The impact of out-of-pocket expenditures on poverty and inequalities in use of maternal and child health services in Bangladesh: evidence from the household income and expenditure surveys 2000–2010

The impact of out-of-pocket expenditures on poverty and inequalities in use of maternal and child health services in Bangladesh: evidence from the household income and expenditure surveys 2000–2010

Bangladesh needs to increase the supply of medicines in public facilities so the poor can utilise maternal healthcare

The Government of Bangladesh is committed to ensuring access of its population to adequate healthcare services. However, substantial inequalities exist in maternal and child health outcomes in Bangladesh, with child and maternal mortality rates being much higher in the poorest families than in the non-poor.

The current paper clarifies that the major factor driving this inequality is the perceived cost of obtaining treatment at public and modern providers. In addition, the reduced likelihood of poorer and less educated families recognising their ill children as sick and needing treatment is another reason.

Findings are that:

  • the treatment of children at Ministry of Health and Family Welfare facilities is as or more expensive as at private doctors, and much more expensive than at pharmacies and traditional providers
  • higher costs of treatment explain why most sick children are taken to pharmacies or traditional providers, where they are unlikely to receive appropriate treatment
  • overall out-of-pocket expenditures by families to obtain medical care frequently impoverish them

The author suggests that if the government wishes to target additional resources to improve access for the poor, an effective option would be to substantially reduce their out-of-pocket expenditure burden. This can be achieved by increasing the supply of medicines in public facilities through increased budget allocations and more efficient supply systems.
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