Health Systems for Tuberculosis (HS4TB) Bangladesh Country Program Fact Sheet

Funded by USAID and implemented by Management Sciences for Health (MSH), HS4TB is currently working in Bangladesh, Ethiopia, India, and Kenya. The project aims to strengthen health systems and improve governance, financing, and resource use in these countries. In Bangladesh, HS4TB is supporting policy reforms to increase and improve domestic contracting of TB services, greater domestic financing, and more efficient use of resources. The project is also building in-country financial and managerial skills and leadership. Bangladesh has made significant progress in improving its TB program by leveraging the complementary strengths of the Government of Bangladesh and non-governmental and civil society organizations (NGOs/CSOs). However, the non-governmental part of the national TB response has been solely funded by external development partners, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), whose support will decrease as Bangladesh's economy grows. The Government of Bangladesh remains the overall steward of the national TB response but does not have a mechanism to contract health services, including TB services, to NGOs through the public procurement system. This puts the government in a less powerful position to guide the response and leaves the TB program in a challenging situation as the country reduces its reliance on external financing. To address this challenge, the National TB Control Program (NTP) with the support of the Health Economics Unit (HEU) in the Ministry of Health and Family Welfare is leading an initiative to establish government-led contracting of select TB/health services to NGOs, CSOs, and private entities. The NTP and HEU conducted an assessment of the legal and regulatory environment, political economy, and government capacity for contracting TB/health services in Bangladesh. The assessment revealed that the existing legal and regulatory framework provides only limited scope for the contracting of TB/health services to NGOs, CSOs, and other private entities. The NTP and HEU have developed a roadmap outlining the pathway to establish government-led contracting of TB services over the next several years. HS4TB and the government have outlined a 3-stage approach to regulatory reforms related to health services contracting, identified a possible package of activities for a contracting pilot, and started working on a capacity building curriculum. The NTP plans to launch a pilot in 2024 to test the government mechanisms for contracting TB services to NGOs/CSOs/private entities and to facilitate the NTP's capacity through a practical learning-by-doing approach. The pilot aims to test a novel approach for tendering TB services through the public procurement system, assess the NTP's capabilities to contract, steward, and oversee third-party TB services provision, gauge the interest, capacity, and performance of NGOs/CSOs/Private entities to effectively compete and deliver on public procurement contracts, and gain operational experiences and lessons to inform how the public procurement system can contract TB and other health services in the future.