A World Bank (WB) report says that the rate of extreme poverty in Bangladesh in 2024 is projected to rise to 5.1 per cent from 4.9 per cent in 2023. The extremely poor, according to the WB, are the segment of the population that earns US$2.15 a day. Similarly, there are also the moderately poor, who earn US$3.65 a day in purchasing power parity, which compares the purchasing power of different currencies taking into account the price level differences between two countries. And in 2024, the number of people who are projected to join the ranks of the moderately poor is 840,000, the WB report further goes. In sum, more people are now becoming poor, both extreme and moderate, in Bangladesh. Going by the standard set by the WB, it is expected that even the extreme poor should daily earn US$2.15, which is around Tk258 a day. But if an extremely poor person who is the breadwinner of a household fails to find work on a particular day, the members of that household are likely to starve on that day. In this connection, the WB pointed out that the main causes of extreme poverty are high inflation which affects consumption, especially of food. According to Statista, a global data and business intelligence platform, unemployment rate in Bangladesh in 2024 is forecast to be 5.09 per cent, with the number of the unemployed at 3.98 million. So, a large segment of the unemployed run the risk of starvation in Bangladesh.
Now, the WB report only gives an idea of how difficult it is for the extremely poor persons and their families to survive with the insignificant amount of money they might earn. Notably, the poor households spend more than 50 per cent of their earning on food. With food getting still costlier due to runaway inflation, its (food's) share of the family budget may go still higher leaving little for meeting other unavoidable expenses such as health emergencies. The WB report has highlighted the role high inflation is playing in rendering people poorer. But there are also other more powerful factors that are behind the growing level of pauperisation in society. Loss of land due to river erosion, natural calamities like drought, downpour, flood, heatwaves and so on have, of late, been affecting the rural communities at higher frequencies than before. These are on top of the traditional causes of poverty in the rural communities that include transfer of land from small landholders like peasants to the neo-rich. In fact, the global literature on poverty is rather rich. Be that as it may but that does not mean that there should be no further work on identifying other factors, often not listed in the mainstream research, pushing the people with modest income into the category of moderate to the extremely poor one overnight. Meeting healthcare cost is one such issue.
A Bangladesh Bureau of Statistics (BBS) found that Catastrophic Health Expenditure (CHE) among the Bangladeshi households was 26 per cent in 2016-17. CHE is the amount of healthcare-related expenditures people make from their own pockets, also called Out-Of-Pocket (OOP) spending that exceeds 10 per cent of their total income or family expenditures. What is concerning is that a study based on the Household Income and Expenditure Survey (HIES) of BBS shows that the public's CHE is rising every year rather than falling thanks to the government's declining budgetary allocations (though in absolute terms, the health budget in FY2024-25 showed an increase of about 8.0 per cent over the previous fiscal, in real terms, it actually decreased, if inflation is taken into account). Considering the persistent fall in the value of Taka, erosion of the public's income due to rising inflation, the government's health budgets actually remained stagnant at around 5.0 per cent of the national budget over the past decade. This is far below the suggested international standard at 15 per cent of the national budget. With the government's public health spending showing no sign of increasing, people have been compelled to meet the costs of their hospital treatment from their own incomes, or by way of borrowing from friends and relatives. In some cases, they have to sell whatever moveable or immoveable property they possess to meet hospital expenses. In the process, these people get poorer and, in consequence, every year about 5.0 million people have been falling below the poverty line, the HIES of the BBS further adds.
However, a study by the Bangladesh Institute of Development Studies (BIDS) says that in 2022 alone, 6.1 million, which is 3.7 per cent of the total population, fell below the poverty line after meeting their hospital expenditures. In fact, it is not only hospital expenses, but incidental expenses including those of transport, accommodation and food have also to be included. There are also other costs including those for medicines, diagnostic fees and related miscellaneous expenses. The reason is for major treatments, the poor have no other option but to travel to cities as the health complexes at the local levels are mostly understaffed and lack required facilities. But in cities, too, these patients from countryside are not treated free. They are to buy medicines and do diagnostic tests from outside. There are also the dalals (middlemen) from mushrooming private clinics surrounding public hospital out to take the hapless patients from the countryside for a ride. The country's health sector has turned into a veritable abattoir for the poor seeking healthcare service. It is time the poverty fighters within the government and those engaged in related research at local and international forums took a long, hard look at CHE that is driving hundreds of thousands into abject poverty every year.
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