NATIONAL HEALTH ACCOUNTS INSTITUTIONALIZATION: BANGLADESH DRAFT WORK PLAN

Transcription

1 NATIONAL HEALTH ACCOUNTS INSTITUTIONALIZATION: BANGLADESH DRAFT WORK PLAN Prasanta Bhushan Barua Joint Chief (Joint Secretary) Health Economics Unit Ministry of Health and Family Welfare Government of Bangladesh 1

2 Outlines of the Presentation Introduction Basic Health Information Health Financing in Bangladesh Bangladesh National Health Accounts (BNHA) Institutionalization: Draft Work Plan 2

3 Bangladesh Surrounded by India, Myanmar and Bay of Bengal 3

4 Bangladesh World s Longest Sea Beach at Cox s Bazar 4

5 Bangladesh World s Largest Mangrove Forest in Sunderban UNESCO declared World Heritage. 5

6 Demographic Information Area Density : sq.km : 993/sq. km. Sex Ratio(M/F) : 105: 100 Average HH size Population : 4.8 persons : 146 million. Annual growth rate (in 2008) : 1.39% Total fertility rate (TFR) : 2.7 Urban/Rural population Ratio : 1:3 Source:(BBS, 2009) 6

7 Guiding Principles in Health Sector Constitution : Article 15(a).. ensure basic necessities of life including medical care to its citizens. Article 18(1).. raise the level of nutritional status and improve public health. MDGs: achieve MDGs by 2015 MDG 4: Reduce Child Mortality MDG 5: Improve Maternal Health. MDG 6: Combat HIV/AIDS, Malaria and other Diseases HNPSP: Sustainable improvement in health, nutrition and family welfare. Health Policy: Ensure quality health, nutrition and family welfare services which is affordable, attainable and acceptable to its citizens. Vision 2021: Welfare of the people, Life expectancy target 70 years. 7

8 Basic Health Information Indicators Base year ( ) Current Status (2009) MDG Target (2015) Under -5 mortality Rate /1000 LB Infant Mortality Rate /1000 LB Proportion of 1 yr. children immunized against measles Maternal mortality rate/ 100,000 LB Proportion of births attended by skilled health personnel, %

9 Basic Health Information contd. Indicators Antenatal care coverage (at least one visit) Antenatal care coverage (at least four visits) Base year ( ) Current Status (2009) MDG Target (2015) Total Fertility Rate (TFR) 3.0 (2004) 2.7 (2007) 2.2 (2011) Prevalence of Malaria/100,000 population Prevalence of TB/100,000 pop. TB Detection rate under DOTS, % TB cure rate under DOTS, % (2008) 586 Halting (2008) Halting Sustain Sustain 9

10 Health Financing in Bangladesh ( ) Sources of Fund Exp. (Million Taka) Public Sector 41, Rest of the World 12,391 8 NGOs 2,092 1 Household OOP 103, Private Firms 1,325.8 Private Insurance Total Health Exp. 160, % 10

11 Health Financing in Bangladesh Source: BNHA

12 Total Health Expenditure by Financing Agents Source: BNHA

13 Source: BNHA Total Health Expenditure by Providers

14 Source: BNHA Total Health Expenditure by Functions

15 Source: BNHA Total Health Expenditure

16 Source: BNHA Per capita Health Expenditure and per capita GDP (Taka)

17 Share of Public and Private Financing in % Source: BNHA

18 Total Health Expenditure : BNHA I, BNHA II, BNHA III NHA NHA NHA Year

19 Chronological History - BNHA BNHA I (1996/97) : Draft SHA Consulted with the support from ADB BNHA II (1996/ /02) : Comparable ICHA Classifications for BNHA developed with the assistance from DfID BNHA III (1996/ /07) 2010 : Capacity to Report all SHA tables with the support from GtZ

20 Institutionalization of BNHA Issue arises 1998 after BNHA I Incorporated in the Terms of Reference (ToR) during BNHA II During BNHA III issue of Regular Updating raised by HEU HEU-GTZ Work-plan Initiated the process World Bank came forward with GSAP

21 Achievements Acceptance of Ministry of Health and Family Welfare to produce NHA regularly by HEU Established a dual reporting system for Bangladesh as well as globally comparable standard In each round new estimates along with revised estimates Started thinking of institutionalization within Government -GTZ supported through expert advice and consultation with integration in HEU-GTZ work plan Senior Policy Makers of MoHFW (Minister, Secretary) stressed the need and role of HEU in institutionalization

22 Constraints Not sure how to organize Uncertainty of funding support for successive rounds Lack of trained/experienced human resources Lack of mechanism to retain knowledge/memory Retention of trained/experienced professionals High cost of production -- each time have to start from zero

23 Way Forward Capacity development/building of HEU HEU to be strengthened to able to handle NHA process as a part of its overall health economics work Incremental approach for regular NHA production Task shifting collaborative work of IHE & BBS Out sourcing some technical work (survey with preliminary analysis) on the basis of PPP during transition

24 National Health Accounts Institutionalization Activities Work-plan

25 Vision Role - Responsibility Vision - Regular Production of NHA of internationally comparable standard Role - Coordination among partner organizations - Updating BNHA framework adopting international classifications - Coordination among DPs for funding support Responsibility - Supporting policy formulation of government based on BNHA findings - Translate BNHA data for evidenced based policy suggestions -- Policy Briefs

26 Contents Activities Environment Resources Data Sources and Collection Data Management Information Products Quality and Validity Dissemination and Use Budget by Source Budget by Year Detailed Budget by Year and Source of Funding Aggregate Budget

27 Activities

28 Environment

29 Resources

30 Data Sources and Collection

31 Data Management

32 Information Products

33 Quality and Validity

34 Dissemination and Use

35 Budget by Source

36 Budget by Year

37 Detail Budget by Year and Source of Funding

38 contd.

39 Aggregate Budget

40 40