Cooperative societies: a sustainable platform for promoting universal health coverage in Bangladesh

Correspondence to Abdur Razzaque Sarker; [email protected] Bangladesh is among the most densely populated countries in the world and has enjoyed a steady annual economic growth of 5–6% for more than a decade. According to the Bangladesh economic review, the incidence of poverty has declined considerably from 56.7% in 1991–1992 to 24.8% in 2015. The demographic structure of Bangladesh is changing more rapidly. The population pyramid is slightly narrower at the bottom than the middle, and the youngest age group constitutes more than half of the population. In addition, the increasing per capita income has resulted in heightened demand for public and private sector health services. Bangladesh has made good progress in almost all of the health-related Millennium Development Goals (MDGs). A new universal set of goals—the Sustainable Development Goals (SDGs)—to eradicate poverty, fight inequality and injustice, protect the earth and advance prosperity by 2030 was launched on 1 January 2016. While it seems that the SDGs are less health oriented than the MDGs, the SDGs have the potential to be a game changer in global health, given that achieving universal health coverage (UHC) is among the core objectives of the health SDG. Based on the UHC theme, all people who need health services should receive them without undue financial hardship and should have 100% financial protection from out-of-pocket payments by 2030. 7 Although introducing UHC remains challenging in resource-poor settings, countries such as Thailand, Rwanda and Mexico have proved that UHC is not only achievable by high-income countries only, but that commitment and political obligation also make it possible to advance on the path towards UHC. Thailand, Rwanda and Mexico have shown that political prioritisation of UHC has yielded major gains in health and financial protection for their citizens. However, Bangladesh is not starting from zero. The government of the People’s Republic of Bangladesh already designed a healthcare financing strategy for 2012–2032 to move towards the long-term objective of UHC. Meanwhile, a community-based health scheme combined with microhealth insurance is being tested in different parts of the country. The coverage of existing community-based health insurance or microinsurance prepayment schemes currently serve as an interim measure for social health protection and the plan is that they will gradually expand towards greater coverage of the entire population. A holistic approach is necessary because population coverage is among the key dimensions of UHC, that is, nobody should be left out of the shelter of health coverage. In light of this dimension, Summary box