Healthcare costs should top agenda

What pundits on social and economic issues say, celebrate the outlook of people on how to improve the health of politics, governance and so on. However, of late, attention is also turning to the more fundamental issue of public health or, in other words,  health of the very members of society who constitute politics, economics,  science and what have you. Especially, the issues of free primary healthcare, increasing health budget to 5 per cent of the Gross Domestic Product (GDP) as recommended by the Health Reform Commission formed by the interim government, (experts are of the view that health budget should be 15 per cent of the national budget), giving constitutional recognition of people's right to health, decentralizing services and so on and so forth are being hotly debated at the moment. No doubt these are big ideas about reaching health services at low cost right on the common people's doorstep.

 But it is one thing to have an idea, it is quite another to implement it. Now that the interim administration is soon going to hand over power to an elected government after February 12's general election, all eyes will now be on the next government to assume power. Will that government be just a chip off the old block of politics, or mark a departure from the past?  Talking of promises made in a party's election manifesto, say, on healthcare, it is better forgotten like the leaflets and posters distributed during the election campaign. So, it is time experts and public intellectuals made the issues of healthcare the main agenda of their discussion and prevail upon the next government accordingly.  The focus should be on making primary healthcare accessible to  the low-income people in the rural as well as urban areas. 

Admittedly, the country has a vast network of government hospitals at districts and health complexes and clinics at upazilas to serve the population at the remote corners of the country. Unfortunately, most of those hospitals and health complexes are understaffed and lack the facilities to deliver the basic services to the local communities. Most importantly, for delivering the required services, these hospitals and health complexes need the necessary medical equipment, infrastructures and skilled personnel to operate those. It is also necessary to provide those hospitals/health complexes with the appropriate amenities so skilled health professionals including doctors have the incentive to stay and work there along with their family members. In fact, in modern career-oriented professions, which include medicine, the mere call of serving humanity or fear of administrative action is not enough to motivate and retain skilled health professionals for long in the countryside. 

So, the programme of overhauling the healthcare system should take all these issues into consideration. In hospitals in the bigger cities including the capital city, governance is the central issue and has to be freed from bureaucracy, so service delivery mechanism is speedy and efficient. Of course, the latest digital technology including AI can help healthcare system rid itself of old-style bureaucracy.  But these are all about improving the health service delivery mechanism. Seeing that costs of healthcare and medicine have gone beyond the reach of the low-income people, who make the bulk of the recipients of the service, the issue should be brought to the centre of the discussions at all public forums. And the abstract and catchy idea of affordability of medical service has to be concretized by way of reducing out-of-pocket (OOP) medical expenses to the bare minimum for the low-income segment of society. Consider that in Bangladesh, OOP payments account for more than 70 per cent of national  health spending, while health expenses eat up around 35 per cent of the total earnings of the low-income households. Evidently, it is one of the main drivers of pauperization in Bangladesh. So, reducing OOP health expenses  should top the agenda of the next government.    

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