Streamlining public healthcare sector

Some activists of the Anti-Discrimination Student Movement who sustained eye injuries during the July uprising and are undergoing treatment at different hospitals recently came down on the streets to press for their demand for, what they say, proper treatment and rehabilitation. The authorities on several occasions claimed that the injured have been provided with the best possible treatment. Several foreign teams of ophthalmologists, who visited Bangladesh to see the injured, validated the claim. The injured, however, have rejected the claim as they are still not convinced that they have been given the treatment they deserve, much to their frustration. Their mistrust has originated not only from their experience at the eye hospitals; the indifferent service system in general at public healthcare facilities has contributed to their dissatisfaction. The reality is that most of the people, who visit public hospitals, the primary healthcare providers for the majority of population in Bangladesh, return with a harrowing experience.

The Bangladesh Constitution entrusts the responsibility of providing the citizens with healthcare. Article 15 of the Constitution provides: "It shall be a fundamental responsibility of the State to attain… a steady improvement in the material and cultural standard of living of the people, with a view to securing to its citizens… the basic necessities of life, including food, clothing, shelter, education and medical care."

However, the reality of the public health sector tells a different story. Public hospitals are plagued by a myriad of issues - lack of resources, corruption, inefficiency, negligence, and maltreatment of patients. For millions of underprivileged citizens who solely rely on government healthcare facilities, the service is often dismal and jeopardises both lives and dignity. Major hospitals in Dhaka and other cities witness thousands of patients daily, many of whom are forced to wait in long queues for hours --- sometimes even for days --- for basic treatment. Patients are often treated on the floor or in hospital corridors due to a lack of adequate number beds.

Bangladesh lags in doctor-patient ratio.  Here the ratio is approximately 1:1,581, well below the World Health Organisation (WHO) recommendation of 1:1,000. An acute shortage of nurses and technicians, private practice by doctors at the cost of hospital duties, and absenteeism among them aggravate the situation. Moreover, most of the government hospitals lack essential diagnostic equipment such as MRI and CT scan machines, forcing patients to seek costly tests at private diagnostic centres. Doctors' acceptance of commission, which ranges from 23 to 50 per cent of the fees for diagnostic tests adds to the financial burden on the patients. Then bribery and corruption are rampant in public healthcare. Hospital staff often demands extra money for bed allocations, surgical procedures, and even life-saving medications.

The lack of accountability in the healthcare system further alienates the public. The absence of grievance remedial mechanisms leaves patients in a situation where their families have hardly any option when they are subjected to medical negligence, overcharging, or denial of services.

Besides the constitutional obligation, Bangladesh is committed to achieving by 2032 Universal Health Coverage (UHC), which means that everyone has access to quality health services without financial hardship. Yes, the country has made some progress in this regard, but it will be impossible to achieve the goals without addressing the issues.

The country needs to invest more in healthcare infrastructure, ensuring that hospitals are adequately equipped, expanded, and modernised. New hospitals and community health centres need to be built to serve rural and semi-urban populations to reduce pressure on tertiary hospitals in major cities. The country also needs to invest in medical education and training to combat the shortage of doctors, nurses, and other healthcare professionals. Most importantly, the government should employ a carrot-and-stick approach with healthcare professionals to restore discipline in the public healthcare sector and better serve people with the available resources.

rahmansrdk@gmail.com