The document discusses a study on Shasthya Surokhsha Karmasuchi (SSK), a special health care project in Bangladesh aimed at ensuring quality health services without financial hardship. The study aims to assess if SSK can meet universal health coverage requirements and reduce out-of-pocket health expenditures. Interviews were conducted with SSK patients and health providers. Findings indicate SSK successfully eliminates costs for admitted patients but many still face health costs. SSK coverage and services need expansion to better achieve financial protection goals. Challenges include limited treatments covered, scarce resources, and poor infrastructure.
Report
Share
Report
Share
1 of 22
More Related Content
Similar to Data Analysis ....Stepping Towards Achieving Universal Health Coverage(UHC) by SSK.pptx
The document proposes a model for universal access to primary healthcare in India. It suggests establishing a centralized healthcare system with data collection and sharing across different levels, from community health centers up to a central body. Regular health checkups and surveys would assess needs. Funding would consider local factors and be distributed to states. Compulsory health insurance would provide coverage nationwide. Primary care facilities would be strengthened through computerization, awareness campaigns, and addressing barriers like lack of enrollment. The model aims to equitably and efficiently deliver necessary primary healthcare services to the entire population of India.
Fuzzy Bi-Objective Preventive Health Care Network DesignGurdal Ertek
Preventive healthcare is unlike healthcare for a cute ailments, as people are less alert to their unknown medical problems.In order to motivate public and to attain desired participation levels for preventive programs,the attractiveness of the healthcare facility is a major concern.Health economics literature indicates that attractiveness to a facility is significantly influenced by proximity of the clients to it.Hence attractiveness is generally modeled as a function of distance.However, abundant empirical evidence suggests that other qualitative factors such as perceived quality, attractions nearby, amenities, etc. also influence attractiveness. Therefore, are alistic measures hould in corporate the vagueness in the concept of attractiveness to the model.The public policymakers should also maintain the equity among various neighborhoods, which should be considered as a second objective.Finally, even though general tendency in the literature is to focus on health benefits,the cost effectiveness is still a factor that should be considered.In this paper,a fuzzy bi-objective model with budget constraints of the problem is developed.Later,by modelling the attractiveness by means of fuzzy triangular numbers and treating the budget constraint as a soft constraint, a modified (and more realistic)version of the model is introduced. Two solution methodologies, namely fuzzy goal programming and fuzzy chance constrained optimization are proposed as solutions.Both the original and the modified models are solved within the framework of a case study in Istanbul,Turkey.In the case study,the Microsoft Bing Map is utilized in order to determine more accurate distance measures among the nodes.
http://ertekprojects.com/gurdal-ertek-publications/
https://link.springer.com/article/10.1007/s10729-014-9293-z
Health financing in bangladesh why changes in public financial management rul...HFG Project
Bangladesh has achieved remarkable improvement in health indicators since its independence in 1971, despite poor economic conditions. It achieved Millennium Development Goal 4 on child mortality and progressed substantially toward Goal 5 on maternal mortality, even with health system bottlenecks such as weak governance, insufficient health financing, and limited capacity to address local need. In a country with a history of adopting low-cost strategies with high health impact, focusing on primary health care—even with limited resources—was the single most important factor in these achievements.
Factors Affecting Consumer Health Care Services Delivery in Private Health Fa...AI Publications
Background: In 2007, the government of the republic of Tanzania has launched the Primary Health care services development programme as one of the renewed efforts to effectively engage the healthy sector in poverty reduction strategies. The study was dealing with evaluation on the factors that affects health services delivery to private hospital facilities Method: Data was collected from 169 patients who are customers of KMH and two sampling techniques were used, namely purposive sampling and random sampling. The study use questionnaire and interviews together with documentary review together information concerning the study objective. Quantities data were analyzed through SPPS data were coded ruined to observe to which percent the variables were significant or not significant towards research objectives. Results: The study finding that there are factors that are challenges towards delivering health services to patients including absence of good communication, customer care, shortage number of health professionals and most of patients are not attended on time, however on other hand study discover that there factors pull health services delivery including presence of social media, good infrastructures that support patients from far and presence of NHIF services to KMH. Recommendations: This study recommends that Private Public Partnership should be more emphasized and applied in health sector for the aim of improving health survives delivery to patients. Conclusion: The study concludes that although much has been done over many years to restructure the health care system and to improve the quality of care being rendered to patients, the literature reveals that a lot of people in Mwanza city still suffer from getting quality health services from health facilities including hospitals which are owned by private institutions.
About Healthcare system of Bangladesh: Health care delivery is a daunting challenge area of the Bangladesh’s healthcare systems. The Health
care system in Bangladesh falls under the control of the Ministry of Health and Family Planning. The
government is responsible for building health facilities in urban and rural areas.
The document discusses pay for performance (P4P) incentives in healthcare and their impact on quality, cost, and financing. It provides background on quality improvement efforts and defines key concepts like structure, process, and outcomes. It then outlines current legislation and initiatives like the Affordable Care Act that link reimbursement to quality metrics. P4P aims to change how care is delivered and financed to improve outcomes while reducing waste. However, it also impacts providers' finances as payments may decrease for preventable readmissions or hospital-acquired conditions.
1) The document examines how customer demographics (age, gender, religion) influence consumer preferences for private health services in Nakuru County, Kenya.
2) It reviews Kenya's public and private healthcare systems and shifts toward increasing patient satisfaction, autonomy, and demand for quality care.
3) The study uses a descriptive survey design and questionnaires to collect data from 136 patients at private hospitals on how demographics relate to their preference, finding a weak but statistically significant relationship between the variables.
Innovative social enterprise, rural health, India Infrastructure Report 2014Poonam Madan
It is a moot issue just how much time and resources can get used up by social entrepreneurs in seeking public partnerships to scale their work, while it would be in the interest of the nation for governments to examine, identify and work with them.
Policy Brief: What Steps Are Countries Taking To Implement Pro-Poor Universal...HFG Project
Universal health coverage (UHC)—ensuring that everyone has access to quality, affordable health services when needed—can be a vehicle for improved equity, health, financial well-being, and economic development. In its 2013 report, Global Health 2035: A World Converging within a Generation, the Commission on Investing in Health made the case that pro-poor pathways towards UHC, which target the poor from the outset, are the most efficient way to achieve both improved health outcomes and increased financial protection (FP). Countries worldwide are now embarking on health system changes to move closer to achieving UHC, often with a clear pro-poor intent.
Much has been written about what steps countries have taken and are currently taking to: (1) set and expand guaranteed services, (2) develop health financing systems to fund guaranteed services and ensure FP, (3) ensure high-quality service availability and delivery, (4) improve governance and management of the health sector, and (5) strengthen other aspects of health systems to move closer to UHC. As background for a meeting on UHC implementation, held at the Rockefeller Foundation’s Bellagio Center, Italy, from 7–9 July 2015, we reviewed this body of literature, and conducted interviews with global UHC implementers and researchers. In this short policy brief, we synthesize the key messages from the literature and interviews.
The purpose of this presentation is to equip audiences with the ability to:
Define universal health coverage (UHC) and understand the basic tenets of UHC
Identify how UHC fits in USAID’s health and poverty reduction strategies
Effectively communicate to country stakeholders how USAID can support a country’s progress towards UHC
Identify relevant UHC resources within the Office of Health Systems and USAID
The presentation is part of the “UHC Toolkit” and accompanies Universal Health Coverage: An Annotated Bibliography, and Universal Health Coverage: Frequently Asked Questions.
The document discusses the healthcare industry and provides context for analyzing delays in patient discharge processes at a hospital from May to July 2015. It describes the objectives of studying delays, the sample size, tools used, and limitations. It then provides an overview of the global healthcare industry, key segments including hospitals, providers and professionals, models for healthcare delivery, and the market size of the industry in different regions. Porter's five forces model is applied to analyze competition in the healthcare industry.
This document summarizes a presentation on health financing strategies for achieving universal health coverage given by Sourav Goswami and moderated by Dr. Subodh Gupta at MGIMS, Sevagram on June 8th, 2017. The presentation discusses key aspects of health financing policy including universal health coverage goals of access, quality, and financial protection. It covers topics such as revenue raising, risk pooling, purchasing of health services, benefit package design, and principles of rationing health resources. Examples from countries like Moldova and Chile are provided. The current scenario of health financing in India is also summarized, highlighting high levels of out-of-pocket spending and a need to increase public financing to achieve equitable access to
http://www.wpro.who.int/asia_pacific_observatory/hits/myanmar_pns1_en.pdf
What are the challenges facing Myanmar in progressing towards Universal Health Coverage?
https://www.irrawaddy.com/specials/challenges-impede-development-of-myanmars-public-health.html
Challenges Impede Development of Myanmar’s Public Health
https://europa.eu/capacity4dev/capacity-building-in-public-health-for-development/document/health-sector-reforms-myanmar-giving-more-space-public-health-interventions-ncds
Health Sector Reforms in Myanmar, giving more space for public health interventions for NCDs
The National Academies Health and Medicine DivisionAbout U.docxdennisa15
The National Academies
Health and Medicine Division
About UsPublicationsActivitiesMeetings
Announcement
Crossing the Quality Chasm: The IOM Health Care Quality Initiative
In 1996, after releasing America's Health in Transition: Protecting and Improving Quality, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care.
The first phase of this Quality Initiative documented the serious and pervasive nature of the nation's overall quality problem, concluding that "the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering" (Chassen et al., 1998).
IOM Definition of Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
This phase built on an intensive review of the literature conducted by RAND to understand the scope of this issue (Schuster) and a framework was established that defined the nature of the problem as one of overuse, misuse and underuse of health care services (Chassen et al). More specifically, the report Ensuring Quality Cancer Care (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.
During the second phase, spanning 1999-2001, the Committee on Quality of Health Care in America, laid out a vision for how the health care system and related policy environment must be radically transformed in order to close the chasm between what we know to be good quality care and what actually exists in practice. The reports released during this phase—To Err is Human: Building a Safer Health System(1999) and Crossing the Quality Chasm: A New Health System for the 21st Century(2001)—stress that reform around the margins is inadequate to address system ills.
The series of IOM quality reports have included a number of metrics that illustrate how wide the quality chasm is and how important it is to close this gulf, between what we know is good quality care and what the norm is in practice.
To Err is Human put the spotlight on how tens of thousands of Americans die each year from medical errors and effectively put the issue of patient safety and quality on the radar screen of public and private policymakers. The Quality Chasm report described broader quality issues and defines six aims—care should be safe, effective, patient-centered, timely, efficient and equitable—and 10 rules for care delivery redesign.
Phase three of the IOM's Quality Initiative focuses on operationalizing the vision of a future health system described in the Quality Chasm report. In addition to the IOM, many others are working to create a more patient responsive 21st century health system, including clinicians/ health care organizations, employers/consumers, foundations/research, government agencies, and quality organizations. This collection of efforts focus reform a.
1Running Head CRITICAL THINKING NEW HOSPITAL PROPOSALCR.docxfelicidaddinwoodie
1
Running Head: CRITICAL THINKING: NEW HOSPITAL PROPOSAL
CRITICAL THINKING: NEW HOSPITAL PROPOSAL 2
Introduction
The system of healthcare in most of the countries is national based healthcare system whereby the government offers health care services to the public using governmental agencies. In Saudi Arabia for example, there are some growing private healthcare facilities. The government of many nations remains the full controller of the healthcare sectors both private and public. The private hospitals are both non-profit and profit for example in Saudi Arabia, most of these private hospital attracts several expats. Both the standards of both private and government hospitals are of more similarity. Some of the private healthcare facilities are of the world class but with poor health service delivery (Penm,2015).
Comparing and Contrasting the Legal Structure and Governance of the Profit and Non-profit international entities
Differences
The selected international entities include the Joint Commission International (non-profit), International Hospital Federation (non-profit) and the Kaiser Permanente (non-profit and profit). The legal structure of the Joint Commission International (JCI) follows the certification and accreditation of the hospital. The hospital must be evaluated first to see if the hospital complies with the standards and meets the activities needed by this entity. There are accreditation programs that any hospital must go through. This is then followed by the certification which can either be based on associated health care organization (Joint Commission, 2016). On the other hand, the International Hospital Federation requires a formal and documented request addressed to the Chief Executive Officer for one to be a member. The legal structure of Kaiser Permanente is consisting of two or three independent legal entities in each region of California (Finz, 2012). The applying employee must have been hired as a new Kaiser Permanente for an award-eligible post.
The governance of the International Hospital Federation is consisting of three organs i.e. the general assembly, governing council, and the executive committee. There are also the designated positions which consist of the president, chairman designate, immediate past president, treasurer, and the chief executive officer (International Hospital Federation, 2015). On the other hand, Kaiser Permanente is consisting of entities with each entity having its management and governance structure. There are regional entities and twelve Permanente Medical groups which were created by the Permanente Federation. The role of the Permanente is to standardized patient care as well as the performance (Finz, 2012). The governing of JCI is under the leadership of the President and the chief executive officer (Matt, 2011).
Advantages of the Entities
Join Commission International provides a wide variety of health care programs l ...
discussion on Health Economics and Health Care in our country and abroad, and what resources are given by the private sectors and with the very scarce help from the DOH, national and local government, and from the support given by WHO.
Lannes - Improving health worker performance The patient-perspectivelaurencelannes
PBF programs in developing countries aim to improve health worker performance through financial incentives tied to meeting targets. This document analyzes data from a PBF program in Rwanda to assess its impact on patient satisfaction. It finds that PBF had a positive effect on satisfaction with clinical services by improving productivity, availability, and competencies of health workers. PBF also positively impacted satisfaction with non-clinical dimensions, suggesting it incentivized improvements in those areas as well. The study concludes PBF can be an effective strategy for increasing patient satisfaction if programs include assessing satisfaction in their incentive mechanisms.
Community-based health financing: CARE India's experience in the maternal an...Siddharth Agarwal
Abstract
In a rural Indian population beset with inadequate health access to people owing to socio-cultural and economic factors, CARE India under the Maternal andInfant Survival Project encouraged village women to form Community Based Oragnisations (CBOs) and collectively save funds for health.
15 months of implementation showed that CBOs were formed in 345 of 447 project villages and health funds were operational in 203. 292 persons benefited from health funds through loans for treatment. 56% loans being repaid within the grace/low interest period.
The experience shows that village women when appropriately encouraged are capable of evolving rules and managing health funds. The process empowers village women (through access to resources and information and the strength of social capital) to take decisions and act to improve their well being.
Health funds have been have proved to be useful in addressing obstetric complications, infant illnesses and have also led to additional initiatives (social marketing of disposable delivery kits, village drug bank and plugging gaps in government supplies), that improve health care.
Similar to Data Analysis ....Stepping Towards Achieving Universal Health Coverage(UHC) by SSK.pptx (20)
Donation for a Poor Elderly Woman's.pptxSERUDS INDIA
Seruds is taking care of nutritious food thrice daily, accommodation, timely healthcare, clothes, recreation like tv, radio, devotional music, etc. By providing her with these minimum basic things, she is able to live with dignity and she feels grateful to Seruds for their support. In this regard, she also needs your support and for her well-being so that she can lead the rest of her healthy life happily
Donate Us
https://serudsindia.org/elders/sponsor-an-elderly-woman-in-seruds-old-age-home/
#oldagehome #donatefoodforelders, #middaymealsforelders #monthlygroceriesforelders #mealsforelders #groceriesforoldagehome, #seruds, #kurnool, #donategroceriesforelders, #sponsorgroceriesforelders, #donatefood, #donategroceries, #charity
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
Hive Overview Deck 2024 by Lito Garin EstemberLitoGarin1
Go paperless and transform your procurement process with the Hive Collaborative app.
I am reaching out to introduce you to an exciting opportunity to streamline and enhance your procurement process through the use of the innovative Hive Collaborative App.
Hive Collaborative App is a cutting-edge procurement software that is designed to simplify and automate the entire procurement process, from requisition to purchase order creation. By utilizing this app, your government unit can save time, reduce paperwork, increase efficiency, and improve transparency in your procurement activities.
Benefits of using Hive Collaborative App include:
1. Centralized procurement platform: All procurement activities can be managed from one centralized platform, making it easier to track and monitor all purchases.
2. Customizable workflows: Tailor the app to meet the specific needs and requirements of your government unit, ensuring a seamless and efficient procurement process.
3. Real-time collaboration: Enable seamless communication and collaboration between different departments involved in the procurement process, improving coordination and decision-making.
4. Compliance and transparency: Ensure compliance with relevant regulations and improve transparency by creating audit trails of all procurement activities.
We would be delighted to provide you with a personalized demonstration of the Hive Collaborative App and discuss how it can benefit your government unit. Please let us know if you would be interested in exploring this exciting opportunity further.
Thank you for considering the Hive Collaborative App for your procurement needs. We look forward to the opportunity to work with you and help you revolutionize your procurement process.
Best regards,
LITO GARIN ESTEMBER
09810066226
Active Digital Twins for Critical Infrastructure_ What & Why_.pptxStarr Long
Active Digital Twins are real-time virtual representations of real world spaces & data (people, vehicles, objects, weather, etc.) that provide actionable insights. In this talk we will explain why you would build one (versus a traditional dashboard) for Critical Infrastructure (Ports, Utilities, Airports, Emergency Dispatch Centers, etc. ) & how they differ from regular Digital Twins (that are focused on simulation). We'll show an example of an Active Digital Twin being used today- in the real world, for the Port of Corpus Christi- to manage Security Incidents & Cargo Flow (called OPTICS).
Active Digital Twins reduce the cognitive load it takes to process data while decreasing the amount of time to assess the overall context.
Active Digital Twins merge multiple systems into a single "pane of glass" and therefore provide faster & more accurate overall context assessment.
Active Digital Twins improve security, resiliency, safety, efficiency, & the environmental impact of critical infrastructure over traditional methods.
OPTICS is high-resolution, dynamic 3D Active Digital Twin of the Port of Corpus Christi (PCCA). OPTICS displays active vessel presence and movement information from ship transponders (AIS) and security information to provide a cohesive and tactical overview of Port situational awareness in real-time. The project is funded through a Port Security Grant from FEMA.
OPTICS is a custom solution built with The Acceleration Agency’s Project Gemini Active Digital Twin platform.
This video was captured on July 18 2024.
NOTE: Displayed Computer Aided Dispatch data and security locations (gates and cameras) is synthetic to comply with CJIS requirements.
Current features include:
ArcGIS Custom Elevation Data: Coastlines and Water Display
ESRI / ArcGIS 3D Building Layer: Docks, Buildings, Refineries, etc.
ESRI / ArcGIS Feature Layers: 3 Types
ESRI / ArcGIS Maps Base Layers: 6 Types
ESRI / ArcGIS Maps SDK for Unity
Facility Information: Name, Location, Type, Description
AIS: Vessel Locations, Types, Sizes, Headings, Images
NOAA Ports: Aid to Navigation Sensor Data
CAD: Computer Aided Dispatch System
USCG Marsec level
Weather.gov: Current Weather and Forecasts
View more on our website https://taa.io/#/optics and use contact@taa.io for a demo.
#activedigitaltwin #intelligentinfrastructure #innovation #3d #digitaltwin #porttechnology #portsecurity #digitalization
UTOPIAN EXPERIMENT: The Blueprint for Modern Governance .pptxSAMASI ANDERSON
In the present form of political system, politicians jeopardize the welfare of its citizens for
political gains. They implement policies that are of massive negative effects on citizens in a
near future but positive at immediate for political gains (e.g. re-election), such as
indiscriminate borrowing, creation of temporal jobs, indiscriminate reduction of interest rates,
favoring of few (mostly to fund campaigns). For instance, the British Prime Minister will always get whatever law, policy,
reform etc. it wants from both the Legislature and Executive arms, The American president
will get whatever it wants from the Legislature and the Executive because the American vice president is the head of the Legislature and it will be more autocratic if same party has a majority in the House of Representatives. And the head of the Judiciary is an appointment made by the Executive and the Legislature, a single ideology, which is a single person.
From the American and British established political systems, the believed existence of
separation of power is a delusion.
Proper education is birth rights of all the girlsSERUDS INDIA
Every year, we distribute the educational material kits to these girls. The education kit contains School bag, Long and Short Note Books, Dictionary, Shoes, Socks, Pencils, Erasers, Writing Pad, branded school uniforms, Sketch Pens, Geometry Box, Colour Pencils, etc.
Donate Us
https://serudsindia.org/sponsor-a-child/donate-education-material/
#sponsorforgirlchild, #donateforgirleducation, #girlchildeducation, #ngochildeducation, #donateforeducation, #donationforchildeducation, #sponsorforgirlchildeducation, #onlinegirlchildeducation, #educationforgirlchild, #seruds, #charitydonation, #kurnool, #educationkitforgirlchild
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
Data Analysis ....Stepping Towards Achieving Universal Health Coverage(UHC) by SSK.pptx
1. Stepping Towards Achieving Universal
Health Coverage(UHC) by Promoting Special
Health Care System in Rural Bangladesh: A
Study on Shasthya Surokhsha
Karmasuchi(SSK)
Fahmida Mridha- 214i414i
Graduate School of International
Cooperation Studies(GSICS)
Kobe University
1
2. BACKGROUND
According to (W.H.O)- Universal Health Coverage promotes quality health service to all without financial hardship. It
includes full range of essential health service including health promotion, prevention, treatment, rehabilitation and
palliative care.
Ensuring universal health coverage is a big challenge for Bangladesh. However, government targets a successful
implementation of SDG goal-3 “Health For All” and its 13 targets including UHC by 2030.
The direct payment by oneself for health expenditure in Bangladesh is about 67% of total health expenditure(Mustafa
et al., 2018) and it is having an upward trend. Around 17% of the households face catastrophic health expenditure due
to direct payment for health which push around 5 million Bangladeshis into poverty every year (khan et.al, 2017).
Such expanding health expenditure leading to financial impoverishment results to an economic burden in the path of
development. But if we can reduce these health expenditure for the vulnerable people who are below poverty line, we
can maintain the stream of our current economic growth. At the same time successful implementation of SDG 1 (No
poverty), 2 (Zero hunger), 4 (Quality education) will also be easier.
2
3. BACKGROUND
As an initial step, special health care project (SSK) is inaugurated to ensure a better health service without financial
hardship for vulnerable people of 3 subdistricts of Tangail district. Each household is provided with an electric health
card providing US$ 620 coverage/year against a government premium of US $12. SSK ensures cost-free inpatient
treatment for various non-communicable diseases (78 types) with a free transportation cost for referral facility in
District Hospital. It also provides with free drug and diagnostic facility. Hospital bed and food is also at free cost.
People also has access to a grievance authority for complaining on the quality of the services.
Key Actors for service assurance:
1. SSK Cell (Management body). It performs administrative task, finance management, benefit package
management, grievance process, monitoring and evolution.
2. Supporting Body: Green Delta Insurance. It select the people below poverty line for providing card, facilitate
the subdistrict hospital in claim reimbursement process.
3. District Hospital and 3 Sub-district hospitals. 3
4. BACKGROUND
There has been some study done on this government project. Since it’s a pilot project it requires more research work
in terms of evaluation of ensuring UHC. The study aims at assessing whether this special health care service can
cover all the dimensions of UHC or not. Additionally, this study will try to identify the problems and challenges for
further scale up in other sub-districts.
Research Question
1. To what extent is SSK capable of meeting the service coverage requirements to the card holders ?
2. To what extent is SSK capable of reducing direct payment for health expenditure (OOP) to ensure financial
protection to the beneficiaries?
3. What are the challenges in implementation of SSK? What are the challenges in ensuring better Services under
SSK?
4
5. Literature Review
Gotsadze et al. (2015)- An impact evaluation of medical insurance for poor in Georgia: preliminary result and policy
implications
Ensuring equity in health sector is a big challenge and many countries have started health insurance scheme
to ensure easy access to health care. However, channeling state premium for the poor through private insurance
company to ensure special health care or special health insurance scheme is a new phenomenon to the target of
ensuring UHC.
To evaluate the impact of MIP this paper used 3 sets of outcome variables in regression model:
Service utilization
Direct health expenditure (OOP) and
Odds of receiving free benefits without copayments.
(self reported due to the limitation noted in literature review)
Cont
…5
6. Literature Review
Service utilization:
Utilizing any services (self treatment/ preventive /or curative/out-patient care) due to illness during the 30 days
period of interview.
Utilization of inpatient service for last 1 year.
Direct health expenditure (OOP)
Average cost per out-patient visit
Average cost per inpatient stay
Monthly cost for self treatment/chronic disease management
All health care related expenditure faced by individual for 1 month
Odds of receiving free benefits without copayments
Socio-demographic variables (age, Gender, education, marital status, household size, consumption level)
Cont…
6
7. Literature Review
Using descriptive statistics of this socio-demographic variables the impact of MIP on different groups were explored.
This paper concluded that MIP had an important role in improving equity among citizen by reducing out of pocket
expenditure (direct payment) and thus providing financial benefits to the poorest. However, MIP could not have
significant role in service utilization to the poor. It suggested that the urban poor people had better access to service
coverage compared to rural poor. Causes detected are-
Service supply
Public awareness of MIP and its benefits
Providers responsiveness
Private insurer behavior.
7
8. Literature Review
Siddiqui et al. (2019)- Role of Social Health Protection in Universal Health Coverage: A case study of Rawalpindi,
Islamabad
This study is based on cross-sectional data which is collected through questionnaire. Researcher used Socio-
economic conditions, food and non-food expenditure, health care expenditure, health service coverage, financial
protection indicators and demographic condition as variable.
To assess the performance of Social Health Protection for UHC; guideline was taken from “Tracking UHC: Global
monitoring report”. Service coverage :3 preventive and 3 treatment indicators were selected from this guideline.
Financial protection Catastrophic expenditure
Impoverish health expenditure
8
9. Literature Review
Financial protection
Somanathan et al., (2013)- Integrating the Poor into Universal Health Coverage in Vietnam
Health coverage for poor people under Social Health Insurance (SHI) was not successful. It could neither
lower direct payment nor improve financial protection. Rather it led to a case of impoverishment for the poor who
had a minimum income and assets.
The cause behind this was including of government subsidy along with main insurance system. Moreover,
there was a fragmentation of funding across different groups.
Nakazawa & Moji (2018)- What is needed to realize universal “health” coverage? The meaning of health revisited
Financial support are not sufficient for ensuring UHC and also requires organized and well-equipped hospital
facilities.
9
10. Literature Review
Financial Protection
Devadasan et al., (2013)- Promoting universal financial protection: evidence from the Rashtriya Swasthya Bima
Yojana (RSBY) in Gujarat, India
Analyzed the extent to which RSBY contributes to Universal health coverage by protecting households from
OOP payments and suggested that it could provide partial financial protection only.
Details of OOP expenditure was measured under Direct health expenditure for buying medicine, diagnosis,
consultation fees, Hospital charges; and Indirect health expenditure for food, travel, informal fees. Payment for
buying medicine and diagnosis were the main causes detected for poor financial protection.
10
11. Literature Review
Challenges
Lahariya (2018)- ‘Ayushman Bharat’ Program and Universal Health Coverage in India
Ayushman Bharat (AB) Program gave emphasis on successful use of human resources of health sector.
Challenges detected are- Recruitment of health service providers.
Proper identification and enrolment of health beneficiaries to avoid fraud.
Proper assessment of the service provided.
Well functioning IT platform and trained staff.
11
12. Literature Review
Ahmed et al., (2018)- Evaluating the implementation related challenges of Shasthyo Suroksha Karmsuchi
(health protection scheme) of the government of Bangladesh: a study protocol
Implementation related challenges-
Problems in selection process of BPL
Availability of necessary equipment, drugs, logistics for providing service
Scarcity of human resources
Referrals problem
Fund management difficulties
Barrier in claim management
12
13. Financial Factors
Contextual Factors
Financial Protection
Service Coverage &
Challenges
UHC
Adopted and modified from
WHO cubic model for UHC
Devadasan et al., (2013)
Gotsadze et al. (2015)
Ahmed et al., (2018)
Conceptual Framework
14. Variables for Financial Factors: (Will be taken by INTERVIEW from 20 patients selected by PURPOSIVE SAMPLING who have
taken health care service under SSK.)
1.Expenditure during Hospitalization
Direct expenditure during hospitalization
Direct payment for medicine
Direct payment for diagnosis/ Lab. Test
Direct payment for hospital bed/ Accommodation
Direct payment for food
Indirect expenditure
Informal Fees
2.Source of health expenditure
SSK/ Own/ SSK& Own/ Borrow/Sold asset
Cont….. Adopted and modified from Gotsadze et al. (2015) and Devadasan et al., (2013)
14
15. Variables for Financial Factors
3.Monthly income of card beneficiary.
4.Total health care expenditure per year.(per month)
Adopted and modified from Gotsadze et al. (2015) and Devadasan et al., (2013)
Variables for Contextual Factors: UHFPO(1), Doctors(3),Nurses(2), UNO, Chairperson (elected by people) will be interview = 8 people by KII
1.Medicine Availability
2.Diagnosis/Laboratory Facility
3.Transportation Facility during referral to district hospital
4.Problems related to Fund Management
5.Manpower/Human resources
6. Limited Types of inpatient treatments
7.Limited number of beds
8. Poor Infrastructure of hospital
9. Poor coordination 15
16. Methodology
•Method: Qualitative (Exploratory)
•Study area: Kalihati (Subdistrict of Tangail District) where SSK project is running.
•Study population : Patients who have received inpatient care after being enrolled as card beneficiary
•Sampling: Purposive
•Data collection: Interview
•Respondents:
I. Twenty SSK card beneficiaries who received inpatient care after being enrolled.
II. Three Doctors currently providing service.
III. Two Nurses currently providing service.
IV. Upazilla/ Sub-district Health and Family Planning Officer (UHFPO).
V. Upazilla/Sub-district Executive Officer (UNO).
VI. Upazilla/ Sub-district Chairperson ( People’s Representative)
16
17. Capability of SSK in reducing direct payment for health expenditure (OOP) to ensure financial protection to the
beneficiaries?
17
Expenditure during hospitalization
None of the admitted patient had to pay any direct or indirect money for availing health service.
Usual willingness to seek health consultation
Seven of Twenty patient Usually seek help for health care consultation from SSK.
Another Seven seek help from both SSK and Private.
Rest of them seek help to private hospital or other sources.
A large portion of respondents who seek health care facility other than SSK opined that they also preferred other sources since they needed
to buy medicine unless a case of admission.
Major Source of health expenditure
Only for two patient SSK is the only major source of health expenditure.
For Ten patient major source of health expenditure is both SSK and Own. There are also incidence of borrowing and selling asset.
A considerable number of the respondents said that consultation from SSK was free. However, medicine is not provided at free cost unless
admitted. Moreover, those drugs are not provided from general outdoor service of sub-district hospitals. So, they needed to buy.
Health Care Expenditure
Some respondents have annual health expenditure which is above 50,000TK and majority of them seek consultation from both SSK or
SSK and private.
Considerable number of respondents have monthly health expenditure which is half of their monthly income or even more than
that.
18. Summary of Findings
Capability of SSK to meet the service coverage requirements to the card holders.
18
Contextual Factors
Drugs and diagnosis facilities
As a primary health care center drugs and diagnosis facilities provided for the listed inpatient care is sufficient. However,
the number of listed treatments is not sufficient. List should add more services including outpatient care to meet the
actual demand of BPL. ( 3 Doctors)
One of the doctors mentioned that update of the operating principle including financial management is needed for better
assurance of the services to the targeted population.
Sufficient availability of drugs, laboratory facilities. (2 Nurses)
Ensure drugs and diagnosis for limited inpatient care only. To ensure the actual goals of financial protection for the
BPL, outpatient service should be included along with increase of the list for inpatient care. (UHFPO)
19. What are the challenges in ensuring better Services under SSK?
Contextual Factors
Limited Types of inpatient
treatments
• Doctors opined that convincing patient about the limited inpatient service delivery is a big
challenge. Sometimes they also demand for outpatient service. (3 Doctors)
• As a peoples’ representative feel the need to add outpatient service.(UHFPO)
Limited number of beds • Sometimes overload of admitted patient create pressure on ensuring bed for SSK patient.
(Doctor 3 & Nurses)
Ensure Transportation for
referral cases
• Written in provision but practically does not exist (UHFPO)
Scarcity of Human
Resources
• All the doctors demanded for increase of human resources.
• Two of them informed that Doctors recruited under SSK is posted somewhere else and is
absent for a long time. So, all the extra official writings in the admission form needs to be
written by the doctors recruited under Bangladesh Civil Service (BCS). They added that
this painful situation interferes their regular routine work. However, this over task could
also be minimized by use of ICT based consultation system.
• UHFPO assured to the scarcity of cleaning staffs.
• Inadequate supply of cleaning staffs delay service delivery. (Nurse 1)
19
20. What are the challenges in ensuring better Services under SSK?
Contextual Factors
Fund Management Sometimes delayed but does not have any noticeable interference with the service
delivery. (Chairperson and UHFPO)
Poor Infrastructure of hospital It is essential to improve overall infrastructure of the sub-district health complex to
ensure quality health service by reducing out of pocket payment for BPL(UHFPO).
Poor coordination Reservation of information (UNO)
Poor response from Headquarter and insufficient coordination meetings ( Peoples
representative- Chairperson).
20
21. Findings on Financial Protection
There is no doubt that SSK is beneficiary to BPL. Its success lies in reduction of out pocket expenditure during
hospitalization. However, there are instances of borrowing or selling asset among the respondents which indicates this
targeted population need more support with health care service to meet the actual target of UHC.
There are also instances where a large portion of their monthly income goes for treatment of their family members. A
considerable number of family have annual health expenditure above 50000 BDT.
SSK has limited number of inpatient care which needs to be expanded to ensure more beneficiaries to receive the
service only from SSK. Moreover, addition of outpatient service can attract more receiver (BPL) to rely on the service
from SSK only.
Findings of Service coverage and challenges in ensuring better health care service
Drugs and diagnosis facilities are sufficient to meet the demand of the admitted patient under the limited list of
inpatient care. However, infrastructural development of the hospital along with bed and transportation facilities need to
be ensured. Human resources are another essential elements which need to be increased for a better health service
delivery. ICT based consultation system can minimize the over task load of Doctors.
Due to the covid situation coordination meetings were not regular. However, this could be overcome by use of ICT.
21
22. BIBLIOGRAPHY
Ahmed, S., Hasan, Z., Ahmed, M. W., Dorin, F., Sultana, M., Islam, Z., Mirelman, A.J., Rehnberg, C., Khan, J.A.M., Chowdhury, M. E. (2018).
Evaluating the implementation related challenges of Shasthyo Suroksha Karmasuchi (health protection scheme) of the government of
Bangladesh: a study protocol. BMC Health Services Research, 18: 552.
Devadasan, N., Seshadri, T., Trivedi, M., & Criel, B. (2013). Promoting universal financial protection: evidence from the Rashtriya Swasthya Bima Yojana
(RSBY) in Gujarat, India. Health Research Policy and Systems, 11(1), 1-8.
Gotsadze, G., Zoidze, A., Rukhadze, N., Shengelia, N., & Chkhaidze, N. (2015). An impact evaluation of medical insurance for poor in Georgia:
preliminary results and policy implications. Health policy and planning, 30: i2-i13.
Khan, J. A., Ahmed, S., & Evans, T. G. (2017). Catastrophic healthcare expenditure and poverty related to out-of-pocket payments for healthcare in
Bangladesh an estimation of financial risk protection of universal health coverage. Health policy and planning, 32(8), 1102-1110.
Lahariya, C. (2018). ‘Ayushman Bharat’program and universal health coverage in India. Indian pediatrics, 55(6), 495-506. Retrieved from
https://link.springer.com/content/pdf/10.1007/s13312-018-1341-1.pdf
Mustafa, A., Rahman, A., Hossain, N., Begum, T. (2018). Bangladesh National Health Accounts 1997-2015 (BNHA-V).
file:///C:/Users/Dell/Downloads/BNHA1997-2015%20(2).pdf
Nakazawa, M., & Moji, K. (2018). What is needed to realize universal “health” coverage? The meaning of health revisited. Journal of Global Health
Reports, 2, e2018021.
Siddiqui, M. H., Khattak, F. H., Khan, M.I. (2019). Role of Social Health Protection in Universal Health Coverage: A Case Study of
Rawalpindi, Islamabad. Health Economics Working Paper No 1. Retrieved From
https://pide.org.pk/pdf/HealthEconomics/WorkingPaper-Hira.pdf
Somanathan, A., Dao, H. L., & Tien, T. V. (2013). Integrating the poor into universal health coverage in Vietnam. Retrieved From
https://openknowledge.worldbank.org/bitstream/handle/10986/13315/74945.pdf?sequence=1&isAllowed=y
22