Assessing the Future of Bangladesh’s Health Sector: Should Bangladesh Continue with Sector Programs or Strengthen Core Activities?
Overview of Bangladesh’s Health Sector Programs
Since 1998, Bangladesh has implemented four Sector-Wide Approaches (SWAps) in the health sector, aimed at improving health outcomes, strengthening health systems, and advancing towards Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs). These programs include:
- Health and Population Sector Program (HPSP, 1998-2003)
- Health, Nutrition, and Population Sector Program (HNPSP, 2003-2011)
- Health, Population and Nutrition Sector Development Program (HPNSDP, 2011-2016)
- 4th Health, Population and Nutrition Sector Program (HPNSP, 2017-2024)
Despite some progress in areas such as child and maternal health, life expectancy, and communicable disease control, several critical challenges persist in the health sector.
Key Challenges in Bangladesh’s Health Sector
1. Uneven Progress Toward UHC and SDGs
Progress towards UHC and the health-related SDGs in Bangladesh has been slow and inconsistent. Significant disparities in access to healthcare services remain, especially for rural and marginalized populations. High out-of-pocket expenditures continue to be a major barrier, indicating that financial protection under UHC is not fully realized.
2. Limited Impact of SWAps on Health System Strengthening
While SWAps have promoted coordination between donor funding and government programs, their impact on sustainable health system strengthening has been limited. Key areas such as human resources for health, health financing, governance, and accountability have not seen substantial improvement. Service fragmentation and lack of integrated planning have further hampered program effectiveness.
3. Inadequate Response to Emerging Health Challenges
The health sector in Bangladesh has struggled to respond effectively to emerging challenges, including non-communicable diseases (NCDs), mental health issues, and the COVID-19 pandemic. The system’s lack of preparedness and resilience raises concerns about its ability to handle future health crises.
Options for the Future: Sector Programs vs. Strengthening Core Activities
Given the current challenges, a critical assessment is necessary to determine the most effective path forward for Bangladesh’s health sector. Two primary options emerge:
Option 1: Proceed with the 5th Health, Population and Nutrition Sector Program (5th HPNSP)
Advantages:
- Continuity in Funding and Coordination: A new sector program could continue to provide a coordinated framework for donor funding and government efforts, crucial in a resource-constrained environment.
- Opportunity for Strategic Reorientation: The 5th HPNSP could address previous shortcomings by focusing on evidence-based interventions and enhancing monitoring and accountability mechanisms.
Disadvantages:
- Risk of Repeating Past Mistakes: Without significant strategic changes, there is a risk of repeating the failures of past SWAps, particularly if the program lacks actionable plans and effective governance structures.
- Dependency on Donor Funding: Continuing with another SWAp might perpetuate reliance on donor funding, undermining efforts to build a self-reliant health system.
Option 2: Strengthen Existing Core Activities
Advantages:
- Sustainability and Ownership: Strengthening core activities, such as increasing government health expenditure, can lead to more sustainable health financing and greater national ownership of health programs.
- Targeted Interventions: By focusing on specific areas needing improvement—like health workforce development, health information systems, and financial protection—Bangladesh can address critical gaps more effectively.
Disadvantages:
- Potential Fragmentation: Focusing solely on core activities might lead to fragmented efforts, where different components are strengthened in isolation without a comprehensive strategy.
- Risk of Reduced Donor Engagement: Without a structured program like a SWAp, donor engagement and funding may decrease, leading to reduced financial and technical support.
Recommended Path Forward: A Hybrid Approach
Given the advantages and disadvantages of both options, Bangladesh should consider a hybrid approach that leverages the strengths of sector programs while also strengthening core health system components.
1. Design a More Focused and Flexible Sector Program
Instead of launching a broad 5th HPNSP, Bangladesh should design a more focused program targeting specific weaknesses identified in previous SWAps. This program should emphasize health workforce development, financial protection, and health system governance. Flexibility and adaptability, coupled with robust monitoring and evaluation mechanisms, will be key to its success.
2. Strengthen Core Health System Components Through Revenue Activities
Parallel to the focused sector program, Bangladesh should strengthen core health system components through dedicated revenue activities. Increasing domestic health financing, improving health workforce management, and enhancing health information systems will build a more resilient health system capable of achieving UHC and SDGs.
Conclusion
By adopting this dual approach, Bangladesh can create a more integrated, effective, and sustainable health system. This strategy will better position the country to achieve its long-term health goals, including UHC and the SDGs.