Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders
Abstract Background Community-based health insurance (CBHI) is a part of the health system in Bangladesh, and overcoming the obstacles of CBHI is a significant policy concern that has received little attention. The purpose of this study is to analyze the implementation barriers of voluntary CBHI sch...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-08561-7 |
| _version_ | 1811265138473304064 |
|---|---|
| author | Nurnabi Sheikh Eunice Twumwaa Tagoe Raisul Akram Nausad Ali Susan Howick Alec Morton |
| author_facet | Nurnabi Sheikh Eunice Twumwaa Tagoe Raisul Akram Nausad Ali Susan Howick Alec Morton |
| author_sort | Nurnabi Sheikh |
| collection | DOAJ |
| description | Abstract Background Community-based health insurance (CBHI) is a part of the health system in Bangladesh, and overcoming the obstacles of CBHI is a significant policy concern that has received little attention. The purpose of this study is to analyze the implementation barriers of voluntary CBHI schemes in Bangladesh and the strategies to overcome these barriers from the perspective of national stakeholders. Methods This study is exploratory qualitative research, specifically case study design, using key informant interviews to investigate the barriers of CBHI that are faced during the implementation. Using a topic guide, we conducted thirteen semi-structured in-depth interviews with key stakeholders directly involved in the CBHI implementation process. The data were analyzed using the Framework analysis method. Results The implementation of CBHI schemes in Bangladesh is being constrained by several issues, including inadequate population coverage, adverse selection and moral hazard, lack of knowledge about health insurance principles, a lack of external assistance, and insufficient medical supplies. Door-to-door visits by local community-health workers, as well as regular promotional and educational campaigns involving community influencers, were suggested by stakeholders as ways to educate and encourage people to join the schemes. Stakeholders emphasized the necessity of external assistance and the design of a comprehensive benefits package to attract more people. They also recommended adopting a public–private partnership with a belief that collaboration among the government, microfinance institutions, and cooperative societies will enhance trust and population coverage in Bangladesh. Conclusions Our research concludes that systematically addressing implementation barriers by including key stakeholders would be a significant reform to the CBHI model, and could serve as a foundation for the planned national health protection scheme for Bangladesh leading to universal health coverage. |
| first_indexed | 2024-04-12T20:18:18Z |
| format | Article |
| id | doaj.art-921c227abb264cfc9707ee810dea0657 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-12T20:18:18Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-921c227abb264cfc9707ee810dea06572022-12-22T03:18:04ZengBMCBMC Health Services Research1472-69632022-09-0122111310.1186/s12913-022-08561-7Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholdersNurnabi Sheikh0Eunice Twumwaa Tagoe1Raisul Akram2Nausad Ali3Susan Howick4Alec Morton5Department of Management Science, Strathclyde Business School, University of StrathclydeDepartment of Management Science, Strathclyde Business School, University of StrathclydePopulation Studies Division, Bangladesh Institute of Development Studies (BIDS)Population Studies Division, Bangladesh Institute of Development Studies (BIDS)Department of Management Science, Strathclyde Business School, University of StrathclydeDepartment of Management Science, Strathclyde Business School, University of StrathclydeAbstract Background Community-based health insurance (CBHI) is a part of the health system in Bangladesh, and overcoming the obstacles of CBHI is a significant policy concern that has received little attention. The purpose of this study is to analyze the implementation barriers of voluntary CBHI schemes in Bangladesh and the strategies to overcome these barriers from the perspective of national stakeholders. Methods This study is exploratory qualitative research, specifically case study design, using key informant interviews to investigate the barriers of CBHI that are faced during the implementation. Using a topic guide, we conducted thirteen semi-structured in-depth interviews with key stakeholders directly involved in the CBHI implementation process. The data were analyzed using the Framework analysis method. Results The implementation of CBHI schemes in Bangladesh is being constrained by several issues, including inadequate population coverage, adverse selection and moral hazard, lack of knowledge about health insurance principles, a lack of external assistance, and insufficient medical supplies. Door-to-door visits by local community-health workers, as well as regular promotional and educational campaigns involving community influencers, were suggested by stakeholders as ways to educate and encourage people to join the schemes. Stakeholders emphasized the necessity of external assistance and the design of a comprehensive benefits package to attract more people. They also recommended adopting a public–private partnership with a belief that collaboration among the government, microfinance institutions, and cooperative societies will enhance trust and population coverage in Bangladesh. Conclusions Our research concludes that systematically addressing implementation barriers by including key stakeholders would be a significant reform to the CBHI model, and could serve as a foundation for the planned national health protection scheme for Bangladesh leading to universal health coverage.https://doi.org/10.1186/s12913-022-08561-7Community-based health insuranceImplementation barriersNational health protection schemeUniversal health coverageBangladesh |
| spellingShingle | Nurnabi Sheikh Eunice Twumwaa Tagoe Raisul Akram Nausad Ali Susan Howick Alec Morton Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders BMC Health Services Research Community-based health insurance Implementation barriers National health protection scheme Universal health coverage Bangladesh |
| title | Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders |
| title_full | Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders |
| title_fullStr | Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders |
| title_full_unstemmed | Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders |
| title_short | Implementation barriers and remedial strategies for community-based health insurance in Bangladesh: insights from national stakeholders |
| title_sort | implementation barriers and remedial strategies for community based health insurance in bangladesh insights from national stakeholders |
| topic | Community-based health insurance Implementation barriers National health protection scheme Universal health coverage Bangladesh |
| url | https://doi.org/10.1186/s12913-022-08561-7 |
| work_keys_str_mv | AT nurnabisheikh implementationbarriersandremedialstrategiesforcommunitybasedhealthinsuranceinbangladeshinsightsfromnationalstakeholders AT eunicetwumwaatagoe implementationbarriersandremedialstrategiesforcommunitybasedhealthinsuranceinbangladeshinsightsfromnationalstakeholders AT raisulakram implementationbarriersandremedialstrategiesforcommunitybasedhealthinsuranceinbangladeshinsightsfromnationalstakeholders AT nausadali implementationbarriersandremedialstrategiesforcommunitybasedhealthinsuranceinbangladeshinsightsfromnationalstakeholders AT susanhowick implementationbarriersandremedialstrategiesforcommunitybasedhealthinsuranceinbangladeshinsightsfromnationalstakeholders AT alecmorton implementationbarriersandremedialstrategiesforcommunitybasedhealthinsuranceinbangladeshinsightsfromnationalstakeholders |