THE health sector reform report, of all the reforms commission reports, is better poised for a fast implementation, having faced little criticism and barriers as there is almost no contention about the report that recommends steps for the improvement in the health sector. What the authorities now need to do is to set strategic priorities and identify enablers and barriers to implement the recommendations. The health sector reforms commission, formed on November 18, 2024, submitted the final report on May 5, recommending steps towards ensuring health care as a fundamental right and improving health services. The prime among the recommendations is treating primary health care, as defined by the World Health Organisation, as a fundamental right of citizens and making it free. The recommendations also include a constitutional guarantee of free primary health care, a unique health identification number for every citizen, ward-level primary health centres, no value-added tax on medicines for certain non-communicable diseases, the allocation of 15 per cent of the national budget for the health sector, a separate wage board for health professionals, autonomous medical education institutions and an independent and permanent health commission.
Health experts, in a seminar on May 20, said that the recommendations, if implemented, could significantly change the health sector and make it people-friendly. The health sector is now characterised by an abnormally high out-of-pocket expenditure, poor access to quality health care, rampant corruption, poorly regulated growth of the private healthcare system and low government investment that have undermined the advancements that the sector has made and have eroded people鈥檚 access to health care. Out-of-pocket healthcare expenditure, about 70 per cent, in Bangladesh is the highest among South Asian countries. The sorry state of public healthcare facilities is one of the major reasons for the high out-of-pocket expenditures. Persistently increasing out-of-pocket expenditures have also pushed a large number of households below the poverty line. A study by the Bangladesh Institute of Development Studies suggests that at least 6.13 million people dropped below the national poverty line in meeting their healthcare expenditures only in 2022. The budgetary allocation for health has remained worryingly low. In fact, Bangladesh is at the bottom among the South Asian countries in terms of budgetary allocation for the sector. Moreover, the allocated budget is hardly used on time and effectively.
The authorities should, therefore, prioritise the sectoral reforms. They need to identify and devise ways to implement the recommendations put forth. The authorities should begin with adequate allocation for the sector in the next budget and a special focus on public healthcare facilities to ensure universal health care.