Reversing outflow of patients for treatment

Bangladeshis, according to report published in this paper, annually spend a staggering US$5.0 billion only in registered medical bills outside the country. But the volume of actual spending will be much larger if the cost of treatment taken on tourist visas is added to this. They are spending such a large amount of money when the country reels from acute shortage of foreign exchange to the extent of making the country's debt servicing difficult and hampering international trade. Even opening of Letters of Credit is delayed for the same reason. This can only cause more haemorrhage to the economy. Apparently spending on medical treatment abroad may look unnecessary, but the issue calls for a dispassionate analysis.

It is common knowledge that thousands of Bangladeshi nationals used to travel to India every day on medical visas until recently. People also availed treatment facilities even on tourist visas. This additional facility has resulted in the swelling of the number of outgoing Bangladeshis. It is painful to see long queues of Bangladeshi nationals at the Indian visa outlets seeking permission to enter India. Some also visit that country for shopping on different occasions, though most of what they buy is very much available inside the country. This is how a huge amount of hard earned foreign exchange flows out of the country on a regular basis.

Bangladeshis, according to media reports, made up more than 20 per cent of the foreign tourist arrivals in India in 2022, occupying the second highest position after those from the USA. According to reports, about 12,56,000 Bangladeshi nationals visited India that year, the monthly average being as high as 0.10 million. Quoting official statistics, another media outlet informs that Bangladeshis topped foreign tourist arrivals in India during the first half of this year. As long as the root causes behind the travel spree are not removed, the number of Bangladeshi travellers to India will continue to increase.

Inadequate healthcare facilities and poor quality of treatment inside Bangladesh prompt patients from our country to opt for treatment particularly in India and Thailand where healthcare systems are far advanced. The low quality health services in the country are too costly, far beyond the affordability of the common people. Local level government hospitals, fewer in number and poorly equipped, can't cope with the increasing number of patients. The number of physicians compared to the population size is far too small - only 1.1 and 18.2 doctors per 10,000 people in rural areas and urban centres respectively.

Public healthcare outlets are meant for free treatment or at nominal cost but those have allegedly turned into dens of corrupt practices. Syndicates of employees rule the roost there. One can get admission and operation serial only on payment of speed money to them. People don't get the medicines supplied by the government for free distribution. Healthcare service in public hospitals here is another name for harassment.

Budgetary allocation for the health sector in Bangladesh is one of the lowest among South Asian countries. Doctors' fees and cost of health and diagnostic services in private hospitals and clinics are too high for the patients of low financial capacity. According to the Bangladesh National Health Count, the out-of-pocket healthcare expenditure in the country rose to 73 per cent in 2021 from 68.5 a year ago. The majority of physicians, allegedly in an unholy alliance with private diagnostic labs and pharmaceutical companies advise unnecessary tests and prescribe substandard medicines. These doctors are not sincere in their service to ailing humanity.

The combined effect of these malpractices is patients' loss of confidence in the doctors and the country's overall health service system. The situation has given rise to two-fold consequences: on the one hand, poor patients depend either on quacks and pharmacies, and sometimes even on magic healers for treatment; they also take medicines based on self-prescription and thus complicate diseases. Bangladeshis are gradually turning into a sick nation. On the other hand, affluent sections of patients prefer treatment outside the country, especially in India, spending large sums of money at the cost of the country's public exchequer. Instances of VIPs taking treatment in other countries give a distinct message - there is nothing wrong in taking treatment outside the country even when similar medication is available inside Bangladesh.

Many poor men, women and children could be provided with free treatment with the amount rich people spend abroad. But that is not going to be possible immediately until and unless the overall healthcare system gets improved. It hardly needs elaboration that complete overhauling of health services cannot be achieved overnight. The system led to the loss of people's trust over a long period of time; regaining the same is also a matter of a long-term strategy. It is easy to erode people's confidence but very tough to gain it back. Such a formidable task involves a lot of efforts like taking health services to the doorsteps of the people, making the same accessible to the poor and regaining people's confidence through unrelenting sincere services. Global standard facilities for the treatment of lethal and complicated diseases should be made adequately available in the country. Increased budgetary allocations can work wonders in achieving all these objectives. Strengthening the health administration and enhancing its capacity are vitally important for the purpose.

Whether one will take treatment inside the country is a question of both availability of necessary facilities and one's love for the country. It should therefore be dealt with in a two-pronged way - making required arrangements for better treatment and instilling a sense of responsibility for the country into one's mind. People should be made aware of the irrationality of going abroad for healthcare whenever those are available inside the country.

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