[01] Anwar Islam, School of Health Policy and Management, York University, Toronto, Ontario, Canada. [02] G. U. Ahsan, School of Life Sciences, North South University, Dhaka, Bangladesh. [03] Tuhin Biswas, Department of Public Health, North South University, Dhaka, Bangladesh.

The financing of health care in Bangladesh primarily comes from three sources - the public exchequer, out-of-pocket payments by the users, and foreign aid from the development partners. Social and private insurance and official user fees comprise a very small proportion of the total funding. Using available secondary data, the paper is aimed at providing a comprehensive analysis of the dynamics of health care financing in Bangladesh. Bangladesh spends only about 3.5% of its Gross Domestic Product (GDP) on health. The per capita per annum health expenditure is about USD 27. It is important to note that about 63% of the total health expenditure is out-of-pocket expenses. Over the years the government’s share in the total health expenditure has declined considerably and it currently stands at around 35% of the total. Budget analysis shows that the national budget as a per cent of GDP has increased from 14.5 per cent in FY 2008-09 to 18.4 per cent in FY 2012-13. However, the health sector budget as a per cent of the national budget has declined from 5.71 per cent in FY 2008-09 to 4.87 per cent in FY 2012-13. On the other hand, financial allocation for the health sector remained stagnant at 0.9 per cent of the GDP over the last three fiscal years (2010-11 to 2012-13). Evidence suggests that district and sub-district level allocations for health under the revenue budget are determined by norms that relate to the number of beds (for food and drugs) and staff in facilities (for salaries) rather than the population size and other demographic and epidemiological measures reflecting health needs giving rise to serious inequity in resource distribution. It is apparent that Bangladesh needs to spend more on health care and at the same time make every effort to use its existing health care resources more effectively and efficiently. Exploring alternative sources of funding for the health system including social and other forms of insurance should be a priority for Bangladesh. Moreover, exploring alternative sources of funding must go hand in hand with increasing the overall health budget. In order to achieve and sustain Universal Health Care (UHC), Bangladesh has no alternative but to significantly increase public funding for the health system and at the same time promote and protect equity.

Healthcare Financing, Gross Domestic Product, Equity, Pressure Groups

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