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Evaluating the implementation related challenges of Shasthyo Suroksha Karmasuchi (health protection scheme) of the government of Bangladesh: a study protocol

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  • Sayem Ahmed
  • Md. Zahid Hasan
  • Mohammad Wahid Ahmed
  • Farzana Dorin
  • Marufa Sultana
  • Ziaul Islam
  • Andrew Mirelman
  • Clas Rehnberg
  • Jahangir A.M. Khan
  • Mahubi Elahi


Publication details

JournalBMC Health Services Research
DateAccepted/In press - 27 Jun 2018
Number of pages9
Original languageEnglish


Rapidly increasing healthcare costs and the growing burden of noncommunicable diseases have increased the out-of-pocket (OOP) spending (63.3% of total health expenditure) in Bangladesh. This increasing OOP spending for healthcare has catastrophic economic impact on households. To reduce this
burden, the Health Economics Unit (HEU) of the Ministry of Health and Family
Welfare has developed the Shasthyo Surokhsha Karmasuchi (SSK) health
protection scheme for the below-poverty line (BPL) population. The key actors in
the scheme are HEU, contracted scheme operator and hospital. Under this
scheme, each enrolled household is provided 50,000 BDT (620 USD) coverage
per year for healthcare services against a government financed premium of 1000
BDT (12 USD). This initiative faces some challenges e.g., delays in scheme
activities, registering the targeted population, low utilization of services, lack of
motivation of the providers, and management related difficulties. It is also
important to estimate the financial requirement for nationwide scale-up of this
project. We aim to identify these implementation-related challenges and provide
feedback to the project personnel.
This is a concurrent process documentation using mixed-method approaches. It
will be conducted in the rural Kalihati Upazila where the SSK is being
implemented. To validate the BPL population selection process, we will estimate
the positive predictive value. A community survey will be conducted to assess
the knowledge of the card holders about SSK services. From the SSK
information management system, numbers of different services utilized by the
card holders will be retrieved. Key-informant interviews with personnel from
three key actors will be conducted to understand the barriers in the
implementation of the project as per plan and gather their suggestions. To
estimate the project costs, all inputs to be used will be identified, quantified and
valued. The nationwide scale-up cost of the project will be estimated by applying economic modeling.
SSK is the first ever government initiated health protection scheme in
Bangladesh. The study findings will enable decision makers to gain a better
understanding of the key challenges in implementation of such scheme and
provide feedback towards the successful implementation of the program.

Bibliographical note

© The Author(s). 2018

    Research areas

  • Shasthyo Surokhsha Karmasuchi, Health protection scheme, Implementation challenges, Implementation research, Process documentation, Research protocol, BANGLADESH

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