Monday, 14 December 2015

Bangladesh Health Service

Bangladesh health spending.

When I wrote that Bangladeshi exporters have a 0% tariff access to the UK market (and export subsidies) I wondered if their government spends 0% of GDP on healthcare or a welfare state, because I'd read that some Rana Plaza victems face destitution and that medical care at the disaster was provided by unpaid staff and volunteers from a teaching hospital.

The Government of Bangladesh does not spend 0% of GDP on health. It spends 1.1% while allowing a private sector and charities alongside. The non-government organisations presumably can't force people to join nor get government subsidy for those unable to pay. Uninsured people have lower costs and are able to work on lower wages - a problem that's true everywhere and presumably truer in such an over-populated country, with more people chasing each job.

The state system is described on the page numbered 4, automatically numbered 15 on the pdf . I don't understand it, but have transcribed the text, leaving out an extra table that you can see on the original.

This problem isn't just a problem for Bangladeshis now. It is a problem for Bangladeshis in the future, because their government states that it is scared of out-pricing China or whatever other cheap country. Of course it's not keen to increase taxes. Meanwhile, anyone who wants to make sewn products in the UK has to compete with these insanely cheap products shipped-in from Bangladesh on a 0% tariff, with export subsidies, and without the costs of a welfare state built-in. The only solution lies with people in a the UK, or the EU trading block, who can try to make tariffs conditional, so that countries with a health service pay 0% tariff and countries without pay 10%. Simplez.

Health Microinsurance: A Comparative Study of Three Examples in Bangladesh - just an excerpt to give an idea

The first contact with the government health caresystem is at the Ward level where there are health assistants.

At the Union level, the Health and Family Welfare Centres (HFWC) provides preventative and family planning services and is usually managed by a graduate doctor with some support staff.

The next level of health care is the Upazila Health Complexes, which were developed during the 1970s as part of the government’s strategy todevelop primary health care and provide the first level referral services. Usually several graduate doctors are available in an Upazila Complex, which includes specialists and a dental surgeon. The Health Complex usually has a 30-bed in-patient department, an outpatient department, and a family planning unit that to gether provide preventive and limited curative services to the population.

At the District level, there is usually a hospital, with between 50 and 200 beds, which is intended to serve 1 to 2 million people. The District Hospital is under the management of the Civil Surgeon and provides more sophisticated curative, laboratory and diagnostic services. All the tertiary level health facilities are located in the capital city and include post-graduate hospitals, medical college hospitals and specialized hospitals. These facilities provide highly specialized curative treatments, laboratory and diagnostic services and various other kinds of training and educational facilities.

The total number of hospital beds available under the Ministry of Health is approximately 28,000, of which approximately 45% are located at the Upazila level and 17% are at the District level, and the remain ing 36% are either in large tertiary general hospitals or specialized hospitals at the six divisional headquarters. The standard of health care provided by the public sector continues to be poor and inadequate due to low investment, bureaucratic mismanagement, a lack of facilities and equipment, and a shortage of trained medical professionals. With around 3,100 persons per hospital bed in the country, and 23 doctors per 100,000 people, only the middle-class, rich and influential people have access to the public health care system. The poor are unable to penetrate thebureaucracy, the archaic administration and the deliberately biased system. They have access to public health care in theory only. Two of the major limitations of the present health care system and its financing in Bangladesh are: (a) high health care costs, more than half of which is private out-of-pocket expenditure; and (b) unsatisfactory outcomes of the expenses. Most of the out-of-pocket expenses are borne by households engaged in low-income informal economic activities.

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