Doctors we produce, patients we lose

Bangladeshi citizens spend an estimated US$5.0 billion every year on medical treatment abroad, primarily in India and Thailand, a staggering outflow of foreign currency. Many middle-class families travel to India and affluent families fly to Thailand and Singapore to receive healthcare with China emerging as an attractive new destination for Bangladeshi healthcare seekers. This stream of medical exodus exposes a deep crisis of confidence in the country's healthcare system. What makes the situation paradoxical is that Bangladesh has, over the years, emerged as a regional hub for medical education. The country produces thousands of doctors every year not only for itself but also for neighbouring countries.

Bangladesh boasts 37 public and around 70 private medical colleges with the private sector alone offering more than 6,000 MBBS seats annually. Almost half of the private medical college seats are earmarked for foreign students and the majority of them are filled by students from South Asian countries, particularly India, Nepal and Pakistan. These students study at their own cost. They are attracted by recognised degrees, English-medium instruction, and relatively affordable tuition. In addition, public medical institutions host students from the region under various scholarship programmes.

While international students can trust Bangladesh for medical education, the country's patients are reluctant to trust it in local healthcare services. A fundamental question will pop up in anyone's mind based on the knowledge of these data - why does a country that provides medical education to so many international students fail to provide quality healthcare services to its own people?

The answer to this question does not lie in a single factor, but in a number of systemic failures. One of the most important factors is the lack of high-tech healthcare facilities in Bangladesh. Though the country has achieved some remarkable progress in the secondary healthcare services, high-tech tertiary healthcare services are still scarce, let alone quaternary services. Here patients suffering from cancer, heart, or neurological diseases or those requiring organ transplants or complicated surgeries can seek medical services only at a few hospitals, located mostly in the capital city.

Another critical factor is the absence of modern medical technology. Most hospitals lack modern diagnostic equipment, laboratory facilities, and critical care equipment. In contrast, hospitals in India, Thailand, or Singapore market themselves as centres of excellence with state-of-the-art technology, robotic surgery, etc. The choice for patients who can afford it is obvious.

The absence of a comprehensive healthcare insurance system is another gap in healthcare infrastructure in Bangladesh, where most healthcare expenses are paid out of pocket. A major illness can wipe out lifetime savings or push a family into debt. In such a situation, patients often rationalise that if they are going to spend heavily anyway, they might as well seek treatment abroad where outcomes are perceived to be more predictable. Countries like India and Thailand have successfully combined private healthcare, insurance mechanisms and medical tourism policies to attract foreign patients. Bangladesh lags far behind them in this respect.

The most destructive factor is, however, the lack of trust. Perception of the quality of healthcare is influenced not only by results but also by the quality of patient handling. Complaints that Bangladesh healthcare system faces include poor communication skills, a lack of time for consultations, absence of empathy and poor follow-up. Notwithstanding medical skills, the patient handling is wanting. This builds up over time to a lack of trust.

Bangladesh Bank governor Ahsan H Mansur once said at a workshop that had Bangladesh improved its healthcare system, the colossal spending of Bangladeshis' medical tourism would have reduced to $1.0 billion a year. There is no denying that billions of dollars are leaving the country not because treatment is impossible at home, but because it is unreliable.

This outflow has severe economic implications. Medical tourism means loss of foreign exchange, increased inequality, and the perpetuation of a two-tier system where quality healthcare is a luxury, not a right. This situation discourages investment in the sector. When the country's elite regularly go abroad for healthcare, the domestic pressure to reform the healthcare system, regulate the private sector and invest in technology diminishes.

Bangladesh is now a doctor-exporting nation, yet it is losing its patients. Its system of medical education is growing rapidly, but the healthcare system is not keeping up. This is a clear example that just making doctors is not enough, there is also a need for modern hospitals, research facilities, ethical systems, insurance schemes and a system that values the dignity of patients.

rahmansrdk@gmail.com