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07 APR 2018
In countries like Bangladesh, community-based health insurances (CBHI) set up with voluntary contributions can help cover unforeseen healthcare cost for low-income informal workers like rickshaw pullers, shopkeepers and day labourers.
Informal workers constitute a large population in Bangladesh. Photo: Shehzad Noorani / icddr,b
However, informal workers having high health risk are more likely to subscribe to these CBHIs, which is a potential challenge for these schemes to keep supporting them sustainably, indicates an icddr,b study published in International Journal of Environment Research and Public Health.
“When too many individuals with higher healthcare requirements subscribe to these schemes, they  may naturally become unsustainable as soon as they begin to reimburse health bills altogether,” says Mr Sayem Ahmed, assistant scientist working with health economics and financing research group at icddr,b and an author of the study supported by Grand Challenges Canada.
 “The schemes need to be carefully designed considering involvement of a larger pool to ensure sustainability and introduce waiting periods before drawing health bills for the first time,” he adds.
CBHI schemes are considered an interim measure towards Social Health Insurance to ensure financial protection for informal workers, who are otherwise not covered for healthcare costs, according to the Health Care Financing Strategy 2012–2032 of the Government of Bangladesh. The strategy paves way to achieving Universal Health Coverage (UHC) for Bangladesh.
As observed on this World Health Day, the core idea of UHC is reiterated by the slogan “Health for All,” which is making health systems equitable and quality healthcare available for people from all economic strata, according to World Health Organization (WHO).
“The challenge of CBHIs mentioned by the study may be a real challenge for achieving UHC in Bangladesh because informal workers constitute a large population and they are among the most disadvantaged in terms of securing health benefits, while contribute largely to the economy of the nation,” says Dr Jahangir A M Khan, senior lecturer in health economics at Liverpool School of Tropical Medicine (LSTM) and senior author of the study.
People belonging to disadvantaged groups often end up paying big chunks from their monthly income for healthcare, especially for medications and towards physician fees. Such out-of-pocket expenditure becomes a high health burden when these groups are not sustainably covered by health insurances.
Similar findings by icddr,b researchers have earlier shown that relatively economically disadvantaged populations in Bangladesh have the greatest need for healthcare, but are most likely to receive the least benefit.
Such disparity remains a challenge for the equitable healthcare system envisaged by UHC although Bangladesh has made much progress to reform its health system, service delivery and improved many health indicators. The researchers feel that with the current improvements, sustainability is a must in health financing schemes to ensure “Health for All”.
Muhamamd Zahir Hassan Nabil
