In Bangladesh, the health financing system faces a critical challenge where funds are often unavailable in the right places when urgently needed. The current structure relies heavily on rigid line-item allocations within the public health budget. This setup allocates money separately for various inputs like staff, medicines, equipment, and maintenance, making it cumbersome to shift funds quickly to address urgent needs.
During unforeseen events such as accidents, disease outbreaks, natural disasters, or other emergencies, hospitals require immediate access to additional resources like medicines, supplies, personnel, and transportation. However, the existing budget system, which is based on predicted annual needs, does not cater well to such sudden demands.
The focus on financial allocation and expenditure often overshadows the actual delivery of services, speed of service provision, quality of care, and health outcomes achieved. A shift towards measuring the effectiveness of health financing in terms of service delivery and impact on people’s lives is crucial.
Introducing a National Health Fund (NHF) could facilitate this transition by enabling quicker allocation based on needs, ensuring prompt financing during emergencies, and aligning resources with health outcomes. Other countries like Thailand and India have successfully implemented similar reforms through institutions like the National Health Security Office and the National Health Authority.
Establishing a flexible and outcome-oriented financing mechanism like the NHF alongside the existing budget system is essential for Bangladesh. This fund could be managed by an autonomous body and financed through various sources, including a portion of the national budget and contributions from sectors like mobile telecommunications.
To ensure accountability, the NHF should maintain a balance between flexibility and oversight. It could provide hospitals with block grants for specific purposes while emphasizing output- and outcome-based financing. Transparency measures, such as digital tracking of funds and performance audits, must be in place to monitor spending and evaluate achieved results.
The time is ripe for Bangladesh to enact a “National Health Fund Act” and kickstart the establishment of the NHF. Utilizing a portion of the current health sector block allocation could be the initial step towards creating a more adaptable, responsive, and results-driven health financing system for the country.
