Bangladesh observes the World Health Day 2021 as elsewhere in the world today (Wednesday), amid the country's health sector managers facing widespread criticism.
This year's theme of the day is 'Building a Fairer, Healthier World'.
The health sector has so far achieved notable growth, but that has not been equitable and inclusive, health experts said on Tuesday, expressing their frustration over the poor service delivery.
They identified a number of weaknesses, including the lack of fairly available services for the underprivileged, a very high out-of-pocket expenditure on health, the lack of skilled workforce and an inefficient health management system.
Rampant corruption, under-utilisation of super specialised infrastructure, centralisation of tertiary healthcare, and absence of short, medium and long-term planning to meet the demand from an ever- growing population were also blamed by the health experts.
Talking to the FE, Swadhinata Chikitsak Parishad president Professor Dr Iqbal M Arsalan said the health system of Bangladesh is not yet equitable as the country could not ensure services for the underprivileged.
Even the government services could not be made available for this group free of cost or in the form of insurance under universal health coverage system, he added.
There is also a gap in health workforce, which is hindering establishment of an equitable health system, said the health expert.
The thumb rule of ensuring an equitable health system is that the ratio of doctor, nurse and other staff should be 1:3:5. "But here, we have a huge gap in that ratio. We could not address these fundamental issue," he said.
"There are shortages of specialised personnel like surgeons, anesthesiologists and many more. But we did not even try to find out the reasons behind such shortages," he added.
Dr Iqbal said that some infrastructures have been developed and machinery installed, but an adequate manpower to run those are not available.
The health facilities at union and upazila levels do lack adequate consultants and medical officers to provide quality services - be it indoor or outdoor, emergency and OT.
"It is not possible to provide outdoor, indoor, emergency and OT services by four medical officers in a 50-bed upazila health complex," he said.
Public health expert Professor Dr Be-nazir Ahmed said the country fell far behind developing a fairer, healthier, equitable and inclusive health system.
The issues of corruption, ethics and transparency are very important to establish a fairer health system, he said.
"If a person receives proper, sufficient and quality services without being exploited and maltreated, it will be fairer. Besides, lack of skilled manpower is a barrier to ensure a fairer health system," he said.
He pointed out that many hospitals were being constructed, especially in private sector, without proper machinery, ICUs, OTs and skilled health workforce. "These should be strictly regulated."
The former director of CDC of DGHS also identified that the people's behaviour in seeking the health services has changed in an ever-evolving socio-economic context.
In that context, the number of healthcare facilities and infrastructure was also low. Now, the people want to get better health services. The number of infrastructure has also increased, but the health workforce has not been developed and properly utilised that way due to lack of proper planning.
Regarding centralisation of the tertiary hospital and super specialized hospitals in Dhaka, he said the government easily can provide treatment to 80 per cent of the population through the 500 upazila health complexes.
The rest 20 per cent population will receive treatment from the district hospitals, medical college hospitals and super specialized hospitals.
"We have to enhance the capacity of the district level hospitals to 500-700 beds," he said.
The medical college hospitals already have some specialised facilities. As many as 15 per cent of the population can get treated at the district hospitals, 4.0 per cent at the medical college hospitals and 1.0 per cent at the super specialised hospitals like neuroscience hospital, said DR Be-nazir.
This will also help better utilization of the super specialised hospitals like NICVD and NITOR which are now doing many unnecessary things, he added.
He also suggested creating posts for more workforce to ensure quality health services.
Professor Shamiul Islam of DGHS said the country has shown tremendous success in many primary healthcare services, but has some inadequacy in clinical support system.
The budget is also a big issue in developing advanced healthcare facilities, he said.
He also noted that the government has invested a lot in developing skilled manpower in specialised fields in which the private sector could play a role.
Public health expert Dr Ahmed Parvez Zabeen said that there is a lot more to do for ensuring healthcare services for the underprivileged. The upazila health complexes can be equipped with more oxygen support systems, OTs etc. The doctor-nurse ratio should be increased while the operational activities should be more transparent.
At this stage, it is necessary to transfer technology to build an equitable health system, said DR Zabeen, adding: "Poor people will then get access to medicine and vaccine at lower cost."