1

Development In Medical Sector

– Bangladesh Perspective

Presented by - TEAM ALPHA

Dept. of Development Studies
Faculty of Arts & Social Science
Bangladesh University of Professionals

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016

2 Introduction
Few years back even, many diseases took place and became epidemic within a blink of eyes.

Time passed, technology came, development took place and those epidemic diseases simply flee

away from our life. But How? It was Development. Specially in health sector’s development.

Development of Medicines, Environment, Hospitals, Diagnosis System etc are significant

among all.

Bangladesh developed it’s own Pharmaceuticals & Medical Sector and thus it reduced it’s

Mortality Rate and increased it’s Life Expectancy.

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016

3 Historical Study

In previous time, people were so afraid of many diseases like Polio, Cholera etc. Their fear was

DEATH – as there was no remedy of those diseases.

Some statistics of the than epidemic diseases are given below:

 25% victims died during the Polio in 1916.

 In 1817, Cholera became epidemic by the travelers in many countries where 18000 people died
during that time.

 In 1970, Smallpox affected 100,000 people & killed 20000

 In 1990, at least 60% of all deaths in Bangladesh were due to diarrhea

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016

4 Continued

 In 1990, the infant mortality rate was 100 deaths per 1000 live births

 The Influenza of 1918-19 killed tens of millions of people.

 Between 1947 and 1951, the Black Death wiped out as much as two-thirds of
Europe's population.

 Around A.D. 540, by some accounts, it claimed 5,000 lives a day and killed by a
disease plague.

 That devastation period now known as the Dark Ages in Europe.

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016

5 Overview of the Improvement In Bangladesh

 Bangladesh has made significant progress in improvement of the health of

its population to achieve Millennium Development Goals (MDGs) 4 and 5.

 By 2006 it had declined to 52 deaths per 1000 live births.

 Child mortality reduced due to malnutrition, and infectious diseases such as

malaria or tuberculosis.

 The number of deaths has decreased by 91% and 79% in cases of diarrhea
and malnutrition, respectively.

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016

6
Continued
 On the other hand, the number of deaths due to strokes and diabetes has decreased
200% since 1990.

 Infant mortality has decreased from 100 deaths to 52

 Deaths per 1000 live births decreased from 1990 to 2006.

 The under-5 mortality rate fell from 149 to 69 between 1990 and 2006.

 Neonatal deaths account

 For infant deaths is two thirds of all deaths

 For under 5 is over one half of all deaths.

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016
 Development in Health Sector of Bangladesh
7
A Story of Achievements
❶Bangladesh over the years
have achieved remarkable
progress

❷Through the government

agenda the country has
been on track with the health
MDGs

❸The country has the highest

EPI coverage (82%)
amongst neighboring
countries

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016

 Reduced Mortality and
8 Increased Life Expectancy
700 80
650.0
600 70
67.0 68.0 68.0
574.0 65.0
550.0 62.0 63.0
60
500 59.0

LIFE EXPECTANCY AT BIRTH

57.0 500.0
55.0
50
400 410.0
44.0
42 40
300 320.0
295.0 280.0
MORTALITY RATE

30
233.8 220.2
200 192.9 194.0 20
153.0 167.1
143.4 133.0
100 112.0 104.0 116.0
92.0 87.0 82.0 94.0 88.0 10
66.0 65.0 65.0
52.0 51.0
37.0
0 0
1970 1975 1980 1985 1990 1995 1997 2000 2004 2007 2010

MMR (per 100,000 live births) 650.0 550.0 574.0 500.0 410.0 320.0 295.0 280.0 194.0

U5MR (per 1,000 live births) 233.8 220.2 192.9 167.1 143.4 133.0 116.0 94.0 88.0 65.0 51.0

IMR (per 1,000 live births) 153.0 112.0 104.0 92.0 87.0 82.0 66.0 65.0 52.0 37.0

Life Expectancy at birth 42 44.0 55.0 57.0 59.0 62.0 63.0 65.0 67.0 68.0 68.0
8
TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016
 Progressive Improvement In Child Health
9
Over The Years
160
Child 13-60 months Postnatal 1-12 months Neonatal <1 month
140

120
50
PER 1000 LIVE BIRTHS

100 37

80 30
24
35.0
60 34.0
14
24.0 24.0 11 Average annual rate of
40 15.0 reduction
13.0 20
52.0 48.0 10.0
-9.3% per year
20 42.0 41.0 37.0 32.0
18.0 -6.0% per year
0
1991-1992 1994-1995 1997-1998 2001-2002 2004-2005 2010 MDG Target -2.6% per year

Child 13-60 months 50 37 30 24 14 11 20

Postnatal 1-12 months 35.0 34.0 24.0 24.0 15.0 13.0 10.0

Neonatal <1 month 52.0 48.0 42.0 41.0 37.0 32.0 18.0

Sources: Measure DHS- Demographic and Health Survey URL: http://www.statcompiler.com/

9
TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016
 Reduced Fertility Rate And
10 Increased Contraceptive Prevalence Rate
10 70
TFR (per woman)
9
60
58.1 58.0
CPR (per 1,000 population)
8 55.8
53.8

CONTRACEPTIVE PREVALENCE RATE

7 50
7.0 49.2
6.8
TOTAL FERTILITY RATE

6.4 44.6
6
39.9 40
5.5
5
4.5 30
4
25.3
3.4 3.3 3.3
3 3 20
2.7
2.3
2
12.7
10
1 6.5 7.7

0 0
1970 1975 1980 1985 1990 1995 1997 2000 2004 2007 2010

TFR (per woman) 7.0 6.8 6.4 5.5 4.5 3.4 3.3 3.3 3 2.7 2.3

CPR (per 1,000 population) 6.5 7.7 12.7 25.3 39.9 44.6 49.2 53.8 58.1 55.8 58.0

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016

11 Health Care Financing Features

We have a HCF system as part of the national financial management system.

Main Features
❶Share in the national budget --- 4.27% (2013-14)1
❷Public spending as % of GDP --- around 1.4%1
❸Per capita Health expenditure---US$ 27 (2011)1
❹Out-of-pocket---64% of Total health expenditure(THE)2
❺Coverage of insurance --- <1% of THE2
❻Government is financer and provider of services
❼Budget norms follow civil service and budgetary regulations and codes.

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016

 Total Health Expenditure
12
Is increasing over time, it has increased from 48,000 million taka in 1996 to
300,000 million taka in 2011 (almost 6 times in 15 years)
300,000

250,000

200,000
Million Taka

150,000

100,000

50,000

0 Source: WHO-NHA Data-base

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016

 Health Financing in Bangladesh (2006-2007)
13

Private Firms Private Insurance

Tk. 1,325, 0.8% Tk. 314; 0.2% Public Sector
Tk. 41,318; 26%

Rest of the World

Tk. 12,391; 08%

Household OOP
Tk. 103,459; 64% Million Taka NGOs
Source: BNHA 1997-2007 Taka 69 = 1 US $ Tk. 2,092; 0.1%

TEAMTEAM ALPHA
ALPHA - ABRAR,
- ABRAR, RASHIQ,
RASHIQ, SOHID,
SOHID, ADIBA,
ADIBA, SAZZAD,
SAZZAD, ABIRABIR 5/7/2016
14 Comparison Of Health Expenditure - 2011
Per capita total Per capita Govt
THE Public HE
Country health spending spending
as % of GDP as % of GDP
(US $) (US $)

Bangladesh 27 3.7 1.4 9.7

India 59 3.9 1.2 18.3
Nepal 33 5.4 2.1 13.0
Pakistan 30 2.5 0.7 8.0
Sri Lanka 97 3.4 1.5 43.1
Indonesia 95 2.7 0.94 33
Vietnam 96 6.9 2.7 38
Source: WHO-NHA Data-base
TEAM ALPHA - ABRAR,
TEAM ALPHARASHIQ, SOHID,
- ABRAR, ADIBA,
RASHIQ, SAZZAD,
SOHID, ABIR
ADIBA, SAZZAD, ABIR 5/7/2016
 Increase In National And Health Budget - A Comparison
15

TEAMTEAM
ALPHA - ABRAR,
ALPHA RASHIQ,
- ABRAR, SOHID,
RASHIQ, ADIBA,
SOHID, SAZZAD,
ADIBA, ABIRABIR
SAZZAD, 5/7/2016
 Current Problems And Digital Solutions
16

TEAM TEAM
ALPHAALPHA - ABRAR,
- ABRAR, RASHIQ,
RASHIQ, SOHID,SOHID,
ADIBA,ADIBA, SAZZAD,
SAZZAD, ABIR ABIR 5/7/2016
17
Current Problems And Digital Solutions

TEAM ALPHA - ABRAR, RASHIQ,

TEAM ALPHA SOHID,RASHIQ,
- ABRAR, ADIBA, SAZZAD, ABIR SAZZAD, ABIR
SOHID, ADIBA, 5/7/2016
18
Current Problems And Digital Solutions

TEAM ALPHA - ABRAR, RASHIQ,

TEAM ALPHA SOHID,RASHIQ,
- ABRAR, ADIBA, SAZZAD, ABIR SAZZAD, ABIR
SOHID, ADIBA, 5/7/2016
19
Current Problems And Digital Solutions

TEAM ALPHATEAM
- ABRAR,
ALPHARASHIQ, SOHID,
- ABRAR, ADIBA,
RASHIQ, SAZZAD,
SOHID, ABIR
ADIBA, SAZZAD, ABIR 5/7/2016
 Challenges In Bangladesh
20
❶Inadequate funding for the whole health system.
-Government budget is 1.4% of GDP, Total Health Expenditure (THE) is 3.7%
of GDP.

❷Inequity in financing and utilization

-main source of financing for health care is out-of-pocket payment (64% of
THE)

❸Inefficient use of resources

-due to absence of proper resource allocation formula, shortage of health
workers, vacant posts (44%) in public health facilities, lack of provider
autonomy, no purchaser-provider split, duplication of programs and
insufficient coordination leading to wastage

TEAM
TEAM ALPHA ALPHARASHIQ,
- ABRAR, - ABRAR, RASHIQ,
SOHID, SOHID,
ADIBA, ADIBA,ABIR
SAZZAD, SAZZAD, ABIR 5/7/2016
21

TEAM
TEAM ALPHA ALPHARASHIQ,
- ABRAR, - ABRAR,SOHID,
RASHIQ, SOHID,
ADIBA, ADIBA,ABIR
SAZZAD, SAZZAD, ABIR 5/7/2016
22 Common Concerns Across The Globe

❶Increasing health care cost

❷Protect people from financial consequences of health care payment
❸Expand fiscal space in spite of macro-economic constraints
❹Use of available resources efficiently and equitably

For all these, Health care financing is moving towards

Universal Health Coverage (UHC)

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR

TEAM ALPHA - ABRAR, RASHIQ, SOHID, ADIBA, SAZZAD, ABIR 5/7/2016
23

TEAM
TEAM ALPHA - ABRAR, ALPHASOHID,
RASHIQ, - ABRAR, RASHIQ,
ADIBA, SOHID,
SAZZAD, ADIBA, SAZZAD, ABIR
ABIR 5/7/2016
5/7/2016
24

TEAMTEAM
ALPHA - ABRAR,
ALPHA RASHIQ,
- ABRAR, SOHID,
RASHIQ, SOHID,ADIBA, SAZZAD,
ADIBA, SAZZAD, ABIR
ABIR 5/7/2016