Quality public health must for UHC: Gita Sen

Bangladesh must have a ‘strong’ public health system to adopt the idea of universal health coverage (UHC) to protect people from slipping into poverty, Prof Gita Sen has said.

“It does not mean that there will be no private system. Both should be there,” she told bdnews24.com on the sidelines of the Asia-Pacific meeting on gender equality in Bangkok.

Sen is a professor of public policy at the Indian Institute of Management in Bangalore (IIMB) and an adjunct professor of Global Health and Population at Harvard School of Public Health.

She is known globally for her combination of an academic career with policy advocacy and NGO activism.

She authored many books and researches on global health and population and was the member of the Indian Planning Commission’s High Level Expert Group on universal health coverage or UHC.

UHC have become a buzzword in the health sector as the World Health Organisation and the World Bank are promoting this as a way of preventing people from falling into poverty due to heavy out-of-pocket expenditure during medical treatment.

The concept is that people should have access to healthcare without getting into financial trouble.

About 64 percent of the entire health expenditure in Bangladesh is made beyond normal means that in turn pushes 5 percent of the service seekers into poverty every year.

This dismal picture prompted the government to devise a financing strategy to achieve UHC, but so far no progress has been made.

On the contrary, health budgets which is less than 1 percent of the total GDP is shrinking over the year.

But Prof Sen suggested increasing the budgets to improve quality of services in government facilities so that people take those services.

“If you don’t have strong and quality public health system, your private sector will be extremely difficult to control,” she said.

“If strong public sector is there, private sector will have some competition,” she said that what they suggested in the Planning Commission’s report.

She said both India and Bangladesh suffered the same “mindset” of spending less in the health sector.

“Unless people move or ask for it (more budgets), scream for it, it’ll not happen,” she believed.

Peculiar combination

She, however, said that governments might suffer complacency in doing progress in some sector.

She said Bangladesh was doing “quite good” in cutting maternal and child deaths and the government was spending money on particular programmes for that.

It might make the government feel that “we have done enough”.

“…but actually they are not doing all the other aspects”.

“So Bangladesh is a peculiar combination where they do well on something, not very well on general public health, but both need to be done”.

She said Bangladesh was “doing badly” on providing treatment of non-communicable diseases like cancer, and heart diseases which she said was coming in a “big way”.

“You are not doing well in this sector, but these are becoming more and more issue for the people, even for the poor in today’s world”.

She said universal health coverage would be needed for ensuring treatment of those diseases.

“Its not a difficult task to implement (UHC). You need to have a single payer system with strong public service available”.

“You have to improve quality of the public sector that what we suggested in India also,” she said, “it is necessary so that people come to those facilities”.

She, however, said investing on the preventive aspect of health like clean water, sanitation, and effective immunisation, could lessen the burden of heavy expenditure in the secondary and tertiary level.

“We need to put money on primary care, unless you will go on spending more and more in treating people after they are falling sick which should be otherwise”.

She also stressed on the use of ‘generic drugs’ instead of company branded drugs to reduce the costs.