Healthcare system needs reform

The country's healthcare services remain problem-ridden. The citizens do not get standard services from most of the health centres despite mushroom growth of private clinics and diagnostic centres.
Due largely to lax monitoring and regulation by the authorities concerned, hospitals and clinics are being run without any proper guidelines which are posing a grave threat to public health, according to a report in the FE last week.
Private hospitals have created options for the people to seek health services from various facilities other than the government ones only. But these hospitals are allegedly exploiting the patients due to lack of their knowledge and professionalism. The laws too are not effective and there are also problems with compliance level.
What is surprising is that more than 40 per cent of private hospitals, clinics, blood banks and diagnostic centres are not registered with the relevant government agencies. According to the Director General of Heath Services (DGHS), there are 612 government hospitals, 128 secondary and tertiary-level government hospitals, 484 government hospitals at upazila and union level, 4,280 private registered hospitals and clinics and 9,061 private registered diagnostic centres in the country.
The hospital and clinic wing under the DG Health does not have the capacity to regularly monitor mushroom growth of the clinics, hospitals, blood banks, and diagnostic centres in the private sector. Moreover, activities of the wing are limited to Dhaka city only as there is a serious dearth of qualified manpower.
Apart from the government-owned hospitals, the situation in private clinics and diagnostic centres outside Dhaka is even worse. They do not have proper equipment, manpower, doctors, nurses, emergency, ambulances and authorised blood bank needed for a full-fledged clinic.
The quality of services the healthcare workforce is providing in these clinics and diagnostic centres is simply awful. The government recognises three types of degrees for medical technologists - one-year diploma, three-year graduation and four-year BSc in laboratory technology course. It is easily understood that the quality between one-year and four-year degree holders will not be the same.
There is no denying the fact that the number of qualified doctors, nurses and other professionals is too inadequate to cope with the growing demand. Private medical institutions are also being set up at random. But there is a dearth of qualified teachers to produce qualified doctors.
There are allegations that a section of dishonest public hospital staff influence patients to get admitted into private clinics citing for better treatment. Private clinics offer a slice of their income to these touts. Medicare services in public hospitals beggar description. It is hard to get proper services there. Specialist physicians are mostly busy with their private practices.
It's a hell of an anarchy that rules the roost in the country's healthcare system. Affluent people have little faith in local healthcare services. Going abroad for treatment is a regular phenomenon here. A substantial amount of foreign currency is going into drains for the purpose.
Unfortunately, specialist physicians in Bangladesh are very few in number. Quite naturally, patients seldom get their proper services. A specialist physician, after his duty at the public hospital, visits at least 50 patients a day at his own private clinic. How can he make justice in offering fair treatment to the patients? A specialist usually gives only five minutes per patient. He has little time to go through the patient's ailment history to diagnose his disease.
In most of the developed and developing countries, at least 30 minutes are generally earmarked for a patient. Doctors there visit only 20 patients a day. Private practice for a public hospital doctor is strictly prohibited.
In fact, poor doctor-patient communication poses as a hindrance from reaching correct diagnosis. Many doctors in Bangladesh are reluctant to improve such communication which is one of the key elements of treatment. Whereas Bangladeshi physicians have proved their worth abroad, they give little importance on the good relation to heal patients at home.
Studies have shown that of all the risks that poor households face, health risks probably pose the greatest threat to their lives and livelihood. Unfortunately, health systems are frequently ineffective in reaching the poor, generate less benefit for the poor than the rich, and impose repressive cost burdens on poor households.
The consistently inequitable nature of health system limits the access to healthcare by the poor who need it the most. It has been found that the poor and disadvantaged households with only a few assets are likely to struggle to meet even small extra-budgetary expenses Thus, improving the ability of the health system to reach the poor/disadvantaged population is essential to mitigate the income-erosion effect of ill-health and poverty alleviation in Bangladesh.
As the government failed to slap ban on private practice by the public sector physicians, the door is wide open to those who want to engage themselves in private business. Most of the physicians are associated with the country's sprawling nursing homes and hospital business; they are making money at the cost of the people's sufferings.
 The government has set up medical centres at union and hospitals at upazila level. Doctors and nurses remain largely absent in most of the upazila hospitals and life-saving drugs are hardly available. Common people are not getting healthcare services at all. Doctors allegedly stay away in big towns and cities without taking leave from their workplaces. Nurses hardly take care of the patients.
Country's healthcare system needs a drastic reform to better suit the requirements of the common people. Private practice by public hospital physicians should be banned. It is not understood on what ground they are being allowed to do private practice when the number of doctors has significantly increased.
It is essential for the government to revise the curriculum in medical, nursing and pharmacy schools that train healthcare professionals, so that they are trained in keeping with the international practices. Business schools should be encouraged to develop executive training programmers in healthcare, which will effectively reduce the talent gap for leadership in this area.
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