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NATIONAL HEALTH ACCOUNTS INSTITUTIONALIZATION:

BANGLADESHDRAFT WORK PLAN

Prasanta Bhushan BaruaJoint Chief (Joint Secretary)

Health Economics UnitMinistry of Health and Family Welfare

Government of Bangladesh

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Outlines of the Presentation

• Introduction

• Basic Health Information

• Health Financing in Bangladesh

• Bangladesh National Health Accounts (BNHA) Institutionalization: Draft Work Plan

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Bangladesh

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Surrounded by India, Myanmar and Bay of Bengal

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Bangladesh

World’s Longest Sea Beach at Cox’s Bazar

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Bangladesh

World’s Largest Mangrove Forest in SunderbanUNESCO declared World Heritage.

Demographic Information

Area : 147570 sq.km

Density : 993/sq. km.

Sex Ratio(M/F) : 105: 100

Average HH size : 4.8 persons

Population : 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.

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Basic Health InformationIndicators Base year

(1990 – 1991)Current Status

(2009)MDG Target

(2015)Under -5 mortality Rate /1000 LB

146 53.8 48

Infant Mortality Rate /1000 LB

92 41.3 31

Proportion of 1 yr. children immunized against measles

54 82.3 100

Maternal mortality rate/ 100,000 LB

574 348 144

Proportion of births attended by skilled health personnel, %

5.0 24 50

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Basic Health Information contd.

Indicators Base year(1990 – 1991)

Current Status (2009)

MDG Target (2015)

Antenatal care coverage (at least one visit)

27.5 60 100

Antenatal care coverage (at least four visits)

5.5 21.0 100

Total Fertility Rate (TFR) 3.0 (2004) 2.7 (2007) 2.2 (2011)

Prevalence of Malaria/100,000 population

776.9 (2008) 586 Halting

Prevalence of TB/100,000 pop.

264 225 (2008) Halting

TB Detection rate under DOTS, %

21 70 Sustain

TB cure rate under DOTS, %

73 92 Sustain

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Health Financing in Bangladesh(2006-2007)

Sources of Fund Exp.(Million Taka)

%

Public Sector 41,318 26Rest of the World 12,391 8NGOs 2,092 1

Household OOP 103,459 64

Private Firms 1,325 .8

Private Insurance 314 .2

Total Health Exp. 160,899 100

Health Financing in Bangladesh2006 - 2007

11Source: BNHA 1997-2007

Tota l Hea l th Expend i tu re by F inanc ing Agents 1997 - 2007

12Source: BNHA 1997-2007

Total Health Expenditure by Providers1997 - 2007

Source: BNHA 1997-2007

Total Health Expenditure by Functions1997 - 2007

Source: BNHA 1997-2007

Total Health Expenditure 1997-2007

Source: BNHA 1997-2007

Per capita Health Expenditure and per capita GDP (Taka)

Source: BNHA 1997-2007

Share of Public and Private Financing in %

Source: BNHA 1997-2007

Total Health Expenditure : BNHA I, BNHA II, BNHA III

1992-1997

1992-1997

1992-2001

1998-2001

1997 2000 2005 2006 2009

NHA3

NHA2

NHA1

Year

2002-2007

Chronological History - BNHA

BNHA I – (1996/97) - 1998 : Draft SHA Consultedwith 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

ContentsActivities

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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