Third Social Insurance Forum Charts Course for Maternity Insurance in Bangladesh

PRESENTATIONS

The Government of Bangladesh (GoB) has committed to introducing maternity insurance by 2026 as part of the National Social Insurance Scheme (NSIS) under the National Social Security Strategy (NSSS) 2015. This commitment aims to reduce financial barriers, promote institutional births, and improve maternal and newborn health.

High maternity care costs currently limit access to medical facilities, thereby increasing health risks for mothers and newborns, especially in low- and middle-income families. Given the challenges of limited financial resources, high maternal mortality rates, and disparities in healthcare access, the NSSS aims to provide necessary financial protection and medical support to expectant mothers.

In this backdrop, the Third Social Insurance Forum titled Development of a Framework for Establishing Maternity Insurance in Bangladesh was organised. The event, organised by the Centre for Policy Dialogue (CPD) in collaboration with Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH and The ARK Foundation, was held on Monday, 17 March 2025. It focused on reviewing global best practices and developing viable frameworks for maternity insurance in Bangladesh, potentially guiding a sustainable and equitable social health insurance model.

Dr Md Enamul Haque, Director General (Additional Secretary), Health Economics Unit, discussed ongoing efforts to review maternal and child mortality. He emphasised the commitment to ensuring that mothers do not die during childbirth. Dr Haque also mentioned that there have been recommendations to make maternal charges at hospitals free. He stressed that the government should take this into serious consideration and work towards implementing this policy.

Mr Mohammad Khaled Hasan, Additional Secretary, Coordination Wing, Cabinet Division, highlighted the necessity of identifying the challenges and burdens associated with any insurance to foster progress. He emphasised the importance of appointing a dedicated authority to implement social insurance schemes effectively. He noted that establishing trust funds and a straightforward legal framework is essential for the success and clarity of these initiatives.

The Research Director of CPD, Dr Khondaker Golam Moazzem, highlighted the forum’s examination of international social health insurance models from seven countries, including India, Vietnam, and Germany. He noted their dual healthcare systems, governance structures, and funding mechanisms, stating that these models provide valuable insights for creating a framework that addresses the unique socio-economic dynamics and social safety net system in Bangladesh.

‘The overview of Bangladesh’s maternal healthcare system reveals challenges such as high out-of-pocket expenses and significant disparities in service delivery between urban and rural areas,’ said ASM Shamim Alam Shibly, Senior Research Associate at CPD. He also discussed the rising rate of C-sections for childbirth in urban areas, more home births in rural areas, causes and places of maternal mortality during delivery and unethical practices of the doctors in terms of providing maternity healthcare services.

Professor Dr Rumana Huque, Executive Director at the ARK Foundation, discussed the target population and beneficiary categories, including formally employed men and women, informally employed women, and those below the poverty line. She discussed the assumptions of the models, their enrolment processes, coverage, and insurance claim mechanisms. Additionally, she elaborated on the financial model, detailing its sources and the flow of funds. Emphasising the need for an inclusive and sustainable approach, she underscored the importance of addressing gaps in coverage and ensuring equitable access to maternal healthcare, particularly for vulnerable populations reliant on informal employment.

Further detailing the operational framework, Dr Huque advocated for a combination of non-contributory and contributory funding approaches to enhance financial sustainability. She outlined specific strategies for coverage, eligibility, and risk management designed to ensure universal maternity health coverage, including comprehensive antenatal, delivery, and postnatal care.

Ms Tanjilut Tasnuba, Senior Programme Officer at the ILO Country Office for Bangladesh, emphasised the importance of a multi-faceted approach to financing maternity benefits through social protection. She recommended initiating a contextual analysis of the current maternity protection provisions, followed by a feasibility study on a maternity insurance scheme.

Mr Ruben Capote from the Simon Project discussed the maternity issues, highlighting significant concerns surrounding the misconception of the poverty line. He pointed out that once women become pregnant, the absence of overtime and the necessity of taking leave can push them further below the poverty line. He also critiqued the effectiveness of cash transfers, arguing that while they may temporarily alleviate financial strain, they do not permanently elevate families above the poverty threshold, resulting only in a ‘bouncing back’ effect without long-term improvement.

Dr Syed Abdul Hamid, Professor, Institute of Health Economics, University of Dhaka, addressed the delivery of maternity services by government, private, and NGO sectors. He stressed the importance of defining which government facilities can handle insurance funds, including their authority to receive, retain, and distribute these funds. Dr. Hamid also highlighted the lack of clarity about who within the government would be responsible for implementing the maternity insurance scheme.

Mr Razequzzaman Ratan, President of the Socialist Labour Front, spoke on the broader societal benefits of motherhood, questioning the fairness of mothers bearing its burden alone. He highlighted that while the mortality rate among mothers has decreased, the numbers remain alarmingly high, suggesting a need for greater societal support and shared responsibility in addressing these challenges.

In her concluding remarks, Dr Silvia Popp, Project Manager of the Employment Injury Protection Scheme for Workers in the Textile and Leather Industries (EIPS) at Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, noted that Bangladesh has conducted several small pilot projects. She emphasised the need for a broader strategy and comprehensive framework. Dr Popp suggested that implementing the operational recommendations discussed could significantly progress social insurance reforms, particularly in maternity insurance, potentially setting a blueprint for broader social insurance reforms in Bangladesh.

Government officials, experts and academics, development practitioners and international development partners were present at the Forum and shared their valuable insights.