Background
Over the past twenty years, Bangladesh has experienced swift urbanization. According to the 2019 World Bank report, an estimated 29 million individuals, roughly 55% of the nation's urban populace, currently reside in slum areas. Approximately 70% of the urban population surge stems from rural-to-urban migration, while the remainder is due to natural population growth.
Despite having multifaceted health needs, the urban poor in Bangladesh encounter numerous obstacles when attempting to access healthcare services. These challenges often compel many to delay or entirely forgo seeking medical assistance. These barriers encompass a high incidence of non-communicable diseases, limited healthcare accessibility, substantial out-of-pocket expenditures (constituting 74% of the total health expenses), elevated user fees, and significant travel distances.
Implementing Health Vouchers: An Effective Solution
Vouchers, a form of results-based financing (RBF), have been widely employed across various sectors, including healthcare, in numerous low, middle, and high-income nations. Health vouchers have proven to be effective in these regions, serving as both a financial mechanism to offer subsidised healthcare to specific demographics and as a strategic tool to diminish access barriers and bolster the utilisation of crucial healthcare services.
Studies conducted in these regions have shown that vouchers effectively boost utilisation rates, promote equity, and elevate the quality and availability of healthcare. Via vouchers, households can access a clearly outlined healthcare package at predetermined health facilities, either at no cost or at a reduced fee. The subsidy is directly allocated to the client in the form of a voucher, be it in paper format or through an electronic token, which the client can then redeem at a healthcare provider.
Programme activities and Implementation
Funded by the European Union, the “Promoting Sustainable Health and Nutrition Opportunities for Marginalised Urban Extreme Poor Population in Bangladesh” programme was a voucher model aimed at reducing the financial barriers to accessing health services for the urban poor and supporting vulnerable populations in accessing health care without suffering financial hardships.
PROSHOMON improved access to and utilisation of a free Essential Services Package of quality primary health care, nutrition and population services by the extreme poor in Feni and Chandpur Municipalities under the Chittagong Division. SAJIDA Foundation was one of three entities in Bangladesh who implemented the design in Bangladesh.
The distribution of Bangladesh’s first smart health card amongst 15,000 households (over 66,000 beneficiaries) was implemented by SAJIDA Foundation, with technical support from Concern Worldwide under the leadership of the Ministry of Local Government, Rural Development and Cooperatives.
Partnering with the government, and the local municipalities, SAJIDA and the other implementing partners developed a service package for which the vouchers can be used at the designated public and private hospitals.
Hospitals were identified and contracted to participate in the scheme, based on a set standard criterion to ensure quality of care. Households were identified using poverty and vulnerability targeting criteria.
SAJIDA used a smart card voucher, which could be read by a card reader and was linked to a web-based information platform. Each qualifying household received a form of a voucher card.
The services that could be redeemed with the voucher card included maternity care, emergency care and general illness.
In a bid to ensure quality services from the private sectors, SAJIDA used a hotline number as a part of their Complaint Response Mechanism (CRM) system. The complaints received were systematically analysed and necessary actions were taken.
More than 500 batches of extreme urban poor were provided Behavioural Change Awareness Sessions or Orientations during the entire run of the programme.
Impact and success of the programme
The majority of targeted households effectively utilized the vouchers, signifying a substantial enhancement in their access to formal healthcare. This also resulted in positive shifts in their healthcare-seeking behaviour.
To address the primary healthcare, maternal and child health needs, and improve the nutritional status of the urban extreme poor, the program successfully activated the ward health committee (WHC) in these municipalities.
Furthermore, the programme achieved success in securing a designated portion of the healthcare budget and contributed to the development of leadership within municipal bodies. This was achieved by ensuring improved health and nutrition status for the marginalized urban extreme poor through various innovative initiatives.
Local municipalities and district authorities noted that the voucher project played a significant role in fostering improved collaboration with the private sector. Moreover, it was instrumental in enhancing the quality control of private healthcare facilities.
My heartfelt thanks to PROSHOMON for proactively initiating leaflet distribution among the people with appropriate information on the symptoms and protocol to manage the coronavirus.