Framework for Monitoring Progress towards Universal Health Coverage in Bangladesh Md. Ashadul Islam Director General Health Economics Unit Ministry of Health and Family Welfare
National Commitment to UHC Principles underpinning the 4 th Sector Programme SDG Goal 3: Ensure healthy lives and promote wellbeing for all at all ages QUALITY Universal Health Coverage EQUITY Universal Health Coverage EFFICIENCY UHC Goal in 7 th 5Year Plan of the country, Strategic Investment Plan for health, Health Care Financing Strategy and National Social Security Strategy
Development of UHC Monitoring Framework -Objectives To develop a measurement tool for UHC in Bangladesh based on global framework for UHC monitoring To pre-test the tool using available data and come-up with a preliminary assessment of UHC To institutionalize regular monitoring and use the information for policy decisions
Development of UHC Monitoring Framework-Methods Health Economics Unit, MOHFW led the development, in collaboration with 2 core teams Conducted extensive literature review of policy documents, country experiences and discussion with local experts Series of meetings to develop, validate and consult the indicators and framework MOHFW endorsed the final framework and indicators Baseline data collected
Bangladesh Framework is adopted based on Global Framework
Baseline Data using the UHC Framework Service Coverage Indicator Baseline Data Year Source Regularity of Collection 1. Life expectancy at birth 67.7 2010 SVRS Yearly 2. Neonatal mortality rate 26 2010 SVRS Yearly 3. Infant mortality rate 36 2010 SVRS Yearly 4. Total fertility rate 2.3 2011 BDHS Bi-Yearly 5. Population growth rate 1.36 2010 SVRS Yearly 6. % of underweight among under 5 45.0 2011 Nutrition, Health children and Demographic ( 2SD & 3SD) Survey (NHDS) 7. % of stunted among under 5 children ( 2SD & 3SD) 8. TB prevalence rate/100,000 population 40.2 2011 Nutrition, Health and Demographic Survey (NHDS) 45.0 2013 MDG Progress Report 9. Prevalence of HIV among MARP < 1% 2011 National HIV sero-surveillance report 10. Percentage of diabetic patient 64.7 taking treatment Percentage of hypertensive patient taking treatment 11. Maternal Mortality Ratio 194 2010 BMMS
Baseline Data using the UHC Framework Financial Protection Indicator Baseline Data Year Source Regularity of Collection 1. Public spending in health (per capita; as a % of THE) 500.34 BDT; 23.1% 1997-2010 BNHA Every 3 years 1. Social HI contribution (per capita as % of THE) Every 3 years 1. Share of health spending in total government expenditure 4.7% 1997-2010 BNHA Every 3 years 1. Health expenditure per capita BDT 2,144 US$ 27 PPP$ 68 1997-2010 BNHA Every 3 years 1. Health expenditure as % of GDP 3.5% 1997-2010 BNHA Every 3 years 1. OOPS for health (per capita as % of THE) 1371.77 BDT; 63.30% 1997-2010 BNHA 2 years 1. OOPS for health in total household consumption expenditure 4.30% 1997-2010 HIES & BNHA 2 years 1. Share of population (%) lack adequate healthcare due to financial hardship 15.57% 2010 HIES Estimate every 2 years 1. Share of population (%) fall into poverty due to OOPS 1. Share of households (%) facing catastrophic health spending 3.50 2010 HIES 2010 data 14.20% 2010 HIES 2010 data Estimate every 2 years Estimate every 2 years
Equity Perspective (data segregated) Indicator Health Workforce Number of doctors per 10,000 population Number of Nurses & Midwives per 10,000 population District/UPZ hospital and below have 1 Obs/Gynae + 1 anaesthesiologist Disaggregat ion by Service delivery/ Coverage of Intervention % of pregnant women attending 4 ANC visits % of pregnant women attending 4 ANC visits Baseline Data Year Source National Rural 4.04 45% 2013 HRH country profile Urban 55% Male 69% Female 31% National 2.04 2013 HRH country Male 5% profile Female 95% 32% Frequency of data availability Yearly Yearly 2014 Records Yearly National 25.5 2011 BDHS 4 yearly Rural 19.8 Urban 44.7 Highest 81.4 quintile Lowest quintile 45.3 National 25.0 2013 Utilization of Essential Service Delivery Survey (UESD)
UHC Monitoring Currently has an excellent digital connectivity in the health sector, linking all levels of the system for real time, complete and reliable data Aligned with the global core indicators Availability of dashboards and public access to increase transparency and accountability The UHC Monitoring Framework and indicators are also aligned with core indicators and need to be integrated in the DHIS2, including a dashboard for quick update on the 3 arms of UHC: service coverage, financial protection and population coverage(equity) Effectiveness of the system in providing evidence for decision-making
The UHC Monitoring framework and indicators are aligned with the indicators developed by MOHFW Line Directors and Programme Managers Use of Core Indicators in national HMIS portal
Health Information Dashboard
THANKS
Full list of Framework for Monitoring Progress towards Universal Health Coverage is in the Poster