Abstract

Health is a basic requirement to improve the quality of life. A national economic and social development depends on the state of health. A large number of Bangladeshs people, particularly in rural areas, remained with no or little access to health care facilities. The lack of participation in health service is a problem that has many dimensions and complexities. Education has a significant effect on participation in health services and administrative factors could play a significant role in increasing the peoples participation in Bangladeshs health sector. But the present health policy is not people oriented. It mainly emphasizes the construction of Thana Health Complexes (THCs) and Union Health and Family Welfare Centers (UHFWCs) without giving much attention to their utilization and delivery services. The study reveals that financial and technical support is very helpful to ensure health service among village people. However, the Government allocates only 5 percent of the budget to the health sector, while it allocates 13 percent for defense. The paper shows that the Governments allocation and technical support (medical equipments) are not sufficient in the rural health complex and that the peoples participation is far from being satisfactory. The paper concludes with a variety of recommendations.

Introduction
Bangladesh is a mostly rural, developing country of South Asia, located on the northern shore of the Bay of Bengal, covering 147,570 square km. People of this country are known as hardworking, with proven capability to preserve mental strength in the event of unexpected extensive loss due to natural calamities, such as floods, cyclones, epidemics, etc. But, their basic needs have remained unfulfilled. Health is a basic requirement to improve the quality of life. National economic and social development depends on the status of a countrys health facilities. A health care system reflects the socio-economic and technological development of a country and is also a measure of the responsibilities a community or government assumes for its peoples health care. The effectiveness of a health system depends on the availability and accessibility of services in a form which the people are able to understand, accept and utilize. The Government of Bangladesh is constitutionally committed to the supply of basic medical requirements to all levels of the people in the society and the improvement of nutrition status of the people and public health status (Bangladesh Constitution, Article-18). The health service functions were initially restricted to curative services. With the development of modern science and technology, health services emphasize promotive and preventive rather than curative health care. Yet, a large number of people of Bangladesh, particularly in rural areas, remain with no or little access to health care facilities. It would be critical for making progress in Bangladeshs health services to improve the peoples participation in the health sector. The Government therefore seeks to create conditions whereby the people of Bangladesh have the opportunity to reach and maintain the highest attainable level of health. Bangladesh has a good infrastructure for delivering primary health care, but the full potential of this infrastructure has due to lack of adequate logistics never been utilized. The aim of this study is to find out different aspects of health care financing in Bangladesh. This includes sector wise contributions, necessity of foreign aid in health sector, significance of foreign aid, reducing burden of poverty on catastrophic health expenditures by means of progressively expanding national health care insurance, providing more reliable estimates of household out-of-pocket( OOP) expenditure on drugs by alternative and mutually consistent

sources like surveys, administrative records and international drug monitoring market research data and finally, suggested measures to remove the problem of health care financing and its utilization.

Scope and Methodology

This study is based on analysis of prevailing health care financing system in Bangladesh. Data have been collected from various published books, scholarly journal articles, daily newspaper, UNAID, WHO, WB, MOHFW and internet browsing. Due to lack of available sources of primary or raw data, secondary data has been used. This paper also includes health care financing in foreign aid perspective and foreign aid effectiveness in inequality in infant, child and under five mortality perspective. Many descriptive statistics i.e. data tables, statistical bar diagram, time series diagram are used for financing in the health sector in Bangladesh.

Research Problem
Health service is one of the fundamental rights of the people. It is the constitutional liability of the state to ensure adequate health service delivery to the people (Bangladesh Constitution, Artcle-18). However, in the case of Bangladesh, the state is not able to deliver door to door health service as yet. There are various reasons responsible for this condition. One of the main reasons is that Bangladesh is an overpopulated country. It is a difficult task for the government to ensure health services for its population of about 160 million people. In 1978, the World Health Organization (WHO) declared Health for All by the year 2000 in the Alma Ata Declaration. However, this grand vision of primary health care for all has not yet been achieved in Bangladesh. To the contrary, despite some progress, Bangladesh remains a country where poverty prevails at its gravest rate, income inequality is enormous, and the effective literacy rate is low. Basic primary health care services are not accessed equally and the marginalized people of rural Bangladesh are treated in a highly discriminatory nature to access health facilities. Actually, the reliable source of data about health care financing in Bangladesh is insufficient. But, some kinds of traditional data about these are also available in internet. Besides, there is also time constraint for this purpose. But, I have tried my best to present this research paper more accurately.

Health Care Financing

Health care financing system is operated through the Governments revenue and development budget. Estimated expenditure amounts to 6% of the total government budget. Large part of revenue expenditure is incurred for salary support of the government employees and development expenditure is utilized for health developmental activity. A significant part of development budget comes from the external sources which include World Bank and cofinanciers, bilateral donor agencies as well as UN agencies, including WHO, UNICEF, and UNDP. Expenditure for health and population sector has been growing steadily. The major part of funding was channeled through Operational Plans of HPSP and currently HNPSP. This is implemented through a sector wide approach (SWAp) supported by a consortium of the World Bank and ten multi-lateral and bilateral donors. WHO plays a key role as a technical agency as well as executing some of the components of 2003-2010 HNPSP.

The management of SWAp and implementation of HPSP and current HNPSP is an example of partnership with multiple stakeholders which carries lessons for the implementation of the next PRSP and PHC service delivery. Although there is a clear government policy that all citizens will get free services in all government facilities, informal and unofficial charging is widely practiced. The Baseline Service Delivery Survey for HPSP conducted in 1999 found that 22% of people make an extra payment to the workers when they visit government health services and 27% pay an unofficial registration fee.

ICHA-HF Classification of Health Care Financing: Three-Digit Level

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ICHA code Sources of funding ---------------------------------------------------------------------------------------------------HF.1 HF.1.1 HF.1.1.1 HF.1.1.2 HF.1.1.3 HF.1.2 HF.2 HF.2.1 HF.2.2 HF.2.3 HF.2.3.1 HF.2.3.2 HF.2.3.3 HF.2.3.4 HF.2.3.5 HF.2.3.6 HF.2.3.7 HF.2.3.9 HF.2.4 HF.2.5 HF.3 General government General government excluding social security funds Central government State/provincial government Local/municipal government Social security funds Private sector Private social insurance Private insurance enterprises (other than social insurance) Private household out-of-pocket expenditure Out-of-pocket excluding cost-sharing Cost-sharing: central government Cost-sharing: state/provincial government Cost-sharing: local/municipal government Cost-sharing: social security funds Cost-sharing: private social insurance Cost-sharing: other private insurance All other cost-sharing Non-profit institutions serving households (other than social insurance) Corporations (other than health insurance) Rest of the world

Explanatory notes to the ICHA-HF classification of sources of funding HF 1 General government This item comprises all institutional units of central, state or local government, and social security funds on all levels of government. Included are non-market non-profit institutions that are con-trolled and mainly financed by government units ( SNA 93, 4.113-4.130). HF.1.1 General government excluding social security fund This item comprises all institutional units of central, state or local government. Included are non-market non-profit institutions that are controlled and mainly financed by government units (SNA 93, 4.113).

HF.1.1.1 Central government This item comprises all institutional units making up the central government plus those NPIs that are controlled and mainly financed by central government (SNA 93, 4.117-4.122). HF.1.1.2 State/provincial government The state/provincial government sector consists of state governments which are separate institutional units plus those NPIs that are controlled and mainly financed by state government. States and provinces may be described by different terms in different countries. In small countries, individual states/provinces and state/provincial governments may not exist (SNA 93, 4.123-4.127). HF.1.1.3 Local/municipal government The local government sub-sector consists of local governments that are separate institutional units plus those NPIs which are controlled and mainly financed by local governments. In principle, local government units are institutional units whose fiscal, legislative and executive authority extends over the smallest geographical areas distinguished for administrative and political purposes (SNA 93, 4.128). HF.1.2 Social security funds The social security funds sub-sector consists of the social security funds operating at all levels of government. Social security funds are social insurance schemes covering the community as whole or large sections of the community and that are imposed and controlled by government units (SNA 93, 4.130). HF.2 Private sector This sector comprises all resident institutional units which do not belong to the government sector. HF.2.1 Private social insurance This sector comprises all social insurance funds other than social security funds. Includes: programmes that are set up by government for their employees only. HF.2.2 Private insurance enterprises (other than social insurance) This sector comprises all private insurance enterprises other than social insurance. HF.2.3 Private household out-of-pocket expenditure The definition of a household which is adopted by survey statisticians familiar with the socioeconomic conditions within a given country is likely to approximate closely the concept of a household as defined in the SNA and consequently will also be in most cases appropriate for the purposes of health accounting (see SNA 93, 4.134). HF.2.4 Non-profit institutions serving households (other than social insurance) Non-profit institutions serving households (NPISHs) consist of non-profit institutions which provide goods or services to households free or at prices that are not economically significant (SNA 93, 4.64). HF.2.5 Corporations (other than health insurance) This sector comprises all corporations or quasi corporations whose principal activity is the production of market goods or services (other than health insurance). Included are all resident nonprofit institutions that are market producers of goods or non-financial services (SNA 93, 4.68).

HF.3 Rest of the world This item comprises institutional units that are resident abroad. This includes foreign aid, private insurance premiums etc.

Health care financing in Bangladesh perspective

Global spending on health totaled about $ 2.3 trillion in 1994, or about 9 percent of total global income. High income countries,$ those with per capita income above $8500 in 1994 spent just over $ 2 trillion, amounting to 89 percent of total health expenditure, while their populations accounted for 16 percent of global population. In USA, for every $7 spent, $1 goes for financing the health sector. Developing countries, with 84 percent of the worlds populations, accounted for only 11 percent of all health spending (Health affair, 1999) Governments limitations in capacity Limited resources and administrative capacity coupled with strong underlying needs for services pose serious challenges to government in the developing world. Even the richest countries of the world are facing limitations in financing the health sector because of rising medical cost, and are gradually shifting towards alternative financing mechanisms. WHO recommends that countries should adopt an essential set of interventions with average costs of $3040 per person. South East Asian countries, on average, had total health expenditure (THE) of only $12 per person(WHR,2001). There is evidence to show that health systems, which spend less than approximately $60 per capita, find it difficult to deliver a reasonable, minimum range of services. Health care financing in different countries Now-a-days, different countries are adopting health care delivery systems in which the state does both the financing and provisioning, or shares with the private sector in diverse combinations. At present, there are several systems of payments in vogue in USA: Medical, Medicaid, Fee for Services (FFS), Deductibles, Indemnity, Copayments, Insurance, various combinations of the above, and others. All these systems are costs sharing and cost pooling methods among the consumer, government, insurance companies and other third party payers, so that treatment expense does not become any single partys burden, thereby maintaining the right quality of the care. Other systems, like NHS in UK, National health accoutsin the Philippines, Egypt, Mexico, Colombia, Zambia, and BAMAKO Initiative (Community financing) of Thailand, are measures of cost pooling in health sector that have emerged with success. Health care financing in developing countries Low income countries can only raise revenue equivalent to 20 percent of their GDP, less than half of the 42 percent in high income countries. If a basic package of primary care and preventive services were to cost somewhere around $1520, then a low income country must devote onequarter to one-third of its government budget to the health sector. There are sometimes supplemented by user fees, but these constitute a very small percentage of public revenue. External assistance continues to be a significant revenue sources. Thus, ironically, the poorest countries have the highest out-of-pocket spending as a percentage of income. Bangladesh perspective In Bangladesh, approximately 35% of the health sector funding of the government is coordinated through a large consortium of donors and aid agencies, headed by the World Bank. The Bank

heads a consortium of 10 donors that funds around a third of the health ministrys budget, with over 30 multilateral and bilateral organizations supporting the ministry of health. Some 500 NGOs operate in the health, nutrition, and population sectors in Bangladesh. Among the best known is the Bangladesh Rural Advancement Committee (BRAC), which reaches around 17 million people. The Banks fourth population and health project in Bangladesh, which has disbursed around $780 million over six years with $190 million from the bank, $282 millions from other donors, and $310 million from the Bangladeshi government. Bangladesh today spends almost $12 per capita in the health sector, of which $4 comes from the public sector. Of the 63% spending from out-of-pocket, 46% is on drugs from private pharmacies, much of this spending is on party or wholly ineffective or inappropriate medicines. Concept of resource pooling in Bangladesh Pooling of resources refers to the accumulation of health on behalf of a population. By pooling of resource, the financial and health risks are spread and transferred among the population. The essence of health insurance is pooling of funds and spreading the risk for illness and financing. A significant bulk of health care financing in Bangladesh is coming from OOP and informal payment, which indicates that people are willing to pay for better care to supplement the resources staved and ineffective public health sector. An implication is that households are forced to pay for health care when their ability to pay is at its lowest limit. Channeling this money into an organized health insurance scheme would reduce payment at time of illness and spread the cost of care across time and individuals. A limited resource means that much of the allocation is spent on building and staff, with little left over to purchase medicines and other supplies. Based on an income related contribution (average premium of Taka 500 per person annually, or Taka20002500 per household), social insurance could contribute up to 8 per cent additional revenue for the sector, and community insurance would extend funding by at least another 4 per cent (HEU, 2001). A good financing system must envisage contributions based on ability to pay, distribution based on need, reduction of the burden of unexpected catastrophic risks, and must be managed in a way that is accepted as transparent and trustworthy. There should be progressive taxation for the higher income groups, and univeralization of access to health services by subsidizing the poor using both local and outside funds coming both from inside and outside the health sector (in Vietnam, it has been proposed that, in rural areas: The government should end up paying 75 percent of all heath care costs; the community 10 percent; foreign aid 10 percent; and user fees 5 percent. In urban areas: taxes should cover 5060 percent of the costs; health insurance 20-25 percent; fees 10 percent; and foreign aid 5 percent). There is no escape. In one way or another, the government has to increase its health spending. The main challenge will ultimately be to convince people that what is proposed is for them to reduce their envelope payments, and, instead, pay a clearly identified local health tax with safety net for the poor. If a strong argument is to be made for these resources to be channeled into the public sector, or other forms of organized financing, society must be convinced that the resources will be used effectively. Without this assurance, it is likely to prove impossible for the policy makers to convince the public that health service resource mobilization is not "just another tax," and evade it accordingly.

Private Household Out-of-pocket Health Expenditures in Bangladesh A less apparent but important source of private spending is underthetable, or informal, payments by patients to public sector providers. The analysis of WHR, 2002, indicated that most countries in South East Asia have more than 50 per cent of the revenue coming from OOP. Recent studies in thana and district facilities in Bangladesh have found between 2030 per cent of users reporting payments (CIET, Canada 2000). Payments vary between Taka 40140 (Taka 1027 on average for all patients). For large medical procedures payment can be considerably higher, Taka 1275 for normal delivery and Taka 4700 for caesarean section (Nahar, 1998). Sources of health care financing

Household OOP the Dominant source of financing accounting for 65% of the health care financing. MOHFW accounts for 20%. Donors (Development partners) around 12%.

Providers, Bangladesh 1999-2000 (in %)

This diagram shows a overall structure of health care financing in period 1999-2000 in Bangladesh.

Distribution of Benefit from Public Health Subsidy in Bangladesh

Inpatient

Outpatient

Other

Total subsidy

Kakwani -0.1023 -0.2130 -0.3445 -0.1958 Index More subsidy received by poor in outpatient compared to inpatient services. Primary healthcare subsidies are pro poor.

Poverty Impact of OOP Healthcare Household Expenditures in Bangladesh 1999-2000 Poverty Per capita consumption Per capita headcounts Below PPP $1/day consumption Below PPP $2/day Pre-payment 21.8% 71.5% Post-payment Poverty impact 25.3% 3.5% 73.8% 2.3%

Poverty line 1 ($1/Day): About 22% households subsist below poverty. Healthcare payments push approximately 4% households below the poverty. Poverty line 2 ($2/Day): About 72% households fall under the poverty line 2 Healthcare payments push approximately 2% households below poverty

Pre-payment and post-payment consumption, 1999-2000

Out-of-pocket spending occurs across the entire income distribution but the greater payments occur primarily among the better-off households

Foreign Aid For Health Care Financing: Bangladesh Perspective

The socio economic condition of Bangladesh is characterized by widespread poverty, malnutrition and unhealthiness. The present configuration of unhealthiness has been caused by lack of access of the majority of the population to resources and development benefits. Since independence in 1971, Bangladesh has made progress in reducing poverty and lifting its Human Development Indicators from extremely low levels. The 2005 Household Income and Expenditure Survey (HIES) shows that poverty declined to 40% from about 50 % in 2000 (BBS, 2007). Despite improvement in the reduction of poverty and selected health indicators, Bangladesh remains a low income country, with weak social indicators and pockets of extreme poverty. The country is also vulnerable to natural disasters like flood, cyclone, sidor etc. In this situation, foreign aid is badly needed to run the health care activities in Bangladesh. These activities include maternal health, child health, average life expectancy, primary health care, nutrition programme, and so on. Development partners assistance Over the last 35 year period history, Bangladesh has received USS 15 billion in aid. It ranks 38thof 76 countries under the International Development Association (IDA). Assistance from DPs for health development has been available since 1972, shortly after independence. Before 1998 funding was channeled to different health projects with their defined objectives and activities in specific areas. In order to bring efficiency to the system of planning, monitoring and management, and for harmonization and alignment of donor support to national plans and strategies, a sector-wide approach (SWAp) was introduced in the health and population sector, with the launch of the Health and Population Sector Programme in 1998 (HPSP 19982003). Based on the lessons learned from the HPSP implementation and revised Government policy options, the current HNPSP 2003-10 was formulated and later revised in consultation with all

DPs in 2005. It continues to be structured on the SWAp concept, and places greater emphasis on serving vulnerable populations through client-focused and better utilized essential health services. Contributions of DPs in both pool and non-pool funds of the revised HNPSP are depicted in Table 1. There are pool funding, non-pool funding and parallel funding mechanisms in the HNPSP for development assistance to the Government. Contributions to the pool fund of the HNPSP have been pledged by a consortium of donors led by the World Bank/IDA. Most of the UN agencies are non-pool contributors. Non-pool funding has been pledged by DPs to accomplish their specific objectives within the umbrella of the HNPSP. An amount of US$ 580 million has been pledged in the HNPSP as non-pool fund. Considering the present trends in resource mobilization, WHOs estimated contribution of US$ 46 million for the HNPSP period of 2005-10, made in 2004, was too low and has already been exceeded in 2007. The HNPSP at present does not support programmes beyond the MOHFW, and has no scope to shape policies and strategies in other related ministries. Foreign aid effectiveness in Bangladesh:Inequity in infant, child and under-five mortality In order to find out the aid-effectiveness on life expectancy, it is necessary to estimate the inequality in health conditions in terms of infant, child and under five-mortality between the rich and the poor. The effectiveness of aid will not be visible unless there is a reduction in mortality among the poor because roughly 40% of the population is poor. If the health care services do not reach to the poor, the effectiveness of aid will be difficult to measure. In order to understand the extent of poor and rich gap in under five-mortality principal component analysis was carried out using the household asset variables. Information regarding the household items (i.e. television, radio, electricity, refrigerator or car) and ownership of household structure and cultivable land were assigned a weight or factor score generated through principle component analysis. Figure-1 Trends in Infant, Child and Under Five Mortality, 1993 to 2007.

Source:BangladeshDemographicandHealthSurvey2007

The resulting scores were distributed normally with mean zero and standard deviation one. Each household was assigned a standard score for each asset. Inequalities by income in mortality there of are measured here using a concentration index. Concentration index is a generalization of the Gini coefficient i.e. proportion of population up to midpoint of each interval group. Infant mortality rates by different quintiles for successive four surveys are presented in Figure 2 for the five-year period preceding the surveys. Comparisons of infant mortality estimates

over time show continued declines with a faster decline during the period 2004-07. Over the last two decades infant mortality has declined by about 38 percent. The poorest-richest ratio of infant mortality was 1.3 in 1993-4 and since then it is widened between the poorest and richest ratio increased to 1.6 from 1.3.

Table: 1 Infant mortality rates by Economic Status BDHS 1993-94 94.4 104.1 90.3 81.9 71.7 88.6 1.3 -0.0604 0.0208 -2.91 BDHS 1996-97 91.8 92.3 93.0 92.1 58.4 86.3 1.6 -0.0564 0.0474 -1.19 BDHS 1999-2000 85.2 74.4 69.4 61.2 53.9 68.5 1.6 -0.0887 0.0195 -4.55 BDHS 2004 81.8 53.3 78.7 53.7 50.2 65.2 1.6 -0.0703 .0338 -2.08 BDHS 2007 62.7 65.3 57.6 49.2 38.8 54.5 1.6 -0.088 .001 -2.66

Poorest Poorer Middle Richer Richest Total Poor-rich ratio Concentration index(CI) St.Error (CI) t-test(CI)

Similarly, the poorest richest ratio of under five mortality has also increased from 1.5 in 19934 to 1.8 in 2004 suggesting thepoor and rich gap has increased (Table 2 ).This is also supported b y the values of Concentration Index (CI). The CI for under five mortality was 0.0594 in 199394 and .1060 in 2004 respectively. The negative value of concentration indices indicates mortality favor the poor and its corresponding t-value reveal that there are significant inequalities among the rich and poor groups. Table 2: Under five mortality rates by wealth index BDHS BDHS BDHS BDHS 19991993-94 1996-97 2004 2000 Poorest 133.7 111.6 112.5 104.1 Poorer 132.9 123.0 91.0 73.8 Middle 134.6 135.8 95.8 96.8 Richer 125.0 118.9 70.5 64.6 Richest 91.4 76.9 64.0 58.2 Total 123.5 114.3 86.9 80.3 Poor-rich ratio 1.5 1.5 1.8 1.8 Concentration index (CI) 0.0594 0.0454 0.1093 0.1060 St. Error (CI) 0.0348 0.0544 0.0272 0.0364 t-test(CI) 1.71 0.83 4.01 2.91

BDHS 2007 70.1 72.9 71.7 70.8 48.3 66.3 1.5 0.0483 0.0017 1.17

Figure 2 shows the concentration curve on infant mortality. The diagonal line indicates the line of equality. Curve above the diagonal indicates that infant mortality favors the poor. The farther the curve is above the equality, the more concentration in infant mortality amongst the poor. All curves in different surveys clearly indicate the infant mortality concentrated among the poor Similarly, Figure 3 also shows that inequality in under five mortality between poor and rich has been increasing over time. Detailed analyses all the BDHSs data demonstrate that children of poorest family suffered more in mortality than the children of rich family. If the gap can be narrowed down between the poor and the non-poor, there will be more improvement in the overall health status of the population. Figure 2: Concentration Curve of Infant Mortality

Figure: 3 Concentration Curve of Under Five Mortality by BDHS

The following figure 4 provides the trends in allocation and utilization of aid between 1980 and 2004. As evidence from table, total sectoral allocation increased 27 times during the period of study. Both governments allocation and donors allocation also increased substantially. Donors allocation increased 80 times compared 1980 level while government allocation increased only 13 times of 1980 level. However utilization was much lower in project aid increased substantially which might have influenced on the overall health status of the population. Share of project aid is shown in Figure 5. As the figure suggests the increased share and utilization of aid in 1990s are also supported by the rapid decline in infant and under five mortality, increased coverage of immunization and increased in life expectancy at birth.

Figure 4. Allocation in Health Sector by Sources (Project Aid and Government)

Figure 5: Share of Project Aid and Utilization in Health Sector by Source.

The above discussion shows that foreign aid is a very factor in our country after 1980s. The above tables show that infant mortality and under five mortality substantially reduce over time. This evidence shows that foreign aid is more effective in this case. But the figure 2 shows that over the time of study, the inequality between rich and poor roughly increases. Figure 5 shows that foreign aid or project aid is very important in health care financing in Bangladesh.

Findings
Health is basic human need. Every human being should have a capability or entry in health care programme. As Bangladesh is a poor, over populated country, its health sector financing is closely dependent on foreign aid. Bangladesh receives grant from UNAID, WHO, WB etc. The domestic source includes government expenditure, NGOs insurance etc. In Bangladesh, approximately 35% of the

health sector funding of the government is coordinated through a large consortium of donors and aid agencies, headed by the World Bank. Bangladesh today spends almost $12 per capita in the health sector, of which $4 comes from the public sector. Of the 63% spending from out-ofpocket, 46% is on drugs from private pharmacies, much of this spending is on party or wholly ineffective or inappropriate medicines. Besides, the foreign aid or grant is very important in Bangladesh in reducing infant mortality rate, under five mortality rates etc.

Conclusion and Recommendations

Health service is most important factor for human well being. Health services based on primary health services have been expanding gradually in Bangladesh to improve the health status of the people, especially in rural areas where more than 85 percent of the people are living and are underserved and underprivileged groups. So, in this situation to provide proper health care to all people, health care financing is very important. As Bangladesh is partly dependent on foreign aid, the government of Bangladesh is trying to find out better internal source of funding. The Government also tries to motive the people to use the existing health facilities, but most of the people are not willing to use modern health care facilities due to the ignorance and traditional mentality of rural people. Besides, we should have a close outlook in proper utilizing the foreign aid. On the basis of our findings we present the following recommendations: Though the National Health Policy is essentially people-oriented, our analysis shows that the problem lies in the implementation of these policies. So the Government needs to modify its traditional process and be more people-oriented. Bureaucratic response is also very important in the health sector. So the bureaucratic response should be a positive view to the mass people for ensuring proper financing in health. The Government needs to make sure that the donors view does not negatively influence its policy making and implementation in the health sector. Given that the Government receives foreign funds, they are accountable to the foreign donors. But the Government should also keep in mind national interests. Donors performance may go against national interests. So the Government should try to become independent from the donors. Regular monitoring and supervision should be adopted in government health sector for ensuring proper financing in every sector in health. Government should take proper steps to increase internal financing.

Government should try to remove hard and fast conditions of donors in receiving foreign grant. Due to lack of proper information, time, and experience, probably I have not presented this paper accurately. But I have spent my best effort in making this paper. If I get a chance in future, fortunately, then I will try to make this paper more accurate and more attractive.

References
Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh. World Health Organization World Bank UNAID The Daily Star, Dr. Zulfiquer Ahmed Amin, a physician, is specialist in Public Health Administration and Health Economics ICHA-HF Data International Ltd. A.K.M. Ghulam Rabbani. Bangladesh Demographic and Health Survey 2007. Dhaka: National Institute for Population

An assignment on

Health Care Financing and Foreign Aid In Bangladesh

Submitted to Rumana Haque Course Teacher Department of Economics University of Dhaka

Submitted by Taposh Kumar Roy 4th year, Roll no:119 Department of Economics University of Dhaka

Date of submission: