Financing reproductive health in Bangladesh

Bangladesh is the signatory of both, International Conference on Population and Development (ICPD) programme of action and Millennium Development goals (MDGs). The Government of Bangladesh has set ambitious agendas for improving Reproductive Health (RH) services, to achieve the targets till 2015. In Bangladesh, poor access to services, both primary and tertiary care, low quality services, high rate of maternal mortality and child malnutrition are the key challenges in achieving MGDs. An equitable and efficient use of financial resources is essential for the adequate implementation of these agendas to achieve MGDs for reproductive health. This paper discusses the financing for reproductive health in Bangladesh based on various secondary sources including National Health Accounts. The budget allocation for Reproductive Health (RH) and Family Planning (FP) is around 11 per cent of the total health budget. Among RH providers, nearly 48 per cent of the expenditure is incurred through Family Planning Centres, which are key providers for reproductive health services in Bangladesh. General hospitals and outpatient care centres are providers for 23 per cent and 21 per cent expenditure respectively. A large proportion the total expenditure on service provision for RH is spent through the government system, which includes donor support channelled through the government system under pooled funding. The donor expenditure on population assistance in Bangladesh showed fluctuations in the past, but is showing increasing trend for last three to four years. Of the total donor expenditure, almost half is distributed through multilateral channels, one-third through NGOs in 2008, and remaining through bilateral channels. The role of multilateral channels has increased since 2006. Out of pocket spending constitutes a significant proportion (around 65 per cent) of the total spending on reproductive health. The study suggests that Bangladesh needs to increase spending on RH in order to achieve MDG 5. Due to resource constraints, the GOB is currently in a position to contribute only one-fourth of the total estimated budget needed for implementing the RH related operational plans, while the rest is considered to be the funding gap, and needs to be ensured from external sources.