DHAKA -- In the footsteps of India's ambitious program to extend public health insurance to 500 million citizens, Sheikh Hasina, prime minister of neighboring Bangladesh, has set out plans to similarly cover her 155 million-plus constituents.
Hasina announced to parliament last week that a small pilot insurance program would be expanded first to almost one-third of the population and then to the rest of the country by 2032.
"This should be taken as an important matter," said Hossain Zillur Rahman, executive chairman and founder of the Dhaka poverty policy advocacy group Power and Participation Research Center. "Health insurance is essential for both the rural and urban poor."
Bangladesh's economy has been one of the fastest growing in the world in recent years, bringing the country up to middle-income status by World Bank standards. Health care, however, has lagged far behind.
Until now, the government has spent less on health than almost any other, with per capita spending equivalent to just 1% of gross domestic product or less than half the average $75 per person India pays out.
Most Bangladeshis rely on public hospitals, which are overburdened and short of staff -- and charge for their services. Bangladeshis thus end up covering 67% of health costs themselves, with less than 1% carrying insurance. An estimated 5 million citizens fall into poverty each year due to medical bills, according to the World Health Organization.
Under the pilot phase of what is officially known as the Health Protection Program but already nicknamed "Hasinacare," the government is underwriting insurance coverage for about 80 health conditions for some 80,000 families with incomes below $2 a day in three subdistricts around Dhaka.
The coverage, via private local insurer Green Delta Insurance, costs $12 a year and provides up to $600 for tests and treatment, from either public hospitals or private clinics.
The next phase will extend coverage to another 48 million of the poor by 2021. Covering this tab will cost the government around $1.9 billion over the next four to five years, estimated Syed Adul Hamid, a professor and director of the Institute of Heath Economics at Dhaka University.
"Money is not an issue," Hamid said. "What matters is the implementation."
Money though is clearly an issue for the poor. Nashu Mia, a Dhaka slum resident who works for the city sewer operator, said he has long felt scared that someone in his family of four might get sick and require care that he cannot afford. Given that even insurance premiums are beyond his finances, "The government help will benefit us."
Under the new plan, the government would next bring insurance to around 22 million people working for established companies. These workers would need to pay their own premiums, though the cost would likely be partly subsidized.
Already, a $9 million South Korean government aid grant is helping bring cover to the families of 100,000 tea plantation workers in Bangladesh's northeast. SNV Netherlands Development Organization, a private Dutch aid group, is working on an insurance program for clothing factory workers.
By 2032, Dhaka hopes to cover the remainder of the population, largely those dependent on farming or informal employment.
While insurance executives say Hasinacare will provide a welcome boost, both insurers and health care providers will need more skilled staff to make the program work, observers say. The country needs to double its number of doctors just to meet the World Health Organization's minimum standard of one physician per 1,000 people.
"We cannot remove the health sector's problems overnight," said Shahadt Hossain Mahmud, director general of the government Health Economics Unit which is overseeing the pilot insurance program. While admitting Bangladesh is lagging in some key health areas, he said the country has had success with programs for boosting vaccination rates and life expectancy, opening community clinics, and reducing child and maternal deaths.
In her speech to parliament, Hasina said the government will spend $1.36 billion through 2022 to add more community health clinics and hospital beds.