2014年-世界发展银行全球_Bangladesh_Governance_in_the_Health_Sector___A_Systematic_Literature_Review_134页_3mb

Summary of Bangladesh Governance in the Health Sector: A Systematic Literature Review

Core Content

This working paper presents a systematic review of the literature on governance in the health sector of Bangladesh, conducted by the World Bank between 2000 and 2014. The review aims to provide insights into governance practices and challenges, focusing on public financial management (PFM), human resource management (HRM), organizational effectiveness, control of corruption, and voice and accountability. It highlights the lack of recent and quantitative peer-reviewed research, relying instead on a mix of formal and informal sources.

Main Points from the Literature

1. Government Effectiveness

• Public Financial Management (PFM):

  • The literature indicates that Bangladesh's health sector budget is around 4.87% of GDP, down from 6.87% in 2007-08.
  • Budget execution is poor, with an execution rate of only 73.32% in FY 2011/12 due to procurement delays, capacity issues, and centralized procedures.
  • There is a need for further research into the planning process, informal budget preparation, and challenges in executing the development budget.

• Human Resource Management (HRM):

  • High vacancy rates for health professionals, especially in remote areas, with an average of 23.7% and ranging from 5.7% to 47.7% across districts.
  • The issue is attributed to factors such as low job satisfaction, compressed wage scales, and complex recruitment and transfer procedures.
  • There is a growing number of medical graduates, but many do not join the public sector due to poor working conditions and low pay.
  • The literature calls for more detailed studies on HRM practices, including informal recruitment and transfer methods.

• Organizational Effectiveness:

  • Limited literature exists on organizational effectiveness, focusing mainly on the Health Sector SWAp and the division between DGHS and DGFP.
  • The continued division of responsibilities highlights resistance to reform by government bureaucracies.
  • There is a need to examine decentralization and the division of roles, especially regarding urban health care.

2. Control of Corruption

• Corruption is a significant concern, with issues such as illegal fees, incorrect prescriptions, and informal payments by MoHFW officials.
• The literature suggests that while some progress has been made, corruption remains prevalent in procurement and facility-level operations.
• There are gaps in understanding the root causes of corruption and the effectiveness of control measures.

3. Voice and Accountability

• Voice and accountability initiatives are limited and often face implementation challenges such as lack of citizen mobilization and government responsiveness.
• Unofficial oversight bodies also struggle with similar issues.
• The mobile feedback system under DGHS has been introduced but only addresses mild complaints.
• The need for national-level voice and accountability research and more detailed impact assessments is emphasized.

4. Regulatory Quality

• The private health sector includes a variety of providers, from commercial hospitals to village doctors and traditional healers.
• The government has a regulatory legal framework, but implementation is weak.
• Regulatory bodies such as the Bangladesh Medical and Dental Council and Bangladesh Nursing Council lack independence and capacity.
• There is a need for more research on the regulation of private health care and pharmaceuticals, including quality of care and drug management.

Key Findings

• Budget Resources: The government allocates over a billion US dollars to the health sector annually, but the management of these resources is lacking in transparency and effectiveness.
• Staffing Issues: High absenteeism and vacancies, especially in rural and remote areas, are major challenges.
• Corruption: Corruption in procurement and service delivery remains widespread, with informal payments and illegal fees being common.
• Private Sector Role: The private health sector is large and diverse, yet the government's role in regulating and supporting it is under-researched.
• Research Gaps: There is a need for more comprehensive and up-to-date studies on governance in the health sector, particularly on decentralization, voice and accountability, and the outcomes of current initiatives.

Recommendations for Future Research

• Focus on the role of government in overseeing and supporting the private health sector.
• Examine the effectiveness of public urban health care and the impact of institutional arrangements.
• Investigate the causes and effects of health staff vacancies, including wage levels and HR processes.
• Conduct a Public Expenditure Tracking Survey to better understand drug distribution and management.
• Study the implementation of voice and accountability initiatives at the national level.
• Explore the regulatory quality and capacity of government bodies in the health sector.
• Improve knowledge management and data transparency for better governance research.

Conclusion

The review underscores the importance of improving governance in the health sector of Bangladesh. It identifies several key areas where further research is needed to enhance transparency, accountability, and effectiveness in public health management. The literature suggests that while some progress has been made, there are still significant challenges that require deeper analysis and targeted interventions.