Health management disparity- 4: Resource allocation spawns disparity

A major policy reform should be undertaken immediately to ensure an equal and safer healthcare for people of all income groups, medical scholars and practitioners say.

They said the government must learn lessons from the Covid-19 pandemic and equip the facilities in a way so that it can respond more efficiently when the next outbreak hits.

To make it happen, they suggested decentralisation and reaching medical facilities even at the union level. The people involved in health sector policymaking must also recognise the fact: healthcare is a necessity and a human right, not luxury.

They think the holistic change in the policies must start from budget formulation and end with need-based distribution of human resources.

They suggested reshaping the century-old concept of medical colleges and hospitals, saying these institutions cannot go side by side as it affects both teaching and learning as well as patient care significantly.

There is a need for creating a room for more medical research where the country lags behind, according to the experts.

Secretary-general of the Bangladesh Medical Association (BMA) Dr Md Ehteshamul Huq Choudhury said the country used to make budgetary allocations considering the capacity of local healthcare facilities.

Terming this allocation methodology flawed, he said the capacity of the government hospitals in the country is not fixed with the population ratio.

"We need to make our hospitals considering the population and set the budgetary allocation accordingly. Then it will make sense. Otherwise, we cannot contain the widening disparity," he said.

Citing an example of Sri Lanka, Mr Chowdhury said junior consultants, senior consultants and chief consultants are taking care of hospitals.

On the other hand, assistant professors, associate professors and professors are engaged in medical colleges, he said.

He said students there get theoretical and practical knowledge from professors and consultants respectively.

"This is the best practice. If we can introduce the system here, we can maintain the high quality of education and services," he added.

The BMA secretary-general also suggested imposing a condition that those who will be head of a department will not be allowed to engage in private practice.

Instead, they will get a lump sum amount of Tk 0.2 million from the government and the agreed doctors will be made departmental heads, he said.

"There are many qualified doctors who want to concentrate on basic research," he added.

Former president of BMA Rashid-e-Mahbub said access to healthcare facilities across the regions is not same or equal in Bangladesh.

He said the mindset of the policymakers needs to be changed first and they should treat people of each area equally before distributing resources.

He said the government allocated fiscal resources at the upazila level equally, although the size of population varies from each sub-district to another.

"Is it justified?" he asked, suggesting the budgetary allocations should be based on the population ratio.

The health right activists said private practice of government physicians and surgeons must be prohibited and it should be compensated with necessary financial incentives.

"Enhancing public investment in the under-privileged regions will bring little benefit unless necessary human resources and other facilities are made available there," he added.

Dr Hamid, a professor of Institute of Health Economics at Dhaka University, said the health directorate requires being decentralised and divisional offices must be empowered administratively and financially.

He said former president HM Ershad took the decentralisation move in early 1980s, but it was suspended soon after he was deposed amid mass upsurge.

"Had we continued with the decentralisation process, we would not have seen such a stark disparity that we're facing now," he added.

Former principal and director of Satkhira Medical College and Hospital Dr S Z Atique said the concept of medical college and hospital needs to be altered as soon as possible.

He said the concept was introduced during the British regime and it is still continuing, although no such system will be found in the United Kingdom now.

"We need to separate college from hospital so that physicians can give full concentration either on teaching or serving patients," he said.

At the same time, teachers at the medical college will get enough time to give more attention to research activities and innovation, he said.

"Research activities are almost zero here, which is very unfortunate. The Covid-19 pandemic shows how important research and innovation is," he added.

BSMMU associate professor of respiratory medicine Dr Shamim Ahmed said the disparity in health, education and other areas is directly linked with the per capita income of people in a particular area.

He said the government can financially incentivise the healthcare professionals, especially for those who will get posted in the peripheral areas.

"Another thing that we can consider is that the next posting of the professionals in the least developed areas will be a good one like the strategy the government followed in hilly districts," he said.

Mr Ahmed also suggested allocating public investments based on the population size and healthcare requirements as the medicare needs in coastal and northern regions are not the same.

Professor Dr Shamsul Alam, senior secretary at the General Economics Division said they have identified remedies to cut back on the widening disparity in the five-year work plan.

He said they have emphasised decentralisation of the responsibilities, budget expenditure through local governments in a transparent way.

"We need to do that gradually. We're marching towards an upper middle income country and then higher income one. To attain the target, we must reduce the health inequality," said Mr Alam, who made a major contribution to the future plan.

At the online media briefing of the World Health Organisation where the FE correspondent attended on September 07, its director general Dr Tedros Adhanom Ghebreyesus said Covid will not be the last pandemic.

"But when the next pandemic comes, the world must be ready, more ready than it was this time," he said.

Mr Ghebreyesus said many countries have done well because they learned lessons from previous outbreaks of SARS, MERS, measles, polio, Ebola, flu and other diseases.

"That's why, it's vital that we all learn the lessons this pandemic is teaching us," he insisted.

[email protected]