Awful healthcare system of Bangladesh
In light of recent events, irregularity and inequality in Bangladesh's health sector has been laid bare to not only our country but to the whole world. Major international media outlets like CNN, Al Jazeera, NY Times, Telegraph, Sky news, to name a few have reported on the fake coronavirus tests issued by Regent hospital and others. This goes to show not only the level of disregard the authority has towards the well-being of its own citizens, but the sheer negligence on the impact it would have on our reputation to other nations, whose authorities took drastic measures putting their economy at risk to protect their own citizens.
It is essential for our government to take some radical steps now to resuscitate the catastrophic healthcare system of our country. At present, we are at the mercy of private healthcare. This condition needs to be changed and stringent laws need to be implemented to regulate these hospitals. Studies have shown the out-of-pocket healthcare expenditures of households in Bangladesh is around 70%, which in 1997 was 57% and the contribution of government at the moment stands around a meagre 23%. It might be worth mentioning that the out-of-pocket healthcare expenditures of households in Nepal is 59%.
In response to the growing disappointment in the role of public healthcare in Bangladesh due to the absence of staffs, unavailability of essential supplies, inadequate facilities, etc privatization of health sector was considered as an alternative. Accordingly, 1996 alone saw registration of 346 private hospitals and clinics, out of which 142 were in Dhaka.
This growth of privatisation was further encouraged to enable people to have access to quality healthcare service within the country and thus by the year 2000 a 15% growth of private hospitals was observed. In 2000, Syed Saad Andaleeb, former VC of BRAC University published a paper, urging to be cautious of such a rapid growth of private hospitals, predicting that it might lead to unfair pricing, increase in unnecessary and harmful services to bolster profit which will eventually lead to decrease in quality of services. Decades of corruption, mismanagement and negligence precisely transpired to what was anticipated.
Amartya Sen the veteran economist, has drawn a strong parallel of how health equity is central to social justice in a country. He suggested that if an illness is untreated only due to social arrangements of a person, it would lead to serious negative impact on social justice as it is discriminatory to a group of people. This is mirrored in a study done by icddr,b which revealed that every year around 6.4 million people in Bangladesh are becoming poorer due to excessive health costs. The burdening costs lead to loss of property, harmful loans, children dropping out of schools, curbing of essentials like food and indescribable damaging impact on mental health. Now that the option to travel abroad for medical treatments is closed due to restriction in air travels, it is time that the wealthier section of our society realize and push for a better public healthcare and well-monitored private health sector from the government. At the moment, even money cannot ensure the availability of proper ICU service in our country.
The first step the government could consider is accountability. Surely, without insider support, criminals like Shahed would not have been able to not only run an unlicensed hospital but also manage authorization from the government to test and treat coronavirus infected patients. Giving harsh punishment or sentences to these corrupt officials will set a precedent. Secondly, fixing unethical practices within the system, such as one that is very prominent is the interaction of pharmaceutical companies and physicians. Pharmaceutical companies in Bangladesh spend over Tk 6,000 crore on marketing every year and a major chunk of it is utilized as gifts for physicians, who prescribes their medicine. Regulators have to look into such malpractices that are rife in our system. Nonetheless, the iceberg to our sinking healthcare system remains "corruption". If steps are not taken to eradicate or even reduce corruption then we will end up with millions of Shahed infecting our healthcare system to a point of irrecoverable damage.
The writer is currently doing PhD in Biological Sciences from University of Cambridge, UK with IDB and Cambridge