Health challenges more complex than ever
Though billed as a successor to the widely-known Millennium Development Goals (MDGs), the new global goals - SDGs or Sustainable Development Goals - push humanity's ambitions much further and much wider. A particularly striking feature of the SDGs is the scaled-up focus on health as a cross-cutting strategic agenda. Health is a poverty driver if unaddressed and can also be a growth driver if addressed holistically. Advancing effectively on this multi-dimensional significance of the health agenda requires a level of stakeholder mobilisation and engagement that goes far beyond traditional sectoral constituencies.
In recognition of the rising strategic importance of the health agenda, UN has declared December 12 as Universal Health Coverage Day. Universal Health Coverage or UHC is the new global vocabulary but this is hardly new since many constituent activities have been in operation in varying degrees. However, what is certainly new is the far greater emphasis placed on the strategic importance of the health agenda, and of aiming for results that are a sum greater than its parts.
Four meta-trends are converging to invest the health agenda with greater strategic urgency. Climate change is raising the spectre of new health risks. Unplanned urbanisation is producing unprecedented consequences for air and water pollution as well as elevating injuries and road fatalities into a 21st century epidemic. Sedentary lifestyles, stresses of modern living as well as shrinking commons have ushered in an epidemiological transition. Non-communicable diseases or NDCs - diabetes, cardio-vascular diseases, cancer, respiratory diseases, birth defects, trauma - now pose the bigger health challenge accounting for over sixty percent of mortalities. The persistently high level of out-of-pocket (OOP) expense burden has elevated financial risk of healthcare into an entrenched source of economic shocks for the poor and middle classes alike. Each of these meta-trends individually and collectively are elevating health into a simultaneously more urgent and more complex challenge.
Advocacy on UHC in Bangladesh thus far have yielded four important insights: firstly, UHC is not a one-stop target but only meaningful if understood as a progressive goal for a country like Bangladesh, secondly, while the broad principles of UHC - access, affordability, quality - hold across countries, creating a contextualised and shared vision on how to advance on the path to UHC is equally important, thirdly, UHC success will lie not only in adoption of appropriate policies but also in the practical pursuit of innovative solutions both big and small, and fourthly, the UHC agenda can become a game-changing social agenda only if it simultaneously prioritises health promotion i.e. the preventive agenda, as much as accessible, affordable and quality healthcare i.e. the curative agenda.
Bangladesh already has many health sector successes such as in child and maternal mortality. However, many of the successes so far have come through stand-alone vertical programmes that progressed despite system weaknesses. Today's UHC challenges such as those emanating from NCD and OOP burdens as well as the under-focused agenda of health promotion and healthy lifestyles present a different level of complexity that demand newer cross-sectoral conversations and coalitions. A narrowly sectoral vision is no longer adequate. Focused multi-sectoral conversations amongst the medical community, civic actors, local governments, economists, private sector and policy-makers are a 'must' if the right solutions are to be identified and carried forward. Such conversations are already underway but require far greater momentum and strategic focus.
A health balance-sheet for Bangladesh shows several pluses. These include reduction in child and maternal mortality, increased life expectancy, near-eradication of open defecation, a pluralistic healthcare delivery system that combines public, private and social sectors extending down to the grass-roots, growth of a domestic pharmaceutical industry, and, policy visibility on selected agendas such as disability. Important and striking as these achievements are, they are no guarantee for overcoming the critical challenges in the next round of health priorities facing Bangladesh such as non-communicable diseases, out-of- pocket expense burdens and new pandemic health risks of climate change. For example, Bangladesh has a reasonably adequate health infrastructure but it is producing sub-optimal outcomes due to poor inter-tier linkage, low workforce motivation, inefficiencies in resource-use and gaps in awareness particularly as they pertain to non-communicable diseases. At the same time, a rapidly urbanising Bangladesh is facing acute new challenges in urban sanitation, absence of a comparable level of public health infrastructure for the urban poor and a largely unaddressed and rising problem of mental health among others.
Ministries and experts are no doubt at work. But success on the next round of health challenges hinges on a larger cross-sectoral conversation and effort. Not just about cure but also about prevention, not just longevity but healthy life. On this day of December 12 that the global community has earmarked for the enhanced significance of the health agenda, it may be fitting to recalibrate the national ambition for graduating into a middle income country from a narrow focus on GDP growth rates to a more holistic dream that embraces a healthy Bangladesh.
The author is executive chairman at Power and Participation Research Centre (PPRC) and a former advisor to the caretaker government.