Why do many basic packages of health services stay on the shelf? A look at potential reasons in the WHO South-East Asia Region

Basic packages of health services (BPHSs) are often envisaged primarily as political statementsof intent to provide access to care, in an era of commitment to universal health coverage. Theyare often produced with little attention paid to health systems’ capacity to deliver these benefitpackages or other implementation challenges. Many countries of the World Health Organization(WHO) South-East Asia Region have invested in developing BPHSs. This perspective paper reflectson the issues that do not receive enough attention when packages are developed, which can oftenjeopardize their implementation. Countries of the region refer to burden-of-disease assessmentsand consider the cost-effectiveness of the listed interventions during their BPHS design processes.Some also conduct a costing study to generate “price tags” that are used for resource mobilization.However, important implementation challenges such as weak supply-side readiness, limited scopefor reallocation of existing resources and management not geared for accountability are too oftenignored. Implementation and its monitoring is further hampered by the limitations of existing healthinformation systems, which are often not ready to collect and analyse data on emerging interventionssuch as noncommunicable disease management. Among the countries of the WHO South-East AsiaRegion, those with better chances of executing their BPHSs have adapted their packages to theirimplementation, financing and monitoring capacities, and have considered the need for a modifiedservice delivery model able to provide the agreed services.

Bangladesh’s digital health journey: reflections on a decade of quiet revolution

Bangladesh has made remarkable progress in digital health in recent years. Through one of theworld’s largest deployments to date of the open-source District Health Information Software 2 (DHIS2),the country now has a national public sector health data warehouse. Information from previouslyfragmented data systems is now unified in a common data repository, enabling data exchange forhealth information systems and decision-making. Work is ongoing to create lifetime electronic healthrecords for all citizens that can be transferred between health facilities. Extensive customization ofopen-source software has laid the foundations for a national digital networking system. Initiativeshave focused on producing digital solutions to aid priorities such as strengthening the health systemas a whole as well as supporting specific technical interventions, for example improving the civilregistration and vital statistics system. Digital solutions have also supported the Bangladesh healthworkforce strategy through a set of registries that electronically captures and maintains humanresource information for the entire public health sector, including monitoring staff attendance throughthe use of low-cost biometric fingerprint time-attendance machines. Citizens are encouraged toengage in shaping health services via a web-based complaints and suggestions system, and a newsystem to raise health awareness via public digital displays has started in Dhaka. Strong support atthe highest political level has been critical to the success of efforts to introduce these innovations.The endeavour has also generated a cadre of enthusiastic eHealth proponents, who are focusedon further strengthening and expanding the existing systems and on harnessing the vast amount ofinformation amassed at the central data repository through big data analysis, artificial intelligence andmachine learning.

Access to health services by informal sector workers in Bangladesh

According to the constitution of Bangladesh, health is a right and, in 2012, initial work towardsuniversal health coverage was marked by introduction of a health-care financing strategy. However,for 2016, Bangladesh’s domestic general government health expenditure was only 0.42% of grossdomestic product, making it one of the lowest-spending countries in the world, with 72% of currenthealth expenditure coming from out-of-pocket spending. One factor that is key to the challenge ofproviding universal health coverage in Bangladesh is the large proportion of the population whowork in the informal sector – an estimated 51.7 million people or 85.1% of the labour force in 2017.Most workers engaged in the informal sector lack job security, social benefits and legal protection.The evidence base on the health needs and health-seeking behaviours of this large population issparse. The government has recognized that increased efforts are needed to ensure that the country’snotable successes in improving maternal, neonatal and child health need to be expanded to coverthe full range of health services to the whole population, and specifically the more marginalized andimpoverished sectors of society. In addition to the universal need to increase funding and to improvethe availability and quality of primary health care, workers in the informal sector need to be targetedthrough an explicit mechanism, with enhanced budgetary allocation to health facilities serving thesecommunities. Importantly, there is a clear need to build an evidence base to inform policies that seek toensure that informal sector workers have greater access to quality health services.