Impact of Maternal and Child Health Private Expenditure on Poverty and Inequity in Bangladesh: Bangladesh Facility Efficiency Survey 2011 - Technical Report A

The efficiency and cost of Ministry of Health and Family Welfare (MOHFW) healthcare services in Bangladesh are critical constraints on how far the Government of Bangladesh can expand healthcare coverage in the country. Regular information can assist MOHFW in improving the efficiency of service delivery. The Bangladesh Facility Efficiency Survey (FES) 2011 surveyed the services and costs in a nationally representative, stratified sample of 135 Ministry of Health and Family Welfare (MOHFW) facilities. The sample included medical college hospitals (MCHs), specialized hospitals, district hospitals, general hospitals, upazila (subdistrict) health complexes (UHCs), maternal and child welfare centers (MCWCs), and union subcenters. Service indicators and recurrent unit costs for outpatient and inpatient services were estimated for fiscal year (FY) 2010, and assessments are made of efficiency gains since 1997, when the last Bangladesh Facility Efficiency Survey was conducted. The FES 2011 shows that there are high levels of utilization in all major types of inpatient facilities, with bed occupancy averaging 80%-100% at UHCs and MCHs, and over 100% at district hospitals. Since 1997 patient throughput has substantially increased, and been accommodated by significant improvements in operating efficiency, reflected in a decline in average lengths of stay across all facilities. Quality of care seems not have been negatively impacted, as case fatality rates have substantially improved since 1997. There has been little increase in real terms in facility operating budgets since 1997, so overall unit costs have been reduced substantially to one-half to one-third of 1997 levels. The findings suggest that the MOHFW delivery system has not only expanded delivery of services in the past decade, but that much of the increase has been financed through efficiency gains.