Let’s promote health issue for economic development  

Health issue and SDGs are interrelated. It would be tough to achieve SDGs by neglecting the health issue. Nearly all the countries in the world have promised to improve the planet and the lives of its citizens by 2030 through 17-life changing the goals, outlined by the UN in 2015. The goals are known as Sustainable Development Goals (SDGs).  

Promoting health and wellbeing is one of 17 SDG goals. SDG 3 aspires to ensure health and wellbeing for all by 2030. It also aims to achieve universal health coverage, and provide access to safe and effective medicines and vaccines for all.      

Communicable disease once was the main health problem in Bangladesh. Bangladesh achieved remarkable success in prevention of such disease due to building necessary health facilities, and various steps taken at public and private level.
With the passage of time, the mode of diseases has also been changed. The scope of non-communicable disease is increasing now more due to  change of lifestyle and food habit of people, use of tobacco, intake of excess calorie (fat and sugar), excess salt, lack of physical work, increasing mental pressure, addiction to mobile phone, online medium and less scope to play at ground.

Unplanned urbanization and environmental pollution are also blamed for the outbreak of non-communicable diseases. It is known to all that across the world several non-communicable diseases such as cardiovascular disease, stroke, cancer, diabetes and lengthy respiratory disease are responsible for 71% death.   

According to World Health Organization (WHO), 67% death is caused due to non-communicable disease, causing huge economic loss to Bangladesh.

The spread of non-communicable disease is a big obstacle to achieving allout development for Bangladesh. Bangladesh is now working to achieve the UN declared SDGs by 2030. It is essential to ensure the good health and healthy living of people to achieve that objective.

It would be tough to control the non-communicable disease if preventive steps along with ensuring medical facilities are not taken at the moment.

Hence, it is needed to increase investment in the health sector, particularly there should be more investment to prevent non-communicable disease.

We should keep in mind that the results of investment in health and education sector is not available immediately, rather it has far-reaching impact. So, it is urgently needed to increase allocation in health sector and ensure its proper utilization in national interest. Steps should be taken for ensuring modern medical treatment facilities, on the other hand, adequate financial allocation should be made for controlling and preventing diseases.

It is also important to spend money for the purpose of carrying out research, publicity and raising mass awareness in this regard.

In the previous budget, the government allocated 5.4 per cent of total budget in healthcare while this year's budget witnessed an allocation of 5 per cent of the total amid the high out-of-pocket healthcare expenditure in the country.

Many experts think that the budget would increase the out-of-pocket expenditure that would be a bar to getting health care.

In 2020, people spent Tk 68.5 from their pocket for every health expense of Tk 100, up from their out-of-pocket expenditure of Tk 67 five years ago, according to the National Health Accounts, a wing of Health Economics Unit.

Among the SAARC countries, Bangladesh has the second highest out-of-pocket health expenditure after Afghanistan where out-of-pocket health expenditure is 78 per cent.

The out-of-pocket health expenditure in the country was 55 per cent in 1997 which rose over the years steadily while the public financing in health declined to a little over 23 per cent in 2020 from 37 per cent in 1997.

Bangladesh continued to spend about 5 per cent of its national budget on health sector, also one of the lowest health investments in the world.

Experts said that the health budget should comprise at least 8 per cent of the budgetary allocation. According to media reports, the per capita health expenditure in Bangladesh is just $45, while it is $58 in Nepal, $73 in India, $103 in Bhutan and $157 in Sri Lanka.

There is no alternative to building skilled manpower for ensuring modern and improved treatment system. Hence, it is imperative for the government to chalk out a master plan for making skilled manpower such as expert physician, nurse, paramedic and technician in different fields.

It is upto the government to ensure health services system for the people. On the other hand, it has to give patronization to the private institutions, who are giving health services, and also it need to supervise the quality of services provided by the private sector and fees collected by them from the patients. Then, I hope, it would be possible that people would get real benefit.

Besides, the government should take effective initiative to provide medicine for free to poor patients, who have been suffering from complex diseases such as diabetes and cardiovascular disease for a long time, and long term loan for medical treatment.

The average age of people is now increasing due to control of communicable disease, on the other hand, risks to old age related diseases is increasing. The government should also look into the matter.

It is not possible for the government alone to contain the non-communicable disease. The government, private and development organizations should work together in this regard.

There must be awareness at the individual level. Non-communicable diseases are related to our lifestyle. People should be aware about the importance of physical work and exercise, intake of healthy and nutritious foods for prevention of non-communicable diseases. The mass media can play an important role in raising awareness.

It is important to make an effective referral system for treatment of emergency and complex patients. An effective referral system is yet to be built up from community clinic/medical sub-centre to upazila hospital, from upazila to district hospital and from district hospital to tertiary or specialized hospital. As a result, one type of coordination less condition is prevailing in medical activities.

Health service is a complete team work. A physician will be the head of this team, while there will be three nurses along with them. According to yardstick of WHO, each team will have 22 trained members.

According to international standard, Bangladesh has half of its required doctors in proportion to its population. In the last three decades, private sector's role in healthcare sector has been increased. The capacities of private sector have increased more compared to the public sector. On behalf of the authorities concerned, there is a clear lack of willingness to properly monitor, control and manage the private sector in health service.

Now the time has come to take necessary steps to make the private sector people-friendly and develop them in the proper ways. We cannot neglect the health issue, because good health of people is the precondition of economic development of a country.

The writer is former Executive Director of Public Health Foundation, Bangladesh