Dr Bardan Jung Rana
On the occasion of the Public Health Association of Bangladesh (PHAB) annual scientific conference this year, I am honoured to address the critical theme “Health Systems Strengthening: Solutions for Tomorrow”. Over the past months, all health systems across the world have been facing the double burden of containing and mitigating the spread of COVID-19 and ensuring the delivery of essential health services. This great challenge has brought to light the vulnerabilities and gaps in many health systems worldwide. Inadequate supply systems have affected the capacity to effectively respond to the pandemic, sustain the delivery of essential health services and restore socio-economic activities. Following these months of emergency and uncertainty, it is of the utmost importance to focus on our further steps, outline strategic solutions to strengthen health systems and ensure we are adequately prepared to effectively respond to these challenges in the future. Since the beginning of the pandemic, and as of 29 August 2021, more than 216 million people have been affected by COVID-19 worldwide, and 4.5 million of them have died because of it. In Bangladesh, over 1.4 million cases were confirmed, and more than 25 000 people died, accounting for 1.7% of the total deaths. The impact of the pandemic has been very high, everywhere. It has reminded us how central and vital health is in our daily lives, both as individuals and in society. It has also emphasized the key role many other sectors have in the response effort, as health is interconnected with all the aspects of our living. Therefore, health challenges need to be addressed through a “whole of society and whole of government approach”. The Agenda 2030 recognizes health as a global priority, enunciating the Sustainable Development Goal #3: “Ensure healthy lives and promote well-being for all at all ages”, ultimately aiming at Universal Health Coverage. The pandemic and its consequences have reiterated the importance of resilient health systems to achieve these goals. A robust health system should not only design and facilitate the delivery of healthcare services, but also operate at a broader and more strategic level by ensuring fairness, equity and equality in access to care and reducing catastrophic health expenditure through financial risk protection. The health systems in Bangladesh must be strengthened and made more resilient, not only to be ready to absorb and effectively respond to similar outbreaks in the future but also to adequately address long-term challenges, such as the impact of climate change on health, the increasing burden of non-communicable diseases and population ageing, among the others. Such problems can only be efficiently tackled through holistic policy reforms, able to address the social determinants of health adequately. Decisive and choral actions are required to guarantee effective and participatory leadership promoting comprehensive primary health care response to health and multisectoral plans and policies across government sectors and key stakeholders, including community participation. It is essential to maintain adequate information systems and flows and to ensure the stability of health system funding through countercyclical health financing mechanisms and reserves. Furthermore, no health system can be strong and resilient without an appropriate level and distribution of human and physical resources and a motivated and wellsupported workforce. The need for these actions and conditions is of the utmost importance in a country like Bangladesh, where COVID-19 has further impacted pre-existing gaps in the health system. In Bangladesh, the Government expenditure on health is only 3% of the total expenditure, with one of the lowest public spending indices globally, at about 0.68%. In the Universal Health Coverage Index, Bangladesh is positioned as 53, one of the lowest in the South-East Asian Region. In terms of qualified health workforce density, Bangladesh has a threshold density of 9.9 doctors, nurses, and midwives per 10 000 population, whereas the global median density is 48.6. A recent study indicates that one-third of the total healthcare providers in the country are unqualified and unrecognized. Though significant progress has already been made in digital governance systems, progress towards building a robust health care information system including interoperability is warranted. Faculty and HR shortage, lack of career path, mal-distribution, ad-hoc planning, skill mix imbalance, rural retention are all hindering the optimal performance of the national health system. There is a long way to go to achieve SDG #3 and Universal Health Coverage, and it can only be a successful path if we walk it together, cooperating and supporting each other. WHO is committed to working closely with the Government of Bangladesh and the development partners to collectively build a resilient health system on the strong foundations of Comprehensive primary health care vision to achieve these goals. COVID19 has proven how interconnected we all are and how critical it is to efficiently work together. We will keep doing so to prepare for upcoming challenges and ensure we are stronger in the future.