Joarder Taufique, Chaudhury Tahrim Z, Mannan Ishtiaq
Bangladesh Office, FHI 360, Dhaka 1213, Bangladesh.
Bangladesh Country Office, Save the Children, Dhaka 1212, Bangladesh.
Psyche (Camb Mass). 2019;2019:4954095. doi: 10.1155/2019/4954095. Epub 2019 Mar 3.
Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three sub districts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector's implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.
灾难性卫生支出迫使570万孟加拉国人陷入贫困。在社会、经济和人口参数的大多数卫生指标中都存在不公平现象。本研究探讨了现有的卫生政策环境和当前为推动全民健康覆盖（UHC）取得进展而开展的活动，以及这些努力所面临的挑战。这项定性研究包括文献回顾（n = 22）和关键信息人访谈（KII，n = 15）。使用人工编码技术对文本进行了主题分析（主题：围绕全民健康覆盖的活动、实施障碍、建议）。我们发现，孟加拉国拥有一套全面的全民健康覆盖政策，例如一项卫生筹资战略以及关于资金统筹的分阶段建议，以创建国家医疗保险计划并扩大卫生方面的财务保护。在多个领域都取得了进展，包括为所有人推出基本卫生服务包、扩大初级卫生保健服务的可及性（由捐助者提供支持）以及在三个分区进行医疗保险试点。这些领域的政治承诺很强。然而，在更大的政策层面存在障碍，其中包括可追溯到殖民时代的僵化公共融资结构。而其他障碍则与卫生部门的实施不足有关，包括人力资源问题、政治干预、监测和监督，大多数关键信息人也讨论了需求侧障碍，如社会文化上的不情愿、历史上的不信任以及缺乏赋权。为克服这些障碍，已提出了多项政策建议，例如重新设计公共融资结构、改善治理和监管机制、明确服务提供者的行为准则、推行卫生筹资改革以及与不同部门合作。为解决实施障碍，建议包括提高服务质量、加强整体卫生系统、改善卫生服务管理以及加强监测和监督。还需要解决需求侧障碍，如患者教育和社区赋权。需要开展研究和宣传，以解决诸如对全民健康覆盖缺乏共同理解等贯穿各领域的障碍。
