Universal health: Higher out-of-pocket costs curb coverage

Universal health coverage (UHC) in Bangladesh is still a major concern as it remains hamstrung by a big burden of significant out-of-pocket healthcare expenses, particularly for medicines.

This pressing issue was the focus of an expert debate on Thursday, bringing together key stakeholders from the pharmaceutical industry, regulatory bodies, public health experts and policymakers.

The debate styled 'Holistic Strategy to Ensure Affordable Medicine Supply Chains towards Realising UHC' was co-hosted by the Power and Participation Research Centre (PPRC) in partnership with health-advocacy platform UHC Forum and with the support of UNICEF.

The debate saw active participation from representatives of the Directorate General of Drug Administration (DGDA), pharmaceutical industry leaders, healthcare professionals and supply chain experts.

The stakeholders underscored the need for a robust regulatory framework, ethical pricing mechanisms and stronger supply chains to ensure equitable access to life-saving medicines.

They also stressed the need for stronger regulatory enforcement and ethical marketing practices to curb exploitative pricing.

The debate, chaired and moderated by PPRC chairman and UHC Forum convener Hossain Zillur Rahman, highlighted critical gaps in procurement, supply chain management and drug administration.

According to experts, medicine affordability remains a key challenge due to unregulated pricing, excessive promotional expenditure and the lack of a structured pricing framework.

Calls were made to update the list of essential drugs, strengthen regulatory agencies like the DGDA and leverage digital tracking systems to improve supply chain efficiency.

The discussion also underscored ethical concerns surrounding the aggressive drug marketing as pharmaceutical companies invest heavily in promotional activities rather than lowering production costs to benefit consumers.

Additionally, inefficiencies within regulatory bodies and supply chain entities such as the Essential Drugs Company Limited (EDCL) and the Central Medical Stores Depot (CMSD) have further exacerbated access issues.

Prof Dr Liaquat Ali of Health Sector Reform Commission, Dr C Soloman of UNICEF, MEFW additional secretary Md Abdus Salam Khan, Ashraf Hossain, DGDA director (admin), Md Zahid Alam of Incepta, Md Abu Shah Jamal Molla of MSH, Khairul Anam of UNICEF, Dr Touhid Anwar of CMSD, Shishir Morol of Prothom Alo, Brig Gen Mahbubur Rahman Bhuiyan, supply chain consultant of National Heart Foundation, Shaikat Kumar, deputy director of DGDA, Fida Mehran of UNICEF and Dr Mohibullah were present.

Addressing the event, Mr Salam Khan emphasised the need to make essential medicines affordable while maintaining quality, warning that a lack of quality medicines could lead to serious consequences.

He also highlighted concerns about overprescription and stressed the importance of a well-regulated supply chain to ensure optimal production and distribution.

Mr Ashraf Hossain said, "Our efforts to ensure quality medicine is ongoing. Our lab is well-equipped, and if any medicine is found to be substandard, we issue alerts to inform the public. We continuously monitor the quality of medicines."

In his concluding remarks, Mr Hossain Zillur called for a better understanding of the cost drivers of medicine prices, and where regulatory and supply chain deficits lie, including the role and efficiency of EDCL, CMSD and DGDA.

Expanding the list of essential drugs and ensuring regulatory oversight over pricing while fostering an efficient and competitive pharma industry and addressing prescription practices and patient literacy are priority actions that should come into reform focus, according to him.

The key recommendations from the debate will be submitted to the reform commission to drive informed policy interventions.

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