The National Health Care Financing Strategy provides the framework for financial protection in Bangladesh with the long-term aim to achieve universal coverage. To support the process of building the future social health protection model, the SSK (Shasthyo Surokhsha Karmasuchi) social health protection scheme was developed by the HEU with support from the German Development Cooperation through KfW.
Through a Social Safety Nets program approach, the overall objectives of the project are (1) to ensure that the poor population of the pilot region is using the health facilities more frequently for the treatment of the insured diseases; (2) to ensure that the scheme’s demand-sided approaches of health financing will have long-term structural impacts on an institutional level beyond the pilot area.
On behalf of KfW and the HEU of the Government of Bangladesh, KfW has contracted the consortium of OPM, m4h, Institute of Health Economics (IHE) of the University of Dhaka and AOK Consult to implement the project titled “Accompanying measure to the Health, Population and Nutrition Sector Development Programme (HPNSDP)”. The objective of this technical assistance programme is to support the HEU of the MoHFW to implement the piloting of social health protection scheme in three sub-districts in Bangladesh.
Scope of Work
To move towards the achievement of this objective, the TA Team of management4health will work within the consortium and the HEU/SSK-Cell on the implementation of the following tasks:
- Design modification/reorientation of the scheme; broaden enrolment, ensuring private public provider mix, ensuring actuarially sound premium setting, readjustment of the insurance benefit package
- Support the setup of IT hardware and Scheme Operator; design of IT module and data requirements (patient records) and general financing.
- Support the development of an IT based Management and Information System (MIS); including grievance and cost containment policies and systems.
- Establish Quality Management System; develop/review existing clinical guidelines and minimum quality standards for services:
- Elaborate a simplified payment scheme for health care providers based on the DRG (Diagnosis Related payment) DRG-like system for inpatient services;
- Review existing cost for Basic Benefit Package, define terms and conditions for reimbursements to service providers (billing system and controlling)
- Assist with the implementation of a fraud-proofing strategy for financial management; electronic cataloguing, procedures of claims processing, service provision supervisions.
- Elaborate a patients’ rights chart and establishment of a grievance system;
- Elaborate quality /accreditation standards for hospitals and health centres operating under the scheme to be contracted by the SSK
- Assist with the establishment of a Health Insurance Information System (HIIS)
- Support the development and implementation of a legal and regulatory framework for the SSK Scheme
- Develop and implement training programme for relevant staff in the hospitals; on implementing clinical guidelines, handling of IT equipment and financial procedures.
- Provide recommendations for further development / improvement of the scheme and future scale-up.