SDG 3: Universal Health Coverage, series 12

Climate vulnerability, Covid and implementation of SDG

Published: 23 Feb 2021     Updated: 23 Feb 2021

Md Abul Kalam Azad

Universal health coverage is defined to receive quality essential health service without being exposed to financial hardship. It covers reproduction and new born health, child immunization, infectious diseases, tuberculosis and non-health sector issues like water and sanitation. These seven essentials constitute universal health coverage. 

In 2013, 32% of total global health expenditure came out of pocket. Better health including anti-tobacco, prevent illness such as vaccine, getting treatment, rehabilitation including palliative care as essential part of universal health coverage. So, in perspective of universal health coverage, quality and cost matter. Now a days looking into the holistic approach of health coverage, universal health coverage (UHC) is introduced and first global monitoring report on UHC was published in 2013 by World Health Organization (WHO) and World Bank. According to that report, 400 million people don’t have access to one or more essential health services and 6% of low- and middle-income country are tipped into or pushed to extreme poverty because of health expenditure. The challenges are sovereign reliable data, meagering effective coverage, monitoring quality attendance of health officials for the patient. The last item, attendance of health official doctor, nurse, mid wives and paramedics in some of the countries reduced substantially during Covid. Universal health coverage shows very low progress; in 2000 it was in a standard of 45 out of 100 which increased to 66 in 2017. During this period, poor countries unexpectedly did well but the performance of middle-income country was not good. If current trend continuous, 39%-63% of global population will be covered by universal health coverage by 2030. So, it needs to double its progress to achieve the SDG. Some 930 million people, in 2015, spent more than 10% of their household spending for health and 210 million spent more than 25%. So, inadequate basic infrastructure, human resource gap, poor quality service, low trust in health service providers are the barriers for implementing the universal health coverage very quickly.

Out of pocket expenditure in Bangladesh is 63% in 2012, increased to 67% in 2015 and this pushes 4 to 5 million people per year in poverty. Fully government finance or fully employee finance universal health coverage is not realistic. So, partnership between the government and the beneficiary is much more prominent. For implementing universal health coverage in Bangladesh resource mobilization, reducing the out of pocket expenditure, reduce inefficient and equitable use of resources, quality of health service are major challenge for implementing universal health coverage. Bangladesh has a special program for ensuring health coverage by 2032

Use of reproductive maternal and child health is worse in poor households; additional $200 billion for primary health care and $170 billion for universal health coverage is required which is 5% increase of present $7.5 trillion health spending globally. And universal health coverage is a potential choice with this 5% increase in health spending universal health coverage can be achieved. Health spending in Bangladesh especially catastrophic health expenditure, 5.7 million Bangladeshi falls in poverty.

If we look into the health infrastructure of Bangladesh, our community clinic, union health center, upazilla health complex and district-level big hospital along with hundreds of medical colleges, these give a better health infrastructure in our country.

The most important part of SDG-3 is universal health coverage, access to health services, affordability of health care, medicine and vaccine. In universal health coverage we had a target to reach at 65 point out of 100 by 2020 from 52 in 2016. But we could proceed only by 2 notches that is 54 in 2019. About out of pocket (OOP) health expenditure, in 2016,  20% people spent more than 25% of their house hold expenditure and more 24.67% people spent more than 10% of their household expenditure for health. In Bangladesh out of pocket health expenditure is remarkably high. This is a threat to universal health coverage. 

Air pollution is another major cause of death. It accounts for 29% of all death and diseases from lung cancer, 25% of all death diseases from ischemic heart diseases, 17% from the lower respiratory infection and 25 % of all death from stroke. During Covid in April 2020, Dhaka has ranked 17th worst on the World Air Quality index where Thailand’s Chiang Mai occupied the worst position with an AQI value of 191.  On the real time ranking Dhaka showed an average AQI score of 82 and classified as ‘moderate’.

Air pollution is the world’s leading environmental health threat. It causes 7 million deaths per year. In Bangladesh, brick kiln, old vehicles, higher level of sulfur in diesel and a huge infrastructure development work are the main causes of air pollution. So, construction site and industry contribution to air pollution needs coordinated efforts. Specially, in Dhaka city, Metro Rail construction through the center of Dhaka city, construction of BRT, several flyovers along with the multi-storied buildings made the air quality of Dhaka very bad. According to WB report, each year 15,000 people die from air pollution. We could save $200 million to $800 million yearly that is 0.7-3.0% of gross national product if air pollution could be reduced in 4 major cities. Global warming, climate change, acid rains, smog effect, deuteration of agricultural field, extinction of animal species, respiratory health problem and deuteration of different construction these are the waste affected area due to air pollution.

Global health observatory data shows in 2016, water, sanitation and hygiene was responsible for about 829 thousand deaths for diarrhea, that is 1.9% of the global burden of diseases. Everyday 6,000 peoples die of water related diseases. While inaugurating the world environment day, former UN Secretary General Kofi Annan, in 2003, told that water related diseases are responsible for 80% of all illness deaths of developing country. Hand wash can reduce 30-48% diarrhea and 20% of respiratory infection. Cholera, Ebola, Sars, hepatitis E and also 36% of Corona can be reduced by regular hand washing. 35 to 77 million people in Bangladesh have been chronically expose to arsenic in the first decade of this century, 8.5% of the total death is caused by water, sanitation and hygiene related diseases, according to the United Nation Water 2013.

One of the most important means of implementation is to reduce tobacco use and reducing death from the use of tobacco. We have the available base data 43.3% people in 2009 used tobacco with a target to reduce to 35% by 2020. Fortunately enough that by 2017, we reached that goal. Hope to lower the use of tobacco to 30% and 25% people respectively in 2025 and 2030 very easily. 

We all know that Bangladesh has done very well in vaccination. Under Extended Program of Immunization (EPI) our target we fixed to reach 95 percent by 2020 and 100 percent by 2030. In 2017-18 we could reach about 82.3%, which is very near to achieve the target. 

Another means of implementation is development assistance. Before Corona in 2018-19 we had $402 million development assistance in research and other basic health services. We achieved the target well which we fixed $300 million by 2020 and $400 million by 2025. Health personnel, we all know is one of the most important areas. We had a target of 18.9, 31.5 and 44.5 health officials for each 1,000 people by 2020, 2025 and 2030 respectively with a base data of 7.4 per one thousand in 2016. We are at a far cry from the target and had 8.3 person per thousand in 2019. On the other hand, WHO had said the ratio of doctor, nurse and technician from existing 1:0.5:0.2 in 2016 to reach 1:3:5 in 2030 gradually. We are far behind the target of achieving this ratio of doctor, nurse and technician rather we have opposite picture. In terms of emergency preparedness, the target was 90 by 2020. We could rich 58 only by 2019.

So far Corona in Bangladesh could not spread and had very less death tool in comparison to other populous country like India and in overall SDG 3 implementation along with Corona with so many limitations our performance is remarkable which brought so many awards for Bangladesh in the last one decade.

Writer: Former Principal Secretary and SDG Coordinator

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