People in Bangladesh are being deprived of their right to proper medical service and healthcare, which the constitution has guaranteed as a fundamental right
।। Jabed Iqbal ।।
The Bangladeshi healthcare system, which is highly decentralized and unregulated, is controlled by a variety of organizations, including for-profit entities, NGOs, the national government, and international welfare organizations. In recent years, the Bangladesh government has prioritized healthcare as a key development area, aiming to improve healthcare infrastructure, expand services, and strengthen the overall healthcare system.
Efforts are being made to enhance healthcare financing, increase the number of healthcare professionals, and promote public-private partnerships to address the existing challenges. Despite facing many challenges, Bangladesh has made remarkable progress in achieving health and population indicators, particularly in achieving the health-related Millennium Development Goals (MDGs) such as MDG 4 and MDG 5.
As noted, the healthcare system of Bangladesh relies heavily on both the government and the public sector for financing and setting overall policies and service delivery mechanisms.
However, the healthcare sector in Bangladesh suffers from a range of problems such as
(a) lack of public health facilities;
(b) scarcity of skilled workforce;
(c) inadequate financial resource allocation;
(d) lack of accountability and established guidelines and
(e) healthcare inequity.
Political instability and demise of ideal democratic practices is also a significant contributing factor. The absence of a pro-active and transformative stewardship able to design and enforce policies to further strengthen and enhance the overall health system is the most crucial challenge.
”Challenges”
The Bangladeshi government has set up many government-funded hospitals in rural areas to provide cheaper treatment for rural citizens, but these hospitals are often poorly funded, understaffed, and crowded.
These challenges are magnified by the unequal geographic distribution of individuals throughout the country, in which 60% of Bangladeshis are primarily concentrated in rural areas compared to 40% in urban areas. Moreover, the shared public and private healthcare systems have caused many problems, including unequal treatment programs between socioeconomic classes.
Enrolment in medical colleges and healthcare training facilities has increased, but the shortage of healthcare workers and clinical equipment is a significant issue, with most physicians and healthcare workers concentrated in urban areas, leaving rural areas with inadequate healthcare facilities.
The socioeconomic inequality affects healthcare in Bangladesh, as poorer citizens cannot afford certain treatments or services due to high out-of-pocket costs. Limited government funding has also led to high out-of-pocket payments, creating a significant financial burden for impoverished families.
A recent study revealed that around 25% of individuals incurred catastrophic health expenditures, and 14% of the population had to forgo healthcare for various reasons, yet close to 70% of total health expenditures continue to be paid out-of-pocket by Bangladeshis . Financial burden and forgone care were higher among households with older populations or chronic illness and those who use either public or private health facilities.
Quality of care in both public and private services has been consistently poor due to the unfortunate (i) lack of assessments and monitoring of the provider care quality; (ii) widespread suboptimal professional knowledge; and (iii) lack of proper established guidelines in clinical practice.
Possible solutions
To ensure access to health services for all, Bangladesh needs to undertake dynamic and visionary steps to implement several policies:
Increase government funding for healthcare:
Bangladesh’s healthcare system relies heavily on out-of-pocket payments, which creates a significant financial burden for impoverished families. Increasing government funding for healthcare can reduce the financial burden on individuals and ensure that everyone has access to affordable healthcare.
Train and educate more healthcare workers:
Bangladesh has a shortage of physicians, specialists, and clinical equipment, particularly in rural areas. Increasing the number of healthcare workers including traditional health care providers by providing training and education facilities can help address this shortage and ensure that everyone has access to healthcare services. Healthcare providers should receive ongoing training and support to maintain high standards of care.
Develop a comprehensive national healthcare quality strategy:
This should include a clear vision for improving healthcare quality, as well as specific goals, aims, and action plans for achieving those goals. The strategy should prioritize patient-centred care, evidence-based practice, and continuous quality improvement.
Strengthen governance and leadership structures:
Effective governance and leadership are critical for creating a culture of quality and accountability within healthcare organizations. This includes establishing clear roles and responsibilities for quality management, developing quality standards and guidelines, and building capacity for quality improvement.
Improve healthcare facilities in rural areas:
Most physicians and healthcare workers are concentrated in urban areas, leaving rural areas with inadequate healthcare facilities. The government can set up more government-funded hospitals in rural areas and provide better funding, staffing, and equipment to ensure that rural citizens have access to quality healthcare. Healthcare systems and infrastructure should be strengthened to support quality improvement initiatives.
Improve healthcare inequity and inequality:
Simplest measure is to compare the health status of the lowest socioeconomic stratum with the highest stratum. Incorporating social safety nets in the health financing system can help alleviate the financial burden on vulnerable populations, such as older populations or those with chronic illnesses, and ensure that they have access to healthcare services.
Time to act is now
The existing laws and policies that deal with healthcare services in Bangladesh have several gaps that need to be addressed for securing quality healthcare for all.
Due to flawed regulatory frameworks, loose accountability and transparency, widespread corruption, poor monitoring systems, inadequate health financing, inequity between rural and urban populations in accessing healthcare services, and a lack of effective grievance procedures, people in Bangladesh are being deprived of their right to proper medical service and healthcare, which the constitution has guaranteed as a fundamental right.
A dynamic and pro-active stewardship that can formulate and enforce policies to strengthen and enhance the overall health system could bring forth a meaningful and effective health system reform.
These policies would be built upon the values of social equity and accountability and work for the betterment of the health of the people of Bangladesh.
Jabed Iqbal is a physician working in the Singapore public health system.
