The PM promised universal healthcare. Can she deliver?

Like many countries, the Covid-19 pandemic has exposed the vulnerability of Bangladesh's healthcare system. But it has also given us the opportunity to reconsider our approach to healthcare. What we have achieved in terms of socioeconomic development over the last 50 years as an independent nation is the envy of many. While we celebrate it, we should not let it extrapolate into a sense of complacency. Our neighbour Sri Lanka, for example, is way ahead of us when it comes to most development indicators; their maternal mortality ratio, for instance, is 36, while ours is still 173, as per the latest World Bank data.

Our goal as a nation is the all-encompassing "Vision 2041." As we work towards it, we should not lose sight of keeping the different moving parts in our system in a healthy and functional state—this will allow us to realise that vision in a sustainable way. The healthcare system is one of those critical moving parts. I believe the pandemic has given us the opportunity to ponder and do something significantly different. Never in the past has the health sector received so much national and international focus. And this is precisely the reason that I think our prime minister should take advantage of this opportunity and do something big and meaningful, which will make her legacy indelible.

I am talking about universal health coverage (UHC). Our prime minister, on a number of occasions, has made a commitment for UHC—most recently at a high-level UN meeting in New York in September 2019. This is also reflected in several policy documents of the government, including the Health Care Financing Strategy 2012-2032, and the 8th Five-Year Plan. Unfortunately, little is seen to have happened on the agenda to make UHC a reality.

UHC is achieved when every citizen receives the health services they need without suffering financial hardship. The key to achieving UHC is by reforming the healthcare financing system. In particular, it requires switching from a system of private financing (mostly people paying for services out of pocket) to a compulsory public system. This has happened in every high-income country of the world—the US is an exception. Many countries in Bangladesh's income level have made tremendous progress towards UHC, including Sri Lanka, Vietnam, the Philippines, Egypt and Morocco. Interestingly, Sri Lanka's universal healthcare system originated from a national crisis caused by a malaria epidemic in the 1930s, similar to the threat posed by Covid-19 today. Thailand achieved UHC in 2002 after the Asian financial crisis, when its GDP per capita was about the same as Bangladesh's today.

UHC, therefore, is perfectly affordable in Bangladesh, even in the midst of a global pandemic and economic challenges, if there is political will to do so. Experiences from other countries indicate that kick-starting successful national UHC reforms typically requires around an additional one percent of GDP in public financing. All this funding would not be needed immediately, but could be done using a phase-in approach over a period of two to three years.

UHC has an important poverty reducing effect as well, as this will save two to three million Bangladeshis from falling into poverty annually due to catastrophic health-related expenditures. As Bangladesh experiences an increasing burden of non-communicable diseases (NCDs), evidence shows that long-term treatment of such conditions can be nearly as financially debilitating as short-term catastrophic health incidences.

Evidence from around the world shows that the best UHC strategies focus on achieving full population coverage of a modest package of services, focusing on primary healthcare, but also including selected hospital services. These should and can be provided totally free to everyone.

Because UHC reforms always require significant increases in public financing, they tend to be led by leaders who have the power to reallocate public budgets. Progressive leaders often take this initiative because UHC reforms are extremely popular. Across the world, politicians who have delivered UHC to their people have become national heroes. This was the case in Germany, the UK, France, Australia, Japan, Canada, Korea, Thailand, Brazil, Mexico, and Indonesia.

In the virtual "International Conference on Covid-19 and the Future Health Systems," organised last month jointly by Brac James P Grant School of Public Health and Bangladesh Health Watch, top health experts from across the world called for implementing UHC as the basis for future healthcare systems. Some of the experts even mentioned our prime minister and strongly urged her to make UHC her top agenda for the next five years. This will make her, as they predicted, the hero for UHC.

We do expect to see her in this role.

Ahmed Mushtaque Raza Chowdhury, PhD, is the convenor of Bangladesh Health Watch and former vice-chair of Brac.