National Health Policy 2011

Health Policy

 World Health Organization (WHO) describes health policy as a guideline to

make “decisions, plans, and actions that are undertaken to achieve specific
health-care goals within society.”

 WHO additionally describes that each country’s health policies, strategies,

and plans take an indispensable role in representing the nation’s
perception, perspective, policy guidelines, and approaches for
safeguarding the health of the majority ordinary people.

 The principal idea of any national health policy is to develop an equitable

situation that confirms functional health status for the people of that
country. Regrettably, most of the countries of this globe consider health policy
as “medical care policy”.
 Why National Health Policy?

 Health policy identifies the priority health needs of the nation based on the
country’s health problem.
 It guides the government in prioritizing the budget according to the health
needs of the country.
 National health policy governs the operative and well-organized use of the
health-care budget. Consequently, people of that country can enjoy better
access to quality health-care services. Thereafter, the national health policy
helps in strengthening the health-care system of the country.
 It supports to cooperate between the public health sector and other health-
related sectors of the country.
 It helps in raising external aid effectiveness, where aid plays a significant role.
 First Attempt of National Health Policy
in Bangladesh 1990
 The success of National Drug Policy–1982 was one of the main driving forces for the
proposed health policy 1990 in Bangladesh. Accordingly, the then president of
Bangladesh, Mr. Hussain Muhammad Ershad, in the middle of 1990, wished for a
new national health policy.
 The Health Care System Improvement Committee was formed by the Government
of Bangladesh in the year 1987, and Dr. Zafrullah Chowdhury was one of the critical
members of that committee.
 There were 16 objectives in the proposed Bangladesh Health Policy 1990. Provision
of health care, sanitation, nutrition, and family planning services were the key areas of
concern of that policy.
 There were 14 proposed structural changes. Fundamental proposed structural
changes include free primary health-care services primarily for the marginalized
community, efficient audit system to ensure accountability, efficient supply chain
management of medicine and logistic supply in the health-care facilities, and
practical devolution of the health system.
 First Attempt of National Health Policy
in Bangladesh 1990
 According to the proposed policy, the Government of Bangladesh put ban on private
practice by medical doctors who are in civil service, with limited permission of
private practice for senior and chief consultants. Nonetheless, there was the
provision of non-practicing allowance for doctors.
 Despite the provision of non-practicing allowance, doctor’s community did not
welcome the prohibition of private practice. Subsequently, they rejected the policy.
Bangladesh Medical Association (BMA), the national doctors’ association, was
continuously non-cooperative with the government.
 The BMA continually demanded and started street protests for withdrawing the
proposed plan. Dr. Shamsul Alam Khan Milon, the joint secretary of BMA, was
killed on November 27, 1990, which ignited the massive mass upsurge and strike.
 The country’s chief justice replaced President Ershad after these episodes in
December 1990, and the president of the BMA was one of the key advisors of the
replaced interim president. The first action of the new government was to repeal
the proposed health policy.
 Specific Aims of National Health Policy 2011
The specific aims of the Bangladesh National Health Policy 2011 are as follows:

 Ensure accessibility of primary health care and emergency care for

all.

 Ensure quality health-care services for all based on equity. Extend

the coverage of quality health-care services.

 Increase community demand for health care considering rights and

dignity.
 Primary Goals of National Health Policy 2011
The primary goals of Bangladesh National Health Policy 2011 are as follows:
1. Establish health care as a right in all layers of society by ensuring essential elements of
care, nutrition, and public health improvement.
2. Providing quality and easily accessible care, irrespective of an urban and rural
community, mainly focusing on the poor and disadvantaged population.
3. Establish a community clinic to provide primary health care for every citizen. Every
6000 population will be under one community clinic.
4. Prioritize emergency care.
5. Reduce maternal and child mortality rates significantly.
6. Achieve a replacement level of fertility within 2021.
7. Ensure the necessary steps to improve maternal and child health status and ensure
safe delivery services in each village.
8. Ensure easy accessibility and availability of family planning services, especially to
poor- and low-income community people.
9. Ensure gender equality in health-care services.
10. Make certain effective and efficient use of information technology in the health-care
management system.
 Primary Goals of National Health Policy 2011
11. Ensure adequate supply of logistics and manpower in government health-care facilities to
deliver quality health-care services.
12. Ensure a mechanism to regulate the quality and price of care and educational expenses
in private facilities.
13. According to the need of the country, ensure modernization and adaptation of medical
education and technology.
14. Ensure coordination between different health-care-related departments, ministry of GoB,
and MOHFW, in addition to coordination between the Government of Bangladesh and NGOs.
15. Strengthening preventive services specially expanded program on immunization
activities.
16. Access to health-related information is right. Steps will be taken to ensure the right.
17. Ensuring the availability of essential drugs by regulating prices for essential medicines.
18. Ensure adequate epidemiological tracking of disease patterns and impacts of climate
change on health.
19. Ensure improvement of allied health care (Unani, Ayurveda, and homeopathic) education
and care delivery system.
 Basic Health Status of the People’s Republic of Bangladesh

Name of index 2007 2017

Total population 142,660,376 159,670,593
Population density (per sq. 1,095.954 1,226.631
km)
Crude birth rate (per 1,000 22.747 18.501
population)
Crude death rate (per 1,000 5.987 5.533
population)
Life expectancy at birth 68.648 72.052
Infant mortality rate (per 45.5 26.5
1,000 live births)
Maternal mortality ratio 297 173
(modeled estimate, per
100,000 live births)
Number of neonatal deaths 103,407 53,785
 Positive Arenas of Healthcare Policy
 Bangladesh has exemplary community-based health-care programs. Among all the
achievements, expanded program on immunization activities achieved global
appraisal significantly. The current the expanded program on immunization coverage in
Bangladesh is 82.5. On March 27, 2014, WHO declared Bangladesh as a polio-free
country.
 Community clinics are an essential people’s health-oriented program in Bangladesh. A
total of 18,000 community clinics exist in Bangladesh. Currently in Bangladesh, it is
the first point of care for the mass people. Primary health care is provided from
community clinics. It remarkably promotes overall health care, cost-effective
program, reduces expenses of the patient, and better utilization of health-care
budget in Bangladesh.
 Bangladesh has not yet achieved sustainable development goals targets in the case of
maternal mortality ratio, infant mortality rate, and under-five mortality rate.
Nonetheless, the health-care situation in Bangladesh has improved dramatically in the
last decades.
 Comprehensive community-based family planning programs are playing a
significant role in reducing the fertility rate in Bangladesh. The contemporary total
fertility rate in Bangladesh is 2.104 and 2.1 births per woman in 2016 and 2017,
respectively. In the year 1971, it was 6.940 births per woman.
 Positive Arenas of Healthcare Policy
 Regular, efficient public-owned health-care services (preventive, promotive, and
curative), promote more life expectancy at birth in Bangladesh, although there are
several deficiencies and a lot more to achieve. The life expectancy at birth in
Bangladesh was 72.49 years in 2016, and 47.14 and 48.87 years in 1971 and 1975,
respectively.
 Bangladesh has achieved cure rates targets of the Millennium Development Goals
(MDGs) target of newly diagnosed smear-positive tuberculosis (TB) through the
Directly Observed Treatment, Short Course (DOTS). WHO enthusiastically expected
globally to reduce the incidence rate (to less than 10 cases per 100,000 populations) of
TB and TB-related death 95% and 90%, by the year 2035. Although the country
achieved a lot by treating TB but the country carried top health-care liability because
of this deadly infectious disease. The year-on-year incidence rate was 225 per 100,000
people, and on average, every 12 months’ death rate was 45 per 100,000.
 Limitations of Health Policy 2011
 Lack of required financial resources is one of the significant problems of the
Bangladesh Health Care System. Current health-care budget allocation is 1.02% of
Bangladesh’s gross domestic product (GDP) for the year 2019–2020. The health-care
budgetary allocation in Sri Lanka was 3.893% of GDP in the year 2016. Even the
country of Islands, Maldives, allocates more over 10 times than Bangladesh. The
health-care expenditure of Maldives was 10.611% of GDP in the year 2016.
Currently, per capita, total health expenditure in Bangladesh is US$34.218 only.
This is less than half of the Chatham House’s recommended amount of US$86. Thus,
it is less than half. There is no specific strategy to increase the GDP contribution
and per capita total health expenditure in the health sector of Bangladesh in the
National Health Policy 2011.

 Bangladesh’s health system has another striking problem of the insufficiently skilled
human resource. The current health workforce is skewed toward physicians. The
doctors to nurses to technologist’s ratio is 1:0.4:0.24, whereas the WHO
recommendation for the doctor-nurse-technologist ratio is 1:3:5. Currently,
Bangladesh has one physician for every 1847 people. There is no specific strategy on
how the government will fulfill the gap.
 Limitations of Health Policy 2011
 Out-of-pocket health-care spending in Bangladesh is gradually going to touch the
zenith threshold, and currently, the out-of-pocket health-related expense is 67%.Out-of-
pocket payment outlays annually push 3.5% of households into poverty. There is no
specific strategy on how the government will reduce the Out-of-pocket health-care
expenditure.

 In Bangladesh, approximately 200,000 patients are newly diagnosed with cancer each
year. Conversely, due to the increase in life expectancy at birth, gradually, the elderly
population is increasing. There is no endowment in the policy to notify these issues
considered at the national level.

 Bangladesh yet does not have an active referral network. This creates an unnecessary
burden on health-care providers and in the health system of Bangladesh. Regrettably,
there is no provision in the policy to strengthen the referral network of the health
system.

 One of the primary building blocks of a health system is the health information system
(HIS). Bangladesh’s HIS is still in the growing phase. Currently, there is a HIS named
“District Health Information System 2 (DHIS2).”There is no specific strategy to
improve the HIS.
Health Information System
 Limitations of Health Policy 2011
 Inequality is a great challenge for Bangladesh Health Care System. There is a far
difference in different health indicators among wealthier and deprived household
quintiles. The under-five mortality rate has been decreased from 133 to 46 per 1000
live births in 15 years’ time (1989–2014). Nevertheless, the under-five child mortality
rate was statistically significant (P = 0.001) and different when compared between
financial status.

 There is a significant lack of devolution in the health-care system. Health-care

institutes are operated under the leadership of chief of staff of that institute. But
there is no local level planning and implementation activities according to the
planning. All the decisions are decided centrally by the MOHFW, Bangladesh. The
health resource allocations do not reflect the local needs. Health-care institutes do
not have any decision-making power. Even they cannot retain their income to
conduct small-scale maintenance work.

 The government mentioned they would prioritize emergency care, but there is no
crucial strategy to develop such care.

 It is progressively deteriorating the relationship between health-care service

provider and patient party in Bangladesh. Multiple reports are published in the daily
newspaper of the county. These days the relationship between the doctors’ community
and the patient’s family is so bad that it can be considered as a public health problem.
There is no strategy in the policy to improve this situation.
 Overcome Limitations of Health Policy 2011

 The government contribution to the total health-care expenditure should be increased.

We are going to be a middle-income country. Gradually, foreign aid will be reduced. To
ensure efficient and effective utilization of our financial resources on health, the
government should have priority plans for preventive actions.
 To protect people from catastrophic health expenditures nationwide, compulsory
participation in a health insurance scheme is mandatory. Initially, it can be started
among formal service providers.
 Still marginalized persons with a disability and those who find it hard to reach an area are
facing barriers in accessing quality, affordable health-care services. These barriers
should be identified effectively and efficiently. Quick, sustainable solutions should be
on the ground as soon as possible.
 The government should develop an adequate health service management expert so that
available resources can be used efficiently and effectively.
 The hospital works are carried out by a team. Here doctors are the key players, but they
need other team members. Thereafter, graduate medical doctor to work efficiently in a
hospital always need a good team-work among all health professionals. The
government should concern about the recruitment of a full team along with the
placement of the doctor in the hospital.
 Overcome Limitations of Health Policy 2011

 To retain the health workforce, promoting the accountability of health-care providers

by community engagement might be a good option. On the contrary, there should be a
special promotional offer for those who want to serve the hard to reach community.
The safety and security of health-care providers should be ensured by the authority
and by the community.
 There should be a strict regulatory mechanism to ensure affordable quality care in
private health-care facilities.
 The final most important fact is that there should be an effective referral mechanism
throughout the country. Without a proper referral network, it is impossible to ensure the
quality of care in a country.
Thank You