The global and local context of universal health coverage

Universal health coverage ensures that all citizens, regardless of their status, can access high-quality health services without compromising their financial wellbeing.

Low- and middle-income countries have made considerable gains in maternal health, child survival and nutrition, and management of communicable diseases. Even so, inequities persist between and within countries, and threaten to grow in an era of global epidemiologic and demographic transitions, urbanisation and climate change. To ensure equitable and sustainable improvements in health, poverty and weak health systems must be addressed.

The WHO defines universal health coverage as “ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”

This definition of universal health coverage spans three ideals:

• equity in access to health services
• quality of health services 
• financial risk protection.

The situation in Bangladesh

Several factors contribute to the lack of universal health coverage in Bangladesh. 

• with only 0.5 doctors and 0.2 nurses per 1000 people, far below WHO recommended levels, the country’s human resources for health are at crisis levels 
• uneven distribution of the health workforce, and issues of retention and overwork, will require innovations in capacity building, incentives and task shifting 
• the lack of effective regulatory systems contributes to poor quality services and a large informal sector catering to the poorest in society 
• high out-of-pocket health care expenditures create financial barriers for those least able to afford the cost of health care.