Streamlining healthcare services

Shahiduzzaman Khan | Published: January 16, 2016 22:26:49 | Updated: October 23, 2017 03:24:36


Instead of improvement, country's overall healthcare services have further deteriorated. Although there is a mushroom growth of health-related infrastructure, proper treatment is absent almost everywhere.  
A seminar on health expenditures in Bangladesh held in the city last week was told that the country has to go a long way in spite of the fact that it had achieved many positive developments in the health sector. For that, both public and private sectors need to invest in the health sector to maintain economic growth momentum and improvement in lifestyle.
Spending enough money does not, in fact, ensure proper services. Everybody looks for quality treatment which local doctors and nurses fail to provide as they lack skills. There is shortage of technicians and their lack of skill is seen in most of the country's diagnostic centres.
Healthcare services in public hospitals are in a shambles. Poor people have no alternative other than going to these hospitals. It is hard to get physicians' services there. Specialist physicians are mostly busy with their private practices. Even on-duty doctors leave hospital premises to visit patients in private clinics without any permission.
There is also little improvement in quality of the private sector services. There are big hospitals but their quality is now being questioned. Also local community has to be involved with service delivery system so that efficiency and quality are achieved and accountability ensured, they said.
There has been widespread growth of private hospitals and clinics in the country in recent years. But standard treatment like in Singapore or Bangkok is absent there. Even India and Malaysia are offering state-of-the-art treatment facilities to the patients that are globally recognised. 
In fact, centralised delivery system has made it difficult for the health ministry to spend its allocated money. There is a need for decentralisation of health and education as nowhere in the world this has worked. What is surprising is that the money is there but it is not reaching the targets, which is something terribly wrong.  
Heavy burden of medical expenses every year makes around 6.4 million people poor in the country, where many people cannot afford treatment of diseases like cancer and kidney failure. A large segment of Bangladesh population is not in a position to afford even treatment of diseases like diabetes and hypertension.
The government is, of late, more focused on delivering health services to rural people in accordance with the national social security strategy. This is good but the urban people are almost getting nothing which is unfortunate.
Given the fact urbanisation is the trend and it will increase over time and may overtake rural population sooner or later, early interventions to try to provide at least some basic healthcare facilities to them should be a priority, say analysts.
Statistics say the government's contribution was 26 per cent in the first national healthcare financing strategy developed in 2012 which has now gone down to 23 per cent. Also per capita government spending is $6.0 while the out-of-pocket (OOP) expenditure is $17 which, according to experts, is not at all desirable. There should be more commitment to health sector from the government.
What is more worrisome is that the health ministry fails to spend the allocated budget every year due mainly to procedural bottlenecks and late disbursements of fund. There is hardly any accountability regarding funding of various organisations working in the programme. Also, there is overlapping of programmes, geographical disparity and absence of need-based resource allocation in the health sector.
Budgetary allocations in the country's health sector has declined showing even a negative -10.24 per cent in FY 2013-14, which was later increased by 13.71 per cent in FY 2014-15 and again dropped to 2.67 per cent in 2015-16. Bangladesh spends 0.7 per cent of its GDP (gross domestic product) on health which is the lowest among the expenditures in other sectors. Medical analysts say the spending for health should be determined on the basis of where the country is and where it wants to reach. 
Although there is a provision to treat 10 per cent poor patients out of the total number of patients at free of cost, no private hospital follows this rule. Some private hospitals have outdoor services that charge some fees from the patients. They have now doubled the amount of fees. Free services were earlier available at the Outdoor of the public hospitals, but now some fees, though nominal, are being charged, adding to the woes of the poor patients. There are no free services wings in these hospitals.
The country's medical system is too ill-equipped to cope out with the illness of the general people. Even in hospitals in the district towns, doctors are fewer in number than the actual need, diagnostic gadgets like x-rays, ECG kits, and potential lab test equipment and technical manpower needed for examination of urine and blood are not available.
Facilities they have at their disposal in these hospitals are pathetically meagre. For that reason, they rush to the capital city for so-called clean diagnosis and effective treatment. Do they really get it? 
Throughout the last few decades substantial amount of funds allocated for hospital development and infrastructure improvement allegedly went into the hands of corrupt health sector officials. Widespread corruption with the medical purchase was recently unearthed in the country's two big hospitals.
In the absence of adequate healthcare facilities in the country, a large number of affluent Bangladeshi patients are going to India, Singapore and Thailand for better treatment. Consequently, the healthcare industry of Bangladesh is losing an estimated amount of US $500m every year.
Healthcare analysts identified inadequacy of health financing, inefficient use of existing resources and weak operational capacity of the health ministry as the major shortcomings of the country's public health sector. All these need to be streamlined. This is, however, not possible unless a proper mechanism is put in place. On its part, the government needs to initiate a move to create a legal framework so as to ensure quality treatment. 
There is a need for greater investment in health sector of the country. In order to ensure quality healthcare services, more hospitals and clinics of international standard should be built here to stem the random outflow of local patients.  For that reason, entrepreneurs, both domestic and foreign, should invest in a bigger way for radical improvement of the country's healthcare services.                                          
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