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Covid-19 calls for reform in health policy

Published : Saturday, 16 May, 2020 at 12:00 AM  Count : 1309

Covid-19 pandemic has brought back the old saying into practice: prevention is better than cure. Though prevention has always been considered to be better than cure, health policy of Bangladesh is focused on the later. The health policy of Bangladesh is purely emphasizing on curative care perspective.  It focuses more on curative care system and it barely covers the mental and social well being issues. The world health organization (WHO) defines health as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. Our health policy intends to comply with this definition, but skip paying more attention to the mental and social well being issues.

Mental health encompasses a state of well being whereas an individual can realize his/her ability to cope with the stress of life; and work efficiently to contribute to his/her own and his/her community. On the other hand, social well being is the foundation for social equality, social capital and social trust and the antidote to racism, stigma, violence and crime. All these aspects of social well being have a substantial effect on mental health and well being. In addition, mental well being refers to the ability that provides happiness for an individual to maintain relationship with others. It helps an individual to take decision for the sake of others and know the boundary of his power to contribute to get rid of the social inequality and improper policy.

Social well-being is the basis for social equality, social capital and social trust, the antidote to racism, stigma, violence and crime. All these aspects of social well being are known to have a profound effect on mental health and well being individually and collectively. Mental well being includes the capacity to make health and happiness enhancing relationships with others. People with mental well being know themselves and their needs, have clear boundaries, relate to others using the skills of emotional literacy and accept and manage conflict without manipulation or coercion. They make good decisions on behalf of others. Mental health learning thus makes an individual to be law-abiding for social well being. Therefore, mental health and social well being issues must be emphasized properly in the health policy of Bangladesh.

However, the current health policy witnesses some major constraints including huge population pressure, indicator specific lower achievement than target (maternal mortality ratio, stunting and wasting rate of under 5 children), lack of skilled birth attendant during child delivery, pressure on urban health structure due to migration from rural to urban area, adverse effect of climate change on health care services, uneven ratio of doctor, nurse and paramedics (required ratio 1:3:5),  higher service charge and treatment cost in private sector, complicated procurement system and meager allocation for healthcare expenditure. The fund deficiency is the reality that cannot be managed within a day. Despite this, all other problems addressed can be tackled applying stringent oversea and proper management mechanism.  

In addition, there are many other issues, which are not addressed properly in the current health policy of the country. There is no specific policy measure concerning the importance of pure water intake, hand wash and sanitation, safe food measurement, physical exercise, negative effect of tobacco use on health. The issue of water and air borne diseases is also omitted from the health policy. Different types of health promotion activities such as information, education and communication (IEC) approach, behavior change communication (BCC) mechanism are not mentioned in the policy. According to WHO, health promotion activities are the process of enabling people to control over, and to improve their health.

Besides, the existing health policy focuses merely on quantitative measure of indicators and avoids the qualitative aspects of health like client satisfaction on received services. Addressing this service-oriented issue is significant for the qualitative improvement in the recovery from poor access to service, low quality of care etc. Also there is no concrete direction about the service of aged population and the roles of Ministry concerned are not specified properly in the health policy. Another important life-centric issue is also skipped from the current health policy, which is the proper guidance to run any laboratory testing. For the sake of public health, the authority concerned should address all these issues of health in the health policy and take effective measures to implement the agenda relating to those omitted issues.   

Moreover, it is also important for government to link up the health related SDGs with other SDGs. Ensuring healthy lives and promoting the well being at all ages are essential to sustainable development in order to materialize the slogan 'good health and well being' as revealed in the third SDG. However, ensuring healthy life is not only connected with the concept of health but also with other SDGs, such as Gender equality (Goal 5), Clean Energy (Goal 7), Sustainability (Goal 11), Climate Action (Goal 13), Peace and Justice (Goal 16) and Partnership (Goal 17) etc which are already identified in the government documents. Therefore, it is expected that these linkages should be focused immediately.       
Given the issues raised, we would like to propose a tentative outline for a revised health policy of Bangladesh. Government should be given focus on health covering physical, mental and social wellbeing issues. Preventative and promotional aspects along with curative measure is highly be prioritized as learned from the Covid-19 outbreak in the country.

 Adequate focus should provide on other dimensions such as population, food, gender, hygiene, equity along with health and nutrition. Besides, integrated HMIS and digitalization of health care services, vaccination/immunization card for migrants and tourists, tough monitoring on the port/border area to limit the spread of any disease, health service guidance for the refugees, role of international humanitarian organizations should be noted in the health policy of the country.

Policy reform is complex process and not driven only by the political agenda. But if we desire to ensure universal health care then we have to move on after experiencing the Covid-19 pandemic.

Tahmina Sultana, Deputy Director (Research), Bangladesh Institute of Governance and Management, and
Md. Monirul Islam, Assistant Professor, Bangladesh Institute of Governance
and Management










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