With five years left to the 2030 universal health coverage commitment, where does Bangladesh actually stand? The most recent WHO/World Bank tracking exercise gives the country a UHC service coverage index of 51 — an improvement from 47 a decade ago, but still below the South-East Asia regional average and well below the global benchmark of 80.
The story behind the average is mixed. On the service coverage side, expansion of community clinics, improvements in immunisation, and progress on tuberculosis case-finding have all moved the index up. On the financial-protection side, the picture is much harder. Out-of-pocket spending as a share of total health expenditure remains stubbornly above 70 percent. Catastrophic health expenditure — the share of households spending more than 10 percent of their income on health in any given year — has barely shifted.
Several health-financing experts BHRF spoke to argue that the country has now exhausted what can be achieved through service-coverage expansion alone, and that the next phase of UHC must be a financing phase. That means resolving long-stalled debates about a national health-protection scheme, the role of the Sasthya Suraksha Karmasuchi (SSK) pilots, and the institutional home of any future risk-pooling mechanism.
"We have been writing planning documents about a national health-protection scheme since 2012. The country has had three different five-year plans speak about it. Each time, the substance has been kicked into the next plan," said Dr. Zubair Ahmed, a health-financing economist who has advised both the Health Economics Unit and the World Bank.
BHRF's policy desk will be running a series of explainers through the year on what each of those building blocks would actually look like, what they would cost, and what the political-economy obstacles are. The first explainer, on the SSK pilot evaluations, runs next week.
