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
Outlines of the Presentation Introduction Basic Health Information Health Financing in Bangladesh Bangladesh National Health Accounts (BNHA) Institutionalization: Draft Work Plan 2
Bangladesh Surrounded by India, Myanmar and Bay of Bengal 3
Bangladesh World s Longest Sea Beach at Cox s Bazar 4
Bangladesh World s Largest Mangrove Forest in Sunderban UNESCO declared World Heritage. 5
Demographic Information Area Density : 147570 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
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
Basic Health Information Indicators Base year (1990 1991) 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, % 146 53.8 48 92 41.3 31 54 82.3 100 574 348 144 5.0 24 50 8
Basic Health Information contd. Indicators Antenatal care coverage (at least one visit) Antenatal care coverage (at least four visits) Base year (1990 1991) Current Status (2009) MDG Target (2015) 27.5 60 100 5.5 21.0 100 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, % 776.9 (2008) 586 Halting 264 225 (2008) Halting 21 70 Sustain 73 92 Sustain 9
Health Financing in Bangladesh (2006-2007) Sources of Fund Exp. (Million Taka) Public Sector 41,318 26 Rest of the World 12,391 8 NGOs 2,092 1 Household OOP 103,459 64 Private Firms 1,325.8 Private Insurance 314.2 Total Health Exp. 160,899 100 % 10
Health Financing in Bangladesh 2006-2007 Source: BNHA 1997-2007 11
Total Health Expenditure by Financing Agents 1997-2007 Source: BNHA 1997-2007 12
Source: BNHA 1997-2007 Total Health Expenditure by Providers 1997-2007
Source: BNHA 1997-2007 Total Health Expenditure by Functions 1997-2007
Source: BNHA 1997-2007 Total Health Expenditure 1997-2007
Source: BNHA 1997-2007 Per capita Health Expenditure and per capita GDP (Taka)
Share of Public and Private Financing in % Source: BNHA 1997-2007
Total Health Expenditure : BNHA I, BNHA II, BNHA III NHA1 1992-1997 NHA2 1992-1997 1998-2001 NHA3 1992-2001 2002-2007 1997 2000 2005 2006 2009 Year
Chronological History - BNHA BNHA I (1996/97) - 1998 : Draft SHA Consulted with the support from ADB BNHA II (1996/97 2001/02) -2003 : Comparable ICHA Classifications for BNHA developed with the assistance from DfID BNHA III (1996/97 2006/07) 2010 : Capacity to Report all SHA tables with the support from GtZ
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
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
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
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
National Health Accounts Institutionalization Activities Work-plan
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
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
Activities
Environment
Resources
Data Sources and Collection
Data Management
Information Products
Quality and Validity
Dissemination and Use
Budget by Source
Budget by Year
Detail Budget by Year and Source of Funding
contd.
Aggregate Budget
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