions on how to select appropriate indicators. This document provides a conceptual framework to guide thinking around the M&E of transitions and will be amended as experience grows.
Measuring Technical Efficiency of the Provision of Antiretroviral Therapy Amo...HFG Project
Botswana has made great strides in combating the HIV epidemic. Deaths due to AIDS have declined dramatically since 2005 (UNAIDS 2014; 2016) and the country is on its way to achieving its 90-90-90 targets. As Botswana implements its ambitious Treat All Strategy and expands treatment to nearly 330,000 people living with HIV, the country will need to critically assess its efficient use of all available resources to sustain gains and continue progress towards an AIDS-free generation. To support the Ministry of Health with evidence regarding the efficiency of antiretroviral therapy (ART) service delivery, the USAID-funded Health Finance and Governance project estimated the overall and component-specific costs and utilization figures of adult outpatient ART care at Botswana’s public health facilities.
Benchmarking Costs for Non-Clinical Services in Botswana’s Public HospitalsHFG Project
Authors: Peter Stegman, Elizabeth Ohadi, Heather Cogswell, Carlos Avila and Mompati Buzwani
Published: April 30, 2015
Botswana’s health sector has embarked on a broad program of reforms and, to this end, the Ministry of Health (MOH) has developed the Health Services Outsourcing Strategy and Programme 2011-2016. This planning document emerges from major strategic thrusts outlined in the National Development Plan 10 and the revised National Health Policy. Decision makers at the MOH, as well as hospital managers and others involved in implementing the outsourcing strategy at the facility level, need to know, among other things, how much the provision of non-clinical services is already costing the government under the existing arrangements. The study described here intended to support the implementation of the outsourcing plan by generating actual costs for the delivery of four non-clinical services that are, or will be, the focus of future outsourcing efforts: cleaning, laundry, catering, and grounds maintenance. The study looked at costs in five public sector hospitals: Athlone District Hospital, Deborah Retief Memorial Hospital, Gumare Primary Hospital, Goodhope Primary Hospital, and Mahalapye District Hospital.
An analysis of the costs and cost drivers of delivering non-clinical services in hospitals that are not currently outsourcing service delivery provides a cost benchmark. This will enable MOH decision makers and implementers to better understand the costs and cost drivers of non-clinical services and to compare current costs with estimated private sector costs, effectively negotiate contracts, and move toward greater efficiency and cost-savings. Further, cost benchmarks will provide hospitals with the critical data needed to understand not only the cost foundation of outsourced services but also more about what they can expect to receive for that cost, such as the type, quantity, and quality of service or product they are purchasing.
Understanding Client Preferences to Guide the Prioritization of Interventions...Md. Tarek Hossain
To summarize, the main findings were:
1. The availability of brand drugs is an important factor in determining which facilities are utilized in this population – more so than any other attribute explored in the study for child health services.
2. Provider attitude is also a key determinant of health facility choice and facilities would benefit from further exploration to define specifically how they can improve this client population's perception of their providers’ attitude.
3. This population, though generally poor, does not have a strong preference for free services (over moderately priced services).
4. Although this population expressed (as expected) strong preferences for a continuum of care that includes effective referral services, higher preference scores for provider attitudes and the availability of brand drugs were observed, suggesting that these should be considered for prioritization.
Sustaining the HIV/AIDS Response in Antigua and Barbuda: Investment Case BriefHFG Project
Antigua and Barbuda has made great strides in organizing its response to HIV and AIDS in recent years, and has managed to control the growth of the epidemic. The National AIDS Program (NAP) is now at a critical juncture as the country plans to adapt to the changing donor funding landscape, new clinical guidelines, strategic objectives, and changes in policy including greater program integration into primary care, which are designed to increase access and reduce the cost of service delivery.
This document provides analytic inputs that support a case for investment in the Antigua and Barbuda HIV and AIDS response. This report provides a quantitative analysis of trends in the HIV epidemic and the impact of various prevention and treatment efforts to date, along with a projection of possible future programming scenarios, their costs, and their implications for the epidemic. The report describes estimated funding available and gaps in funding that The Goals and Resource Needs models – part of the Spectrum/OneHealth modeling system that estimates the impact and costs of future prevention and treatment interventions – were used for this analysis.
Similar to Reproductive, Maternal, Newborn, and Child Health (RMNCH) Expenditure Bangladesh (20)
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
For those battling kidney disease and exploring treatment options, understanding when to consider a kidney transplant is crucial. This guide aims to provide valuable insights into the circumstances under which a kidney transplant at the renowned Hiranandani Hospital may be the most appropriate course of action. By addressing the key indicators and factors involved, we hope to empower patients and their families to make informed decisions about their kidney care journey.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Reproductive, Maternal, Newborn, and Child Health (RMNCH) Expenditure Bangladesh
1. January 2016
This publication was produced for review by the United States Agency for International Development.
It was prepared by Najmul Hossain for the Health Finance and Governance Project.
REPRODUCTIVE, MATERNAL, NEWBORN,
AND CHILD HEALTH (RMNCH)
EXPENDITURE BANGLADESH
Health, Nutrition & Population
3. iii
REPRODUCTIVE, MATERNAL,
NEWBORN, AND CHILD HEALTH
(RMNCH) EXPENDITURE BANGLADESH
DISCLAIMER
The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency
for International Development (USAID) or the United States Government.
4.
5. i
CONTENTS
Acronyms................................................................................................................. iii
Acknowledgments................................................................................................... v
1. Introduction ....................................................................................................... vii
2. Methodology......................................................................................................... 1
2.1 Data Sources Used..............................................................................................................3
2.2 Public Sector Data Analysis...............................................................................................4
2.3 Disaggregating RMNCH Expenditure Component....................................................4
2.4 Allocating Hospital Expenditure by Inpatient and Outpatient ................................4
2.5 Private Sector Data Analysis.............................................................................................5
2.6 Allocating Pharmacy Expenditure by Inpatient and Outpatient..............................6
2.7 Allocating Private Hospital Expenditure by Inpatient and Outpatient..................6
2.8 Limitations of the study......................................................................................................6
2.9 Steps to address the limitations for future exercises................................................7
3. Findings................................................................................................................. 9
3.1 Reproductive Healthcare Expenditure ........................................................................10
3.2 Maternal and Newborn (MN) Healthcare Expenditure..........................................12
3.3 Child Health Expenditure................................................................................................14
4. Conclusions ........................................................................................................ 17
List of Tables
Table 1: BNHA and SHA Framework Total Healthcare Expenditure for 2012...........1
Table 2: RMNCH Classification..................................................................................................2
Table 3: Summary of RMNCH Expenditures by Financing Schemes 2012.....................9
Table 4: Reproductive Healthcare Expenditure by Providers and Functions,
2012......................................................................................................................................10
Table 5: Reproductive healthcare expenditure by Providers and
Financing Schemes 2012..................................................................................................11
Table 6: Reproductive healthcare expenditure by Functions and
Financing Schemes 2012..................................................................................................12
Table 7: Maternal and Newborn healthcare expenditure by Providers
and Functions 2012...........................................................................................................12
Table 8: Maternal and Newborn Healthcare Expenditure by Providers
and Financing Schemes, 2012......................................................................................... 13
Table 9: Maternal and Newborn Healthcare expenditures by Functions and
Financing Schemes, 2012.................................................................................................14
Table 10: Child healthcare expenditure by Providers and Functions 2012.................14
Table 11: Child healthcare expenditure by Providers and Financing
Schemes 2012 ....................................................................................................................15
Table 12: Child Healthcare Expenditure by Functions and Financing
Schemes, 2012 ...................................................................................................................15
List of Charts
Chart 1: Coverage of BNHA-THE, CHE and NHA boundaries considered for
RMNCH Analysis.................................................................................................................2
Chart 2: Hospital RMNCH Expenditure Estimation – A Schematic Presentation.......5
Chart 3: Schematic Presentation of Distribution of Pharmacy Expenditure .................6
Chart 4: RMNCH Expenditures and Remaining Components of CHE, 2012............10
6.
7. iii
ACRONYMS
BBS Bangladesh Bureau of Statistics
BNHA Bangladesh National Health Accounts
CGA Controller General of Accounts
CH Child Health
CHE Current Health Expenditure
DH District Hospital
FES Facility Efficiency Study
FES 2011 Facility Efficiency Survey 2011
FP Family Planning
FS Financing Schemes Revenue
GH General Hospital
GOB Government of Bangladesh
HC Healthcare Functions
HF Healthcare Financing Schemes
HP Healthcare Providers
IP Inpatient
IARS 2006-07 Inpatient Admissions Records Survey 2006-07
ICD10 International Classification for Disease
ICHA International Classification for Health Accounts
ICPC-2 International Classification of Primary Care
MCH Medical College Hospital
MCWC Maternal and Child Welfare Center
MOHFW Ministry of Health and Family Welfare
NHA National Health Accounts
NHA3 Third National Health Accounts
NHA4 Fourth National Health Accounts
OECD Organization for Economic Co-operation and Development (OECD)
OOP Out of Pocket (OOP)
OP Outpatient
PHOMS 2007 Public Hospital Outpatient Morbidity Survey 2007
RMN Reproductive and Maternal Health
RMNCH Reproductive Maternal Neonatal and Child Health
8. iv
SHA System of Health Accounts
THE Total Health Expenditure
UHC Upazila Health Complex
USAID United States Agency for International Development
WHO World Health Organization
9. v
ACKNOWLEDGMENTS
We would like to thank all members Bangladesh National Health Accounts (BNHA) Cell, specifically
Mr. Ashadul Islam, Director General (Additional Secretary) of the Health Economics Unit and Team
Leader BNHA Cell and Tahmina Begum, World Bank consultant, who provided critical contributions
to this analysis. As well, we thank Mursaleena Islam, Yann Derriennic, and Tesfaye Ashagari of HFG
for their technical inputs. Aasit Nanavati of HFG provided production support.
We thank USAID for the funding that made this work possible and we express special appreciation
to Dr. Niaz Chowdhury of USAID Bangladesh for his support.
10.
11. vii
1. INTRODUCTION
National Health Accounts (NHA) presents expenditure flows – both public and private – within the
health sector of a country. They describe, in an integrated way, the sources, uses and channels for all
funds utilized in the whole health system. NHA shows the amount of funds provided by major
financing agents (e.g. government, firms, households), and how these funds are used in the provision
of final services, organized according to the institutional entities providing the services (e.g. hospitals,
outpatient clinics, pharmacies, traditional medicine providers) and types of service (e.g. inpatient and
outpatient care, dental services, medical research, etc.).
The latest edition of the Bangladesh National Health Accounts (BNHA), also termed as the fourth
round of BNHA, tracks the total health expenditure in Bangladesh between the fiscal years 1997 to
2012. It cross-stratified and categorized healthcare expenditures by financing, provision and
consumption on an annual basis. For production of BNHA, System of Health Accounts (SHA)
guideline is followed and the fourth round of BNHA is produced using the SHA 2011 guideline.
Introduction of SHA 2011 has added two new classifications in the financing dimension that provide
more specific answers to the questions: “what instruments are used for fund raising?” and “how the
health resources are managed?” This new classification offers better interpretation of public and
private funding in the healthcare sector.
An useful application of NHA data sets and the conceptual framework is to construct NHA
secondary analysis (previously subaccounts) whereby expenditure outlays can be studied for specific
disease (e.g. tuberculosis, HIV/AIDS), location specific (e.g. urban areas) or a target group of the
population (e.g. specific gender, child). This paper estimates Reproductive, Maternal and Newborn
and Child Health (RMNCH) expenditure for Bangladesh in accordance with the System of Health
Accounts 2011 (SHA 2011) framework.
A secondary analysis of BNHA data for production of Reproductive, Maternal and Newborn and
Child Health (RMNCH) estimates requires additional data sources and methods to analyze each
component of spending. More specifically, the secondary analysis includes three separate estimates
for (i) reproductive, (ii) maternal and neonatal and (iii) child health. Considerably effort was made to
minimize double counting of expenditure, due to definitional overlap. Hospitals, ambulatory
providers and pharmacies are the three major providers that offer direct RMNCH healthcare
service. Their respective expenditure estimates are accounted under BNHA. Public Health Program
of the Government and NGOs also includes RMNCH related expenditure. To estimate the RMNCH
share of hospital and outpatient centers expenditures, user level data by age, sex and disease are a
prerequisite.
The objective of this analysis is to estimate RMNCH related expenditure made at the patient level by
public and private sector institutions as well as households. RMNCH related expenditure made
under various public health program of the government and NGOs are also analyzed. Estimating
RMNCH expenditure using the BNHA data requires identifying relevant services and programs
offered and implemented by various providers in accordance with their respective functions. Studies
conducted by other countries suggest that expenditure on healthcare is highly correlated between
age, sex and reason for encounter (diseases). Expenditure on healthcare also varies based on the
type of service providers and functions such as inpatient or outpatient care.
12.
13. 1
2. METHODOLOGY
National Health Accounts (NHA) and Reproductive, Maternal and Newborn and Child
Health (RMNCH)
Total healthcare expenditure reported under the Bangladesh National Health Accounts (BNHA)
1997-2012 is used as the basis for analysis of the Reproductive, Maternal and Newborn and Child
Health (RMNCH) expenditure. BNHA follows the System of Health Accounts (SHA) framework
which provides systematic description of the financial flows related to healthcare services and
providers. Considering local perspective, boundaries of BNHA for estimating Total Health
Expenditure (THE) is defined differently from SHA. BNHA consider expenditure on traditional
medicine, medical education and research and gross capital formation as part of THE. According to
SHA 2011 guideline expenditures on traditional medicine are reported as “Reporting Items” and
medical education, research is treated as part of human capital development. Therefore investment on
medical education and gross capital formation at the healthcare facilities are reported under a separate
Capital Account. A summary of Bangladesh total healthcare expenditure for 2012 using BNHA and
SHA framework is provided in Table 1.
According to BNHA Total Health Expenditure (THE) in Bangladesh is estimated at Taka 325.1 billion
($4.1 billion) in 2012 (Table 1). BNHA reported THE is inclusive of traditional medicine, medical
education and research and capital expenditure, which constitute a total of Taka 28.2 billion for 2012.
To make the Bangladesh RMNCH estimates internationally comparable it was decided that only
Current Health Expenditure (CHE) according to SHA 2011 framework will be used for RMNCH
analysis. However, due to lack of data, expenditure estimates related to governance and health system
and financing administration were excluded from this analysis. Such outlay accounts for Taka 16.9
billion which is around 6% of CHE, and therefore 94% of CHE or 87% of THE is accounted for
RMNCH analysis.
Table 1: BNHA and SHA Framework Total Healthcare Expenditure for 2012
Healthcare Functions
Financing Schemes (Million Taka) % of
CHE
(SHA
2011)
% of
BNHA
THEPublic
Private
Corporations
and NGOs
Household
Rest of
the
World1
Total
Curative care 26,873 3,420 44,814 8,524 83,632 28% 26%
Rehabilitative care 113 113 0% 0%
Long term care (health) 159 159 0% 0%
Ancillary services 15 5 17,790 17,810 6% 5%
Medical goods 12 133,997 134,009 45% 41%
Preventive care 27,332 3,193 13,753 44,278 15% 14%
Governance and health system
and financing administration
9,752 879 1,367 4,868 16,865 6% 5%
Current HealthExpenditure
(CHE)
64,244 7,509 197,968 27,144 296,866 100%
Reporting Items 168 7,852 8,020 2%
Capital Items 10,659 9,550 - - 20,209 6%
Total BNHA Health Expenditure
(BNHA-THE)
75,071 17,059 205,820 27,144 325,094 100%
Source: Bangladesh National Health Accounts, 1997-2012
1 Rest of the world means Development Partner (DP) funding channelled through NGOs
14. 2
A graphical presentation of total healthcare expenditure under BNHA, SHA 2011 and expenditure functions
covered for RMNCH analysis is presented in Chart 1. In summary, the top four functional activities of the
pyramid are excluded from the RMNCH analysis.
Chart 1: Coverage of BNHA-THE, CHE and NHA boundaries considered for RMNCH Analysis
Defining boundaries of Reproductive, Maternal, Newborn, and Child Health (RMNCH) can be
challenging as some of the disease or conditions overlap with each other. Under this study patients
conditions related to Maternal and Newborn care (MN) are identified using International Classification
for Diseases code, version 10 (ICD 10) --
Table 2. Child Health (CH) covers expenditure associated to child care for children aged starting
from 1 month to less than 5 years. For Reproductive health (RH) definition used by International
Conference for Population and Development (ICPD) Programme of Action in the context of primary
health care related to reproductive health is used for this analysis and it includes: (a) Family planning;
(b) Antenatal, safe delivery and post-natal care; (c) Prevention and appropriate treatment of infertility;
(d) Prevention of abortion and management of the consequences of abortion; (e) Treatment of
reproductive tract infections; (f) Prevention, care and treatment of STIs and HIV/ AIDS; (g)
Information, education and counselling, as appropriate, on human sexuality and reproductive health;
(h) Prevention and surveillance of violence against women, care for survivors of violence and other
actions to eliminate traditional harmful practices, such as FGM/C; (i) Appropriate referrals for further
diagnosis and management of the above.
Table 2 below present conditions related to RMNCH by ICD 10 and age limits considered for
analysis.
Table 2: RMNCH Classification
CurrentHealthExpenditure296.9BillionTaka
BNHATotalHealthExpenditure325.1BillionTaka
ConsideredforMNCHAnalysisTaka280billion
15. 3
Disease/diagnostic category ICD-10 codes
Reproductive Health (RH)
Abortions O00-O08
Antenatal care Z32-Z36
Postnatal care Z39
Family Planning, Prevention, care and treatment of
STIs and HIV/ AIDS
Maternal and New born Health (MN)
Childbirth O80-O84, Z37,Z38
Other maternal care O44-O46, O72
Other maternal conditions O10-O16, O20-O29, O30-O43, O47, O48, O60-O71,
O73-O75, O85-O92, O95-O99,O94
Child Health (CH) Any child age between 1 month to less than 5 years
2.1 Data Sources Used
Multiple data source is used for identifying and reallocating expenditure for; (1) Reproductive; (2)
Maternal and New born; (3) Child health, using the definitions and boundaries discussed earlier. Apart
from using various data, detailed discussions with the BNHA cell and various stakeholders were
organized in tracking of RMNCH component of preventive care expenditure reported under BNHA.
A short description of datasets used for the analysis is provided below.
Facility Efficiency Survey 2011 (FES 2011): This database is a nationally representative survey of
costs and expenditures at all level of public facilities (primary, secondary and tertiary) operated by the
Ministry of Health and Family Welfare (MOHFW). A total of 135 public facilities were survey under
this study as part of the ADB TA-6515: Impact of Maternal and Child Health Private Expenditure on
Poverty and Inequity in Bangladesh project. The survey data permit the estimation of key cost
components at each type of facility.
Inpatient Admissions Records Survey (IARS) 2006-07: A total of 9,867 inpatient data from a
sample of nationally representative public hospitals were collected in 2007. This dataset provide
information on disease coded with International Classification for Disease (ICD10), age and sex.
Medicine prescribed to the patient is also available in this dataset.
Public Hospital Outpatient Morbidity Survey (PHOMS) 2007: A total of 4,683 outpatient data
from a sample of nationally representative public hospitals were collected in 2007. This dataset
provide information on disease coded with the International Classification of Primary Care (ICPC-2),
which classifies information of primary care relating to age and sex. Medicine prescribed to the patient
is also available in this dataset.
Pharmacy Patient Survey 2008: A total of 6,648 patients’ expenditure on medicine was captured
from a sample of nationally representative Retail Drug Outlet collected in 2008. This dataset provide
information on disease coded with the International Classification of Primary Care (ICPC-2), which
classifies information of primary care relating to age and sex. Medicine prescribed to the patient is also
available in this dataset.
16. 4
2.2 Public Sector Data Analysis
The RMNCH analysis of public sector expenditure was done in two steps. In first step RMNCH
related expenditure made under various public health program carried out by the Government and
Non-Government Organizations (NGOs) were identified and classified accordingly. For example
expenditure associated with family planning and counseling is classified as preventive care expenditure
under BNHA following SHA guidelines. For this study all expenditure booked as preventive care in
BNHA were revisited and further disaggregation of those expenditure were made. For further
disaggregation, technical inputs provided by the BNHA Cell of the Health Economics Unit (HEU) of
the Ministry of Health and Family Welfare were incorporated. Electronic data of government
expenditure on healthcare allowed identifying expenditure on procurement of vaccines by various
providers which treated as expenditure for Child healthcare. Non clinical (preventive care) services
provided by the public hospitals and outpatient centers related to RMNCH are also estimated using
final results from “Bangladesh Facility Efficiency Study 1998 and 2010”.
The second step of the analysis addressed patients expenditure incurred for RMNCH at the hospitals
and outpatient centers. Tracking of expenditure at hospitals and outpatient center is done using
methodology adopted for Asian Development Bank (ADB) Regional Technical Assistance Project: TA-
6515 REG “Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity” and
OECD Final Report “Estimating Expenditure By Disease, Age And Gender Under The System Of
Health Accounts (SHA) Framework”. Both studies recommended that estimates of RMNCH
expenditure using National Health Accounts (NHA) should focus on (a) Current Health Expenditure
(CHE) and (b) reallocate hospital and outpatient centers expenditures using patient records, generally
age, sex and disease.
2.3 Disaggregating RMNCH Expenditure Component
For identifying and disaggregating RMNCH expenditure of the public providers like hospitals and
ambulatory service providers, patient data/records collected through facility surveys (IARS 2006-2007
and PHOMS 2007) under the third round of BNHA 1997-2007 is extensively used. Although these
datasets are somewhat dated, using them is still arguably the best option available for two reasons.
First, they were nationally representative sampled surveys; and secondly, disease information provided
in these datasets is already coded using International Classification for Disease (ICD 10) and
International Classification of Primary Care (ICPC-2). Coding diseases by ICD 10 and ICPC-2 is a
highly technical and labor-intensive exercise, and it is opportunistic that such coded data was
accessible under this study.
2.4 Allocating Hospital Expenditure by Inpatient and
Outpatient
Recurrent expenditure and sample of patient records from 135 nationally representative public
healthcare facilities surveyed under the Facility Efficiency Survey 2011 (FES 2011) is used for
distributing expenditures by inpatients and outpatients. For each facility, cost incurred by various cost
centers like inpatient wards, outpatient clinics, laboratory, pharmacy and radiology departments are
studied separately. Costs estimated for each cost center are then redistributed by patient using
inpatient records, with age, sex and disease information, collected under the Inpatient Admissions
Records Survey 2006-07 (IARS 2006-07). This database provided information on the primary
diagnoses (up to three), age, sex, and discharge status of inpatients which were coded using WHO’s
International Classification of Disease, 10th Revision (ICD-10).
17. 5
Similarly, outpatient costs estimated under FES 2011 were distributed using the Public Hospital
Outpatient Morbidity Survey 2007 (PHOMS 2007) dataset. The reasons for outpatient’s visit were
originally coded using the WHO-recommended International Classification of Primary Care 2nd
Edition (ICPC-2e) and later converted to ICD-10. Finally, one combined database was created which
provides cost information by inpatient and outpatient. Final estimates of expenditure by disease or
reason for encounter is produced using “weights” that was calculated considering total number of
facilities, total inpatient and outpatient served for the year 2011. More technical details of this analysis
are available in Technical Report C “ADB Regional Technical Assistance Project: TA-6515 REG,
Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity”.
Chart 2 provides a schematic presentation of various steps applied for data collation, analysis, and
reporting hospital component of RMNCH expenditure estimates for Bangladesh.
Chart 2: Hospital RMNCH Expenditure Estimation – A Schematic Presentation
2.5 Private Sector Data Analysis
All four rounds of BNHA show that healthcare expenditure in Bangladesh is dominated by private
sector and financed predominantly by the household. According to BNHA, in 2012 private sector
spending on CHE was Taka 205.5 billion where Taka 48.2 billion is spend in curative care and Taka
134 billion on procurement of medicine and medical goods. Secondary analysis for tracking of
RMNCH expenditure under private sector requires redistribution of this expenditure amongst a
sample of nationally representative patients using age, sex and disease/reason for encounter
classification.
Facility Efficiency Survey
2011 (FES 2011)
Estimated Inpatient (IP) and
Outpatient (OP) Cost at national
level by provider
IP and OP estimates distributed by
patient and reason for encounter using
Inpatient Admissions Records
Survey (IARS) 2006-07
Public Hospital Outpatient
Morbidity Survey (PHOMS)
2007
A combined database was
created providing cost
information by IP and OP
with reasons for encounter.
International Classification
of Diseases (ICD 10)
coding applied
Ratio of IP and OP cost
by ICD10 estimated
using facility and patient
"weight" for national
representation
Estimated ratios applied to
BNHA expenditure for
providers
RMNCH estimates of
hospital outlay using
ICD10 and patient age
information
18. 6
2.6 Allocating Pharmacy Expenditure by Inpatient and
Outpatient
Expenditure on medicine and medical goods is the single largest component of BNHA which
constitute 45% of total current health expenditure. Pharmacy customers and sales data collected from
the Pharmacy Patient Survey 2008 (PPS 2008) is used in estimating pharmacy expenditures by patient.
Patient information including medicine prescribed from a nationally representative sample of
pharmacies covering 6,624 patients was collected. Patient data collected from pharmacy survey were
originally coded using the WHO-recommended International Classification of Primary Care 2nd
Edition (ICPC-2e) and later converted to ICD-10. These data were combined with aggregate estimates
of pharmaceutical market sales produced by IMS-Health (Bangladesh) to estimate the distribution of
pharmacy expenditures by different types of patient. Chart 3 presents different steps undertaken to
estimate expenditure incurred in pharmacies by households.
Chart 3: Schematic Presentation of Distribution of Pharmacy Expenditure
2.7 Allocating Private Hospital Expenditure by Inpatient and
Outpatient
Due to unavailability of patient records from Private and NGO operated hospitals this study used the
government operated district and general hospital patient data in allocating RMNCH expenditure at
the Private and NGO operated hospitals. It is assumed that share of RMNCH related patient in
Private and NGO hospitals and outpatient centers are similar to public hospital regardless of condition
or complication of the patient. Rational behind using the ratio of district and general hospital as they
match structurally in terms of geographical location and size of the hospital based on bed count.
Method used for allocating private hospital and outpatient centers expenditure by patient for this
analysis is the same that are used for public sector hospitals and outpatient centers.
2.8 Limitations of the study
The methodology applied for RMNCH analysis is based on the SHA/OECD and WHO guidelines.
However, for RMNCH, it is still at a developing stage, and requires further refinement and
standardization. For different public health programs, apportioning outlays by providers was not
straight forward. Discussions with health experts working, including the Bangladesh National Health
Accounts cell of the Health Economics Unit, MOHFW, was solicited to distribute outlays by providers
and financing agents. Some level of over/under reporting cannot be ruled out. The dearth of patient
data, specifically those availing treatment from private hospitals and outpatient center (physician
chamber) was a challenge, and approximation from public sector utilization data were used as proxy.
Pharmacy Patient Survey
2008
Pharmacy customers (patient) and
sales data collected
data are
coded using
ICD10
patient/customer data are
combined with aggregate
estimates of pharmaceutical
market sales
estimated distribution
ratio of pharmacy
expenditures by different
types of patient
The ratios are applied to BNHA expenditure
estimates for pharmacies and RMNCH
expenditure estimated using ICD10 and patient,
age information
19. 7
2.9 Steps to address the limitations for future exercises
Steps used in identifying Reproductive (R), Maternal and Newborn (MN) and Child health (CH)
related expenditures was based on disease or reason for encounter suggested under System of Health
Accounts (SHA) developed by the Organization for Economic Co-operation and Development
(OECD) and the World Health Organization (WHO) guidelines. However, due to resource and data
limitations, the Reproductive (R), Maternal and Newborn (MN) and Child health (CH) analysis were
marginally compromised on selected areas, and should be addressed in similar future analysis. The
issues that need to be rectified are presented below.
1.Inpatient and Outpatient records used for identifying disease or reason for encounter was
collected in 2006/07 (Inpatient Admissions Records Survey (IARS) 2006-07 and Public Hospital
Outpatient Morbidity Survey (PHOMS) 2007), and used in redistributing expenditure of 2012.
These surveys should be repeated to capture data that are more recent.
2.Survey data of patient records used was not designed specifically to address Reproductive (R),
Maternal and Newborn (MN) and Child health (CH) issues. It was designed with emphasis to
capture adequate sample of mothers and infants, and not encompassing Reproductive health (R)
or Child Health (CH). For future analysis, sampling issue needs to be considered in advance. This
would mean that the BNHA cell should work with the designer of the IARS and PHOMS to
include the details needed.
3.Distribution of disease or reason for encounter using ICD-102, and ICPC-23 shows that sample of
patients related to Reproductive (R), Maternal and Newborn (MN) and Child health (CH) by type
of facility was not adequate. In the future, if necessary to over sample patient records for facilities
specialized in providing these services can be pursued, and necessary statistical adjustments would
yield estimates that are more robust.
4.Patient data from private hospitals was not available for the Reproductive (R), Maternal and
Newborn (MN) and Child health (CH) analysis. According to the Bangladesh National Health
Accounts (BNHA), private sector growth in healthcare services is much higher compared to the
public sector. Growth in number of patient treated by the private sector hospital facilities are
increasing at a faster rate than that of public facilities. In addition, the private sector facilities are
offering more diversified and specialized services at the tertiary level hospital. Considering these
factors, it is strongly recommended that patient records from private hospital facilities are
included in future RMNCH studies. This would mean expanding the POHMS to private hospitals.
Getting data from private facilities, not just hospitals, is a priority
The Reproductive (R), Maternal and Newborn (MN) and Child health (CH) analysis requires coding of
diseases or reason for encounter using ICD-10 and ICPC-2 which was not done for this report. The
coding exercise was completed under the third round of BNHA. This type of coding requires
specialized knowledge and substantial amount of time and resource. For future analysis, it is important
to consider additional level of effort and budget for coding of diseases or reason for encounter using
ICD-10 and ICPC-2.
2 International Classification for Disease (version 10)
3 International Classification of Primary Care (version 2)
20.
21. 9
3. FINDINGS
Bangladesh spends around Taka 59.3 billion on Reproductive, Maternal and Newborn, and Child
Health (RMNCH) which is around 20% of total Current Health Expenditure (Chart 4) for the year
2012 Expenditure on Reproductive health for the year is estimated Taka 21.1 billion while it is Taka
22 billion for Maternal and New born, followed by Taka 16 billion on Child health. Expenditures
estimated as RMNCH are directly associated with patients and all indirect expenditure such as
administrative expenditure are therefore not included in the estimates.
Table 3: Summary of RMNCH Expenditures by Financing Schemes 2012
Governmen
t schemes
Non-profit
institution/
NGO financing
schemes
Household
Out-of-
pocket
expenditure
Rest of the
World
Voluntary
Schemes
Current
Healthcare
Expenditure
(CHE)
Million Taka
Reproductive 13,066 1,577 1,279 5,157 21,079
Maternal & New
born
10,968 2,337 4,514 4,357 22,176
Child health 4,067 306 11,645 16,018
RMNCH 28,101 4,219 17,438 9,514 59,272
BNHA-CHE 64,244 7,509 197,968 27,144 296,866
The Government of Bangladesh is the biggest spender on RMNCH -- Taka 28.1 billion in 2012. The
major portion of the funds was used on public health programs. Household making out-of-pocket
(OOP) expenditure for procurement of medicine and paying hospital bills accounts for 29% of
RMNCH. Household OOP expenditure on medicine for Reproductive health and Maternal and New
born healthcare is very small (table 6 and table 9). NGOs contribution in RMNCH from its own
funds is around Taka 4.2 billion with a large contribution of development partners funding (Taka 9.5
billion) in public health programs.
22. 10
Chart 4: RMNCH Expenditures and Remaining Components of CHE, 2012
3.1 Reproductive Healthcare Expenditure
Bangladesh spent around Taka 21.1 billion on Reproductive health in 2012 (Table 4). This is around
7% of total current healthcare expenditure (CHE) for the year and almost 90% (Taka 19 billion) of
this expenditure is made on Information, education and counseling programmes. In terms of
providers, Ambulatory health care centers are the largest service providers of reproductive health,
and in 2012 they spent Taka 12.2 billion. Much of the outlay is on family planning and counselling.
The second largest providers of reproductive healthcare services are the general hospitals spending
around Taka 7.6 billion. Reproductive services provided from the General hospitals is dominated by
services of preventive care offering information, education on family planning and counselling service
at the upazila (sub-district) level and below. Services of the curative care such as inpatient and
outpatient care are also provided by the General hospitals. In 2012 Taka 1.4 billion on inpatient care
and Taka 0.54 billion was incurred on outpatient care by the General hospitals.
Table 4: Reproductive Healthcare Expenditure by Providers and Functions, 2012
Providers
Inpatient
curative
care
Outpatient
curative
care
Pharmaceuticals
and other
medical non-
durable goods
Information
education
and
counseling
programs
Current
Healthcare
Expenditure
Million Taka
General hospitals including
teaching hospitals
1,397 540 - 5,660 7,598
Specialized hospitals 2 2 - 474 478
Ambulatory health care centers - - - 12,156 12,156
Pharmacies/Retail Drug Outlet - - 77 - 77
GoB MoHFW public health
programs
- - - 121 121
GoB non-MoHFW public health
programs
- - - 23 23
NGO public health programs - - - 530 530
23. 11
Providers
Inpatient
curative
care
Outpatient
curative
care
Pharmaceuticals
and other
medical non-
durable goods
Information
education
and
counseling
programs
Current
Healthcare
Expenditure
All other industries as
secondary providers of health
care
- - - 96 96
Reproductive health 1,411 548 77 19,060 21,097
The government, households, NGOs and development partners contributes in financing of
Reproductive healthcare services in Bangladesh. In 2012, the government was the largest financing
schemes entity, who spent around Taka 13.1 billion on reproductive healthcare (Table 5). The
major portion of the government spending was made by the Ambulatory health care centers,
accounts for almost 93% (Taka 12.2 billion) of total government expenditure. Development partners
spending on reproductive healthcare, classified as “Rest of the World Voluntary Schemes,” is the
second largest financing schemes, and accounts for around 25% of reproductive healthcare
expenditure of Bangladesh, . Households out of pocket spending on reproductive healthcare are not
significant compared to the total spending. In 2012, households spend only Taka 1.3 billion on
reproductive healthcare.
Table 5: Reproductive healthcare expenditure by Providers and Financing Schemes 2012
Providers
Government
schemes
Non-profit
institution/
NGO financing
schemes
Household
Out-of-
pocket
expenditure
Rest of
the World
Voluntary
Schemes
Current
Healthcare
Expenditure
Million Taka
General hospitals including
teaching hospitals
636 1,361 1,202 4,399 7,598
Specialized hospitals 31 47 - 400 478
Ambulatory health care centers4
12,156 - - - 12,156
Pharmacies/Retail Drug Outlet - - 77 - 77
GoB MoHFW public health
programs
121 - - - 121
GoB non-MoHFW public health
programs
23 - - - 23
NGO public health programs 3 169 - 358 530
All other industries as secondary
providers of health care
96 - - - 96
Reproductive health 13,066 1,577 1,279 5,157 21,079
The major portion of Reproductive healthcare services in Bangladesh is spent on preventive care. In
2012 Taka 19.1 billion (90%) was spent on preventive care service. Spending on curative care
services related to Reproductive health is very small. In 2012, Taka 1.4 billion was incurred on
inpatient curative care and Taka 0.54 billion on outpatient care (Table 6).
4 This item comprises establishments that are primarily engaged in providing health care services directly to outpatients who do not
require inpatient services. This includes both offices of general medical practitioners and medical specialists and establishments specializing
in the treatment of day-cases and in the delivery of home care services
24. 12
Table 6: Reproductive healthcare expenditure by Functions and Financing Schemes 2012
Function
Government
schemes
Non-profit
institution/
NGO financing
schemes
Out-of-pocket
expenditure
excluding cost-
sharing
Rest of the
World
Voluntary
Schemes
Current
Healthcare
Expenditure
Million Taka
Inpatient curative care 355 224 820 - 1,399
Outpatient curative care 105 94 344 - 543
Pharmaceuticals and other
medical non-durable goods
- - 77 - 77
Preventive care 12,606 1,259 38 5,157 19,060
Total Reproductive health 13,066 1,577 1,279 5,157 21,079
3.2 Maternal and Newborn (MN) Healthcare Expenditure
Healthcare expenditure on Maternal and Newborn (MN) is estimated Taka 22.2 billion (Table 7)) in
2012 which is approximately 7.5% of total Current Healthcare Expenditure (CHE). Hospitals,
Ambulatory service providers and Public health programs implemented by the government and
NGOs are major providers of MN care. A comparison of providers shows that General hospital
alone accounts for almost 69% of total MN care services. In 2012, Taka 15.3 billion is spend by
General hospitals on MN, where Taka 6.2 billion (40%) is spend on inpatient curative care and Taka
9 billion (60%) on preventive care creating awareness and educating mothers.
The Ministry of Health and Family Welfare’s public health program is the second largest provider of
MN service. In 2012 the ministry spent Taka 3.3 billion on information, education and counseling
programs, with much of the outlay was on family planning and counselling. Ambulatory health care
centers like community clinics or other outpatient center also contributes in MN. In 2012, a total of
Taka 1.3 billion was spent by such entities.
Table 7: Maternal and Newborn healthcare expenditure
by Providers and Functions 2012
Providers
Inpatient
curative
care
Outpatient
curative
care
Pharmaceuticals
and other
medical non-
durable goods
Information,
education
and
counseling
programs
Current
Healthcare
Expenditure
Million Taka
General hospitals including
teaching hospitals
6,195 12 - 9,029 15,236
Specialized hospitals 45 0 - 871 916
Ambulatory health care centers - - - 1,318 1,318
Pharmacies/Retail Drug Outlet - - 748 - 748
GoB MoHFW public health
programs
- - - 3,280 3,280
GoB non-MoHFW public health
programs
- - - 12 12
25. 13
Providers
Inpatient
curative
care
Outpatient
curative
care
Pharmaceuticals
and other
medical non-
durable goods
Information,
education
and
counseling
programs
Current
Healthcare
Expenditure
Million Taka
NGO public health programs - - - 333 333
All other industries as secondary
providers of health care
- - - 333 333
Total Maternal and Newborn
healthcare
6,239 12 748 15,176 22,176
The government financing schemes is the largest financer of MN healthcare services in Bangladesh. In
2012, the government spent around Taka 11 billion (Table 8) on MN healthcare. As mentioned
earlier, general hospitals plays a significant role in providing MN. Further disaggregation of this
provider by financing schemes shows that only 39% of general hospital funding is made by the
government. In 2012 household out-of-pocket expenditure and Rest of the World funds given to
NGOs are the two second biggest financer of RM, as they spent Taka 3.8 billion and Taka 3.6 billion
respectively. Apart from financing hospital expenditure, households also make out-of-pocket
expenditure on medicine. NGOs from its own fund finance in hospital service, and in 2012 total
contribution of NGOs in MN was Taka 2.3 billion.
Table 8: Maternal and Newborn Healthcare Expenditure
by Providers and Financing Schemes, 2012
Providers
Government
schemes
Non-profit
institution/
NGO
financing
schemes
Household
Out-of-
pocket
expenditure
Rest of the
World
Voluntary
Schemes
Current
Healthcare
Expenditure
Million Taka
General hospitals including teaching
hospitals
5,975 1,894 3,766 3,602 15,236
Specialized hospitals 50 172 - 694 916
Ambulatory health care centers 1,318 - - - 1,318
Pharmacies/Retail Drug Outlet - - 748 - 748
GoB MoHFW public health programs 3,280 - - - 3,280
GoB non-MoHFW public health programs 12 - - - 12
NGO public health programs 1 271 - 61 333
All other industries as secondary providers
of health care
333 - - - 333
Total Maternal and Newborn healthcare 10,968 2,337 4,514 4,357 22,176
A breakdown of Maternal and Newborn healthcare by functions like inpatient and outpatient shows
that in 2012, Taka 6.2 billion (Table 9)) was spent on inpatient care. Expenditure reported as
outpatient care related to MN is very low due to couple of definitional reasons: (1) home visits made
by Family Welfare Assistant (FWA) and Health Assistant (HA) is not classified as outpatient visit; (2)
mothers visits to facilities with a child older than one month is classified under childcare. Apart from
the definitional boundary, having no patient data from private hospitals also contributed in estimation
of low outpatient expenditure for MN. According to NHA definition, pharmaceuticals and other
medical non-durable goods provided to the patient by hospitals is not shown separately and as a
result such expenditure reported for MN is only Taka 0.75 billion in 2012.
26. 14
Table 9: Maternal and Newborn Healthcare expenditures
by Functions and Financing Schemes, 2012
3.3 Child Health Expenditure
Bangladesh spend around Taka 16 billion (Table 10) on Child healthcare (CH) in 2012. Healthcare
service related child are provided from hospitals, ambulatory healthcare centers and
Pharmacies/Retail drug outlet. In 2012 highest amount of CH related expenditure is reported by the
provider of Pharmacies/ Retail drug outlet (Taka 10.5 billion). For the same year, expenditure
reported by hospital and ambulatory centers are Taka 2.3 billion and Taka 2.7 billion respectively.
Further breakdown of hospital expenditure suggest that almost 97% of the CH expenditure
reported by hospitals are made on inpatient and outpatient curative care. In 2012, expenditures
reported by Ambulatory centers are primarily on information, education and counseling programs,
inclusive of immunization services.
Table 10: Child healthcare expenditure by Providers and Functions 2012
Providers
Inpatient
curativecare
Outpatient
curativecare
Pharmaceuticals
andother
medicalnon-
durablegoods
Information
educationand
counseling
programs
Immunization
programs
Current
Healthcare
Expenditure
Million Taka
General hospitals including teaching hospitals 1,357 814 - 62 - 2,233
Specialized hospitals 20 30 - 4 - 55
Ambulatory health care centers - - - 2,647 43 2,690
Pharmacies/Retail Drug Outlet - - 10,525 - - 10,525
GoB MoHFW public health programs - - - 501 - 501
GoB non-MoHFW public health programs - - - 12 - 12
NGO public health programs - - - 1 - 1
All other industries as secondary providers of health care - - - 2 - 2
Total Child Healthcare 1,377 844 10,525 3,228 43 16,018
Function
Government
schemes
Non-profit
institution/
NGO
financing
schemes
Out-of-
pocket
expenditure
excluding
cost-sharing
Rest of
the
World
Voluntary
Schemes
Current
Healthcare
Expenditure
Million Taka
Inpatient curative care 1,495 1,017 3,727 - 6,239
Outpatient curative care 8 1 3 - 12
Pharmaceuticals and other
medical non-durable goods
- - 748 - 748
Information, education and
counseling program
9,465 1,319 35 4,357 15,176
Total Maternal and
Newborn healthcare
10,968 2,337 4,514 4,357 22,176
27. 15
For child healthcare, the household is the largest financing schemes entity, spending Taka 11.6 billion
in 2012 (Table 11). A major portion of the household spending is made at the Pharmacies/Retail
Drug Outlets. Household expenditure on medicine and medical goods was Taka 10.5 billion and
Taka 1.1 billion on hospital services. Government financing schemes accounted for only 25% (Taka
4.1 billion) of CH in 2012. The bulk of government spending are made by the ambulatory health care
centers (Taka 2.7 billion) followed by General hospital (Taka 0.81 billion) and GoB MoHFW public
health programs (Taka 0.5 billion).
Table 11: Child healthcare expenditure by Providers and Financing Schemes 2012
Providers Government
schemes
Non-profit
institution/
NGO
financing
schemes
Household
Out-of-
pocket
expenditure
Current
Healthcare
Expenditure
Million Taka
General hospitals including teaching hospitals 807 306 1,120 2,233
Specialized hospitals 55 - - 55
Ambulatory health care centers 2,690 - - 2,690
Pharmacies/Retail Drug Outlet - - 10,525 10,525
GoB MoHFW public health programs 501 - - 501
GoB non-MoHFW public health programs 12 - - 12
NGO public health programs 1 - - 1
All other industries as secondary providers of
health care
2 - - 2
Total Child healthcare 4,067 306 11,645 16,018
Child healthcare expenditure by functions shows that major portion of the expenditure is made for
the function of medicine and other medical non-durable goods. In 2012, Taka 10.5 billion (Table 12)
was spend on medicine and other medical non-durable goods by households. Government public
health program on CH accounts for Taka 3.2 billion followed by inpatient and outpatient. In 2012,
Taka 0.5 billion and Taka 0.3 billion was spent on inpatient and outpatient respectively. Inpatient and
outpatient service related to CH is also financed by households and NGO’s own funding.
Table 12: Child Healthcare Expenditure by Functions and Financing Schemes, 2012
Function
Government
schemes
Non-profit
institution/
NGO
financing
schemes
Out-of-
pocket
expenditure
excluding
cost-sharing
Current
Healthcare
Expenditure
Million Taka
Inpatient curative care 540 179 658 1,377
Outpatient curative care 301 117 427 844
Pharmaceuticals and other medical non-durable goods - - 10,525 10,525
Information, education and counseling programs 3,183 10 35 3,228
Immunization programs 43 - - 43
Total Child Healthcare 4,067 306 11,645 16,018
28.
29. 17
4.CONCLUSIONS
Current Health Expenditure (CHE) for 2012 on Reproductive (R) health is estimated at Taka 21.1
billion. In terms of percentage, this is around 7.1% of CHE. Reproductive healthcare services are
primarily provided by ambulatory service providers (outpatient centers), 58% followed by general
hospitals (36%). Health financing schemes offered by the Government of Bangladesh is the largest
financer of Reproductive healthcare (62%). Reproductive healthcare financed by the development
partner and implemented through NGOs also plays key role. It accounts for 24% of total R-CHE. A
Functional breakdown of the Reproductive healthcare services shows that 92% of the expenditures
are made on preventive care.
In 2012, Taka 22 billion was spent on Maternal and Newborn (MN) care in Bangladesh. It constitutes
around 7.5% of total CHE. Further breakdown of MN-CHE by Financing Schemes shows that the
government financing around 49% of total MN expenditure followed by Household and development
partners financing at 20% each. As a provider of MN services, general hospitals are the largest
provider accounting for almost 69% of total MN expenditure. MN services include inpatient and
outpatient curative care, pharmaceuticals and other medical non-durable goods and preventive care.
A Functional breakdown of the MN healthcare services shows that a major portion of the
expenditure (68.4%) are made on preventive care followed by inpatient curative care (28%).
Expenditure on Child Healthcare (CH) for 2012 is estimated at around Taka 13.7 billion which
translate to 5.4% of total CHE. Compared to the Financing Schemes of R and MN healthcare
expenditure, household out-of-pocket (OOP) expenditure on CH is significantly higher. In 2012,
household financing schemes financed almost 73% of CH-CHE. The main reason for shifting of
financing responsibility from government to household on CH care is due the high level of outlay on
pharmaceutical drugs. A Functional breakdown of the CH healthcare services shows that almost 66%
of CH care expenditures are made for pharmaceuticals.
Improvements in Reproductive, Maternal and Newborn, and Child Health (RMNCH) care are a
priority policy objective of the Government of Bangladesh. The government has made considerable
investment in health targeting improvements of maternal and reproductive health as part of its
commitment to achieve MDG 5 (Maternal health). Estimations on Reproductive, Maternal and
Newborn and Child Health expenditures are policy relevant as the government can objectively
assess the returns from such investments in terms of health performance indicators.