Centre of Excellence on Universal Health Coverage
James P Grant School of Public Health, BRAC University
Coordinator, Timothy G. Evans
Overview:
To accelerate evidence informed, equitable and sustainable action towards Universal Health Coverage (UHC) in Bangladesh and globally, a Centre of Excellence on Universal Health Coverage (Centre) based at the James P. Grant School of Public Health (JPG SPH) has been established with generous support from the Rockefeller Foundation.
The Centre will serve both as a national and global catalyst for evidence informed policy and practice and the development of country-based cadres necessary to implement UHC. The Centre will also work with a broad coalition of partners within Bangladesh and internationally on advancing practical efforts to accelerate Universal Health Coverage.
The Centre will contribute three critical ingredients to the broader agenda that fit with its comparative advantages of being an academic institution nested in a world-renowned, entrepreneurial NGO, BRAC, and working in close partnership with a premiere international research centre, ICDDR,B. These ingredients include:
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essential evidence necessary to guide the design of UHC policies and programs and to monitor and evaluate their implementation;
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core competencies for effective policy and practice towards UHC acquired through on-the-job and pre-service training;
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a UHC Forum providing key stakeholders with a continuous opportunity for reporting and learning on best practices for
UHC.
The Centre will act as a co-secretariat for the Global Task Force on UHC ensuring strong Southern leadership and facilitating a synergistic interface between the work in Bangladesh and efforts towards UHC regionally and globally.
What is meant by Universal Health
Coverage?
According to the World Health Organization, universal coverage of health care means that everyone in the population has access to appropriate promotive, preventive, curative and rehabilitative health care when they need it and at an affordable cost. Universal coverage thus implies equity of access and financial risk protection.
UHC in Bangladesh
In Bangladesh, despite excellent coverage in some essential public health interventions e.g. immunization or TB treatment, there remain significant shortfalls related to universal health coverage. There is very limited coverage of an essential package of services especially related to secondary and tertiary care. Similarly financial protection is very limited with almost 70% of health expenditure paid directly by patients from their pockets resulting in millions of persons being pushed into poverty annually. The NGO community has found that a primary reason for failure of micro-credit to lift members out of poverty is catastrophic expenditure on illness within the family. .Moreover, less than 1% population has coverage of formal insurance.
Nevertheless, growing demands from the public for comprehensive care and increased recognition of the need for equitable and sustainable financing is fostering much interest in UHC. The Government of Bangladesh has begun discussion on comprehensive health insurance and is actively exploring pilot mechanisms in social insurance as well as ramping up universal coverage of community clinics. NGOs such as Grameen Kalyan, BRAC, GK and others have been piloting micro-health insurance schemes. The WHO, with partners, has piloted a demand -side financing scheme through provision of vouchers for maternity care and the World Bank is examining different modalities of enhanced social protection in health working with large employers e.g. garment industry.
The role of a School of Public Health.
With this favourable but challenging global and national context, what is it the role for a School of Public Health in furthering UHC? How can a School of Public Health make a difference? A school of public health through the creation of a centre of excellence on UHC can generate essential evidence, train appropriately skilled workers, and foster learning through knowledge sharing: three critical inputs to informed policy and action related to UHC. These inputs have the potential to enhance the efficiency, sustainability and speed of implementation of UHC efforts. Furthermore, given the public goods nature of these vital ingredients to UHC - evidence, competencies and knowledge sharing - the contribution to change is relevant not only in Bangladesh but in many low and middle-income countries that aim to achieve UHC. Engagement of critical UHC stakeholders in the activities of the Centre helps to insure the relevance of the evidence, training and knowledge sharing functions. Furthermore, a dedicated Centre can help to sustain evidence, training and knowledge sharing efforts over time recognizing that the road to UHC is both long and full of unexpected twists and turns.
Core Programs of the Centre.
The centre of excellence on UHC will generate essential evidence, train appropriately skilled workers, and foster learning through knowledge sharing: three critical inputs to informed policy and action related to
UHC.
1. Essential Evidence:
The evidence program will focus on three areas of research for UHC: descriptive; design and delivery. The descriptive research will assess levels, trends and determinants of UHC. The design research will look at how policy and programs for UHC can be informed by evidence. The delivery research will assess the bottlenecks and opportunities encountered in implementing efforts to achieve UHC. The essential evidence activities will be focused primarily on UHC in Bangladesh, however, where appropriate cross-country comparative research collaboration will be undertaken.
2. Core Competencies:
To address the scarcity of national capacity and expertise related to the design and implementation of mechanisms for UHC, the JPGSPH will develop a menu of training opportunities for the acquisition of core UHC competencies. The Centre will undertake a comprehensive needs assessment of the spectrum of individual and institutional capacities required for UHC systems. Together with key partners (government, NGOs and private companies providing health care or health insurance), priorities for training will be agreed. A menu of training opportunities is expected including: a) a new module in the Masters of Public; b) a short-course aimed at government workers; and c) larger scale training linked to the rolling out of UHC efforts in various regions of Bangladesh through the network of BRAC training centres across Bangladesh.
Recognizing the need for depth expertise and faculty leadership in UHC, a Professor of UHC position will be created at the School along with the creation of a PhD program.
3. UHC Forum:
The evidence and competencies must be part and parcel of an on-going dialogue with interested parties on UHC and strongly linked to the mainstream of health and development policy in Bangladesh especially in the context of the new 5 year plan for Health Nutrition and Population beginning in 2012. To this end, a "Bangladesh Forum for Universal Health Coverage" will be created. This Forum would meet regularly throughout the year to discuss specific challenges and opportunities related to UHC and to promote information exchange and the development of a common agenda inclusive of both the evidence and competency dimensions above.
The Forum will host annual international workshops on UHC with strong participation from the South/South-east Asian Region, The UHC Forum will facilitate linkages with international initiatives such as the Joint Learning Network on UHC and the Global Symposium on Health Research.
