Health sector in Bangladesh Health sector in Bangladesh B B Bangladesh National Health Accounts Bangladesh National Health Accounts l d l d h N ti h N ti l H l H lth A lth A t t Financing vs. performance 1997 2012 1997 1997 1997- -2012 2012 2012 BNHA Cell BNHA Cell � Bangladesh Paradox: exceptional health Health Economics Unit achievement despite economic poverty. Ministry of Health and Family Welfare Ministry of Health and Family Welfare � � One of the great mysteries in global health One of the great mysteries in global health � Unusual success - The Lancet Series Nov, 2013 The Lancet Series Nov, 2013 January 2015 2 National Health Accounts NHA National Health Accounts-NHA National Health Accounts-NHA National Health Accounts NHA NHA is a statistical process that It tends to answer � identifies total health expenditure � How much is spent for health? � Who pays, how much? � traces the sources of health expenditure � traces the sources of health expenditure p y , � How the expenditures are distributed across � shows the distribution of funds by functions different services ? different services ? (prevention and curative services etc ) (prevention and curative services etc.) � Who is benefited how much ? (Income groups, � traces the channels of distribution of funds by regions diseases etc ) regions, diseases etc.) i inputs (pay & salaries, medicines etc.). t ( & l i di i t )
Global Guidelines – evolving towards more precision evolving towards more precision Guidelines Guidelines NHA follows standard guidelines as it: � makes cross-national comparisons � k ti l i � provides international validation � saves time and cost � There are similarities among national health � There are similarities among national health systems where international standards can be applied pp � It is partly customized to the national situation situation NHA Frameworks over time � Features of SHA Pre 2000 � No global framework � Provides � explicit and comprehensive Ad-hoc national standards & international frameworks � Lack of comparability in international estimates boundary of health and health related � � System of National Accounts (SNA) System of National Accounts (SNA) production production � Not widely used for health � Analyses health expenditure in three core � 2000 dimensions: financing sources, providers dimensions: financing sources, providers roviders roviders and functions � OECD System of Health Accounts (SHA) � Detailed sets of classifications for the � First global standard P uses of spending: providers and functions � Endorsed by WHO for international reporting � 2011 � Linkages with other international classifications including SNA l ifi ti i l di SNA � System of Health Accounts 2011 f l h � Basis � Functions Functions Updated SHA for adaption to meet specific � Agreed and adopted by OECD, Eurostat, WHO g p y , , national requirements national requirements
International Classification of Flow of Funds Health Expenditure (ICHA) H lth E dit (ICHA) Revenues of Revenues of � SHA 1.0 Taka Financing Schemes Schemes � Health care by function (ICHA-HC) • Government schemes � Health care by provider industry (ICHA-HP) Taka • Voluntary health insurance � Sources of health care financing (ICHA-HF) schemes Providers • Non ‐ profit institution/NGO � SHA 2011 financing schemes • • Corporations autonomous Corporations, autonomous � H � Health care by function (ICHA-HC) lth b f ti (ICHA HC) Health services bodies and private and Functions � Health care by provider industry (ICHA-HP) companies (other than health insurance) � H � Health financing schemes (ICHA-HF) lth fi i h (ICHA HF) Beneficiaries • Out ‐ of ‐ pocket household � Financing agents (ICHA-FA) expenditure excluding (by age, sex, region, disease, income group) cost ‐ sharing � Revenues of health financing schemes (ICHA FS) � Revenues of health financing schemes (ICHA-FS) • Rest of the World voluntary schemes Process undertaken for BHNA-IV NHA in Bangladesh NHA i B l d h - Preparation � � � First BNHA-conducted in 1998 ( 1996/ 97 ) Previous rounds of NHA done through outsourcing P i d f NHA d th h t i � Initiatives taken to institutionalize the process in HEU 2011 � Financial assistance from ADB a d and costed action plan developed o d a o p a d op d � Second BNHA � Second BNHA- in 2002 ( 1996/ 97–2001/ 02 ) in 2002 ( 1996/ 97 2001/ 02 ) � Three committees formed: Revised estimates for 1996/ 97 and new estimates for 1997/ 98 – o National Steering Committee 2001/ 02 o Stakeholder Coordination Committee Stakeholder Coordination Committee � Financial assistance from DFID o Technical Working Committee � Third BNHA- in 2009 ( 1996/ 97–2007/ 08 ) � BNHA Cell formed in July 2012 with representations y p New estimates for 2002/ 03-2007/ 08 and revised for earlier years from HEU, BBS, IHE, ICDDR-B and DI, support from WB � Financial assistance from GIZ Dhaka Office � Fourth NHA � Fourth NHA- produced in 2014 ( 1996/ 97-2011/ 12 ) � Working arrangements with Partners (BBS ICDDRB IHE � Working arrangements with Partners (BBS, ICDDRB, IHE produced in 2014 ( 1996/ 97 2011/ 12 ) and DI) outlined through signing MoU in 2013 New estimates for 2007/ 08-2011/ 12 and revised for earlier years � BNHA Cell received Hands on Training on SHA and NHA at � Support from Rockefeller Foundation, GIZ, WB, WHO pp , , , IHP, Sri Lanka in September 2013
Process undertaken for BHNA-IV Data Sources : Public Sector Data Sources : Public Sector - Data collection BNHA BNHA Source Data Code Financing Schemes g � Data collection from : Public & Non-Public sector BHF.1 Government schemes and compulsory health care financing schemes � Data collection instruments developed Controller General of MoHFWs’ expenditure p Accounts (CGA), MoF � Different Sampling frame developed for BHF.1.1.1.1 MoHFW schemes Line Directors Office, Spending at district and � � MoHFW below Private clinics/ hospitals/ diagnostics survey Private clinics/ hospitals/ diagnostics survey � Corporation survey (those have health expenditures) Planning Wing, MoHFW RADP � NGO Survey BHF.1.1.1.2 Government Govt. Employees Welfare Reimbursement of Employees Schemes E l S h Di Directorate, MoPA t t M PA treatment cost t t t t � Insurance expenditure survey conducted through IDRA Controller General of other Ministries’ health � DP expenditure survey conducted through DP Consortium Accounts (CGA), MoF expenditure p y g Non MoHFW Non ‐ MoHFW BHF.1.1.1.3 M o D, M o H A, M o R, Health Expenditure � Medicine expenditure from IMS & DGDA schemes M o W & C A, M o S W, � Household Income and Expenditure Survey from BBS M o R A, M o C A & T BHF.1.1.2 Local Government Mo L G R D & C City Corporation, Schemes Municipalities Data Sources : Private Sector Data Sources : Private Sector Data Sources : Private Sector BNHA BNHA BNHA BNHA Source Data Code Financing Schemes BNHA BNHA Source Data BHF.3 Households out ‐ of ‐ pocket payment Code Financing Schemes g BNHA Survey Private Hospital/Clinic/Diagnostic Survey BHF.2 Voluntary health care payment schemes Household Income and Expenditure Survey Insurance Development Insurance Companies B B S B B S Bangladesh National Accounts Bangladesh National Accounts and Regulatory Authority Survey Out ‐ of ‐ pocket Morbidity and Health Status Survey expenditure Voluntary Health Bangladesh Bureau of Household Income and BHF.3.1 BHF.2.1.2.2 DGHS and DGFP User fee excluding cost Insurance schemes Statistics Expenditure Survey p y sharing h i IMS Pharmaceutical Survey Bangladesh National Accounts DGDA, MoHFW Pharmaceutical ‐ Production, import, export BHF.2.2.1 BHF.2.2.1 NIPISH/NGO NIPISH/NGO BNHA Survey BNHA Survey NGO Survey NGO Survey NBR NBR Tax ‐ VAT ‐ Excise duty Tax VAT Excise duty financing scheme BHF.4 Rest of the world health financing schemes (non ‐ resident) BHF.2.3.1.1 Parastatal firms BNHA Survey BNHA Survey NGO Survey Corporations and p and corporations and corporations Autonomous Bodies DP Consortium Development Partner Survey BHF.2.3.1.2 Private firms and BNHA Survey Survey Rest of the world BHF.4.2 Planning Wing RADP corporations voluntary schemes y C G A / E R D D P Expenditure OECD D A C Data
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