Health concerns received fresher impetus in the context of the Covid-19 crisis. The big network of public health service facilities and a huge number of private hospitals and clinics of the country need massive funding support to confront newer challenges in the new normal. The Government of Bangladesh has assigned greater weight and allocated higher volume of funds to streamline health sector and to improve healthcare services to combat the Covid-19 situation. However, healthcare sector needs much more. Corporate sector and business houses of Bangladesh might be a great force to support and improve healthcare services of the country, especially to take these to the low-income and vulnerable population.
Policy initiatives are contributing to reshape the country's health sector that broadly include health, population and nutrition issues under several national level policy goals. The Vision 2021 identified strategic priorities to maintain highest attainable level of health in the country. Necessity of improved health situation is also an important condition for Bangladesh to transform the country into a developed economy and to attain the Sustainable Development Goals (SDGs). The government has steps to improve its leadership and regulatory role to increase both equity and quality of health services, especially for the poor and the disadvantaged. In spite of improvements, further steps are needed to make health services responsive to the needs and demands of the common population. Alongside public sector, the roles of private sector health providers and their accountable and responsible approaches are particularly crucial in this context.
Financing strategy is crucial for quality healthcare services in the country. According to the Health Facility Survey 2017 (published in February 2020) of Bangladesh, the goal of the Health Care Financing Strategy is to attain universal coverage by 2032 by extending financial risk protection and ensuring access to quality service. The strategy provides a framework for developing and advancing health financing in Bangladesh. The framework aims to increase the level of funding for health, ensure an equitable distribution of the health financing burden, improve access to essential health services, reduce the incidence of impoverishment caused by soaring health care expenditures, and improve the quality and efficiency of service delivery. Supply-side financing of healthcare services in Bangladesh has been the key strategy for ensuring the access of poor households to essential health care services. The bulk of health care financing comes from out-of-pocket expenditures, which suggests that people are willing to pay for better care. This is a burden for the low income classes who has less ability to pay for healthcare services.
Despite some remarkable success in terms of decreased child and maternal mortality rate, improved child and mother health, and successful implementation of family planning strategy, Bangladesh is still having a good number of challenges where interventions and resources are needed. Lack of medical equipment, insufficient health budget or financing, lack of proper health management including absence of accountability and transparency of health service providers, changing disease patterns, insufficient number of empirical research on health, inadequate supply of purified drinking water, inadequate supply of necessary drugs, and also lack of access to information are contributing for low quality of health services. In addition, neglecting patients' rights and satisfaction are very crucial challenges for health service system of the country. Covid-19 and related complexities are adding to the list. Especially, low income people need support.
So far, many modern private hospitals have been established but all of these hospitals are concentrated in Dhaka, and not accessible by the low income population. Health expenditure consists of doctors' consultation fees, charges of laboratory test, travel costs to and from health clinics and hospitals, drugs and accommodation costs. The poor are exposed to greater health risks, are less well nourished, have less information and less able to access health care. As a consequence, they have a higher risk of illness and disability. On the contrary, illness can reduce household savings, lower learning ability, reduce productivity, and lead to a diminished quality of life. Investment in health related information, research, nutrition and healthy food, and addressing environmental degradation have notable implications for the quality health services and safe and productive upcoming generation.
In responses to the health related intervention gap and growing demand for quality health services, CSR and philanthropic activities by the corporates and business entities have grown in the healthcare sector of Bangladesh. In this context, corporates and business entities may be categorised into corporates or business entities in the non-health sector; and corporates or business entities of the health sector. By engaging in healthcare related CSR, the corporates may draw benefits in terms of social acceptance, improved reputation, goodwill, and customers' loyalty, retention of the employees, attracting more investors; and attaining competitive advantage.
Big corporates and business houses generally pursue some forms of CSR and philanthropic activities under written policy and strategic documents. As a whole, probably 'banking' is the most structured corporate sector in their ways of executing CSR activities. CSR activities of the banks and NBFIs have mainly been guided by the Bangladesh Bank (BB). CSR funds of banks may be used under eight heads as per the instructions of the central bank. BB has also instructions to use 30 per cent of the fund for education, 20 per cent for health, and 10 per cent as part of climate risk fund. In the context of the Covid-19, BB asked banks to allocate 60 per cent of their CSR fund for health purposes.
Telecommunication sector of the country has notable presence in the CSR area of the country. Grameenphone and other corporate market players of the sector have policies, strategies, budget allocations and responsible human resources/units to take care of the CSR activities in several key areas including health. The industry has also notable contribution in disseminating health related information and telemedicine services. RMG, the key export sector of Bangladesh, and their associations have been engaged in health related CSR activities in several instances. Practically, RMG industry (have over 4000 factories) needs to play significant role to take care of the health and nutrition issues of their employees of which over two-third are women. Other industrial groups have also scattered initiatives related to health and medical services. In addition, many of these corporates came up with special efforts in the context of the Covid-19 situations.
Of the private sector healthcare service providers, big hospitals and health service providers have specific policies, strategies, and also disclosure arrangement for CSR activities. Hospitals like Square, United, Labaid, Evercare, Ad-din etc are well structured in executing their CSR and philanthropic activities. There are instances of undertaking and executing CSR and philanthropic activities by the relatively small hospitals and healthcare service providers as well that are large in number and providing healthcare services throughout the country. However, CSR activities by these private entities are not organised or strategically designed, and thus information on their CSR activities is hardly available in the published form. This is a rapid expanding sector. Being a significant part of the sector, private healthcare service providers have to contribute to improving the quality of healthcare services in the country and supporting excluded section of the society. Along with efficient services, structured and strategic CSR activities might contribute a lot. This is also associated with growing commercial opportunity for the private healthcare services in the country.
It is well recognised that many low-income and poor people need free and subsidised healthcare services of different types: free treatment and medicine, low cost of medical tests, special support to child, mother and aged people, availability of quality medicine, hassle-free treatment system, timely vaccination arrangement, availability of doctors and ambulance facilities at reasonable costs.
Necessity of private healthcare services and their essential complementary role to ensure quality health services in the country is well known. These relatively small health service providers have great roles to play through their CSR activities where corporates may also use their resources. There are ample scopes to channel corporate CSR funds for the betterment of the vulnerable people by providing them with essential healthcare services, and most corporates have options for it.
Dr Shah Md Ahsan Habib is Professor, Bangladesh Institute of Bank Management (BIBM).