Oliveira Cruz Valeria de, Islam Mohammad Touhidul, Nuruzzaman Mohammed
World Health Organization Country Office for Bangladesh, Dhaka, Bangladesh.
WHO South East Asia J Public Health. 2019 Apr;8(1):35-37. doi: 10.4103/2224-3151.255347.
According to the constitution of Bangladesh, health is a right and, in 2012, initial work towards universal health coverage was marked by introduction of a health-care financing strategy. However, for 2016, Bangladesh's domestic general government health expenditure was only 0.42% of gross domestic product, making it one of the lowest-spending countries in the world, with 72% of current health expenditure coming from out-of-pocket spending. One factor that is key to the challenge of providing universal health coverage in Bangladesh is the large proportion of the population who work in the informal sector - an estimated 51.7 million people or 85.1% of the labour force in 2017. Most workers engaged in the informal sector lack job security, social benefits and legal protection. The evidence base on the health needs and health-seeking behaviours of this large population is sparse. The government has recognized that increased efforts are needed to ensure that the country's notable successes in improving maternal, neonatal and child health need to be expanded to cover the full range of health services to the whole population, and specifically the more marginalized and impoverished sectors of society. In addition to the universal need to increase funding and to improve the availability and quality of primary health care, workers in the informal sector need to be targeted through an explicit mechanism, with enhanced budgetary allocation to health facilities serving these communities. Importantly, there is a clear need to build an evidence base to inform policies that seek to ensure that informal sector workers have greater access to quality health services.
根据孟加拉国宪法，健康是一项权利。2012年，通过引入医疗保健筹资战略开启了实现全民健康覆盖的初步工作。然而，2016年，孟加拉国政府一般性卫生支出仅占国内生产总值的0.42%，使其成为世界上卫生支出最低的国家之一，当前卫生支出的72%来自自付费用。在孟加拉国，实现全民健康覆盖面临挑战的一个关键因素是，从事非正规部门工作的人口比例很大——2017年估计有5170万人，占劳动力的85.1%。大多数从事非正规部门工作的工人缺乏工作保障、社会福利和法律保护。关于这一庞大人群的健康需求和就医行为的证据基础很薄弱。政府已经认识到，需要加大努力，确保该国在改善孕产妇、新生儿和儿童健康方面取得的显著成就扩大到覆盖全体人口的全方位卫生服务，特别是社会中更边缘化和贫困的群体。除了普遍需要增加资金和改善初级卫生保健的可及性及质量外，还需要通过明确的机制针对非正规部门的工人，增加对服务这些社区的卫生设施的预算拨款。重要的是，显然需要建立一个证据基础，为旨在确保非正规部门工人能更多地获得优质卫生服务的政策提供信息。
