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Urgent need for health sector reforms

Published : Wednesday, 18 September, 2024 at 12:00 AM  Count : 265
Prof Dr Md Golam Sharower
The poor health sector of the last one and a half decades is going on today. A nation can never dream of potential in a weak state of health. Can't walk upright. The health sector of Bangladesh is a large sector. There are specialist doctors as well as support staff in this sector are working.  If the health sector is not reformed then a sick nation will be created. Now the question is where, when, how and how long the health reform is needed. The reform process is a systematic ongoing process. Bangladesh's health sector is stuck in a vicious cycle of neglectful exploitation.

Especially the long decade and a half has fallen into extreme condition due to the evil lack of various types of syndicates. The reflection of we can see with our own eyes. It is seen that the highest class of people of the country go abroad for treatment only when it is a common cough. Such a situation would not have happened if an automated public-welfare sustainable health system had been established in our country. Health is one of the basic human rights. In order to promote this health, special emphasis should be placed on 2 subject matters. One is public health and the second is general medicine and treatment. But the most regrettable thing is the first, that is, public health is extremely neglected in our country. As a dire consequence, the second means that there has been a great pressure on the treatment and medical management. Overcrowding in all public and private hospitals of the country.

Even in private clinics where the patient's pressure is constantly increasing it is definitely undesirable. If public health was given importance like in developed countries, then the extreme reality of economic bankruptcy of citizens for medical treatment would be reduced to a great extent. Neglected Tropical Diseases (NTDs) as defined by the World Health Organization can be prevented only when the advice of public health experts is properly implemented. An example will give you a clear idea.In 1854, when 616 people lost their lives due to a terrible disease called cholera in Broad Street, London, England, a famous public health specialist named John Snow saw that this terrible organism had flowed into the human body through the water from which the sick people drank. He was able to prevent cholera by disabling that water source. Yes, public health is a credit here. So, there is no alternative to strengthening public health. Even during the past covid-19 we have been able to realize the importance and significance of public health. Where medical services will act as a very supportive management of public health. 

The main task of public health research and education for public health professionals like us is to research the health of citizens and provide advice for making the right decisions based on the results obtained. The necessary reforms are urgently needed to speed up this work. These reforms include increasing the scope of research. Launching public health units at each district and upazila level. Currently, the breeding season of Aedes mosquitoes is going on. Today till September 16, the total number of infected patients with dengue is 19075 and the death toll is 107. Not even one death is desirable. Establishment of high-quality research facilities is absolutely necessary for the study of reproduction, behavior, mode of transmission of dengue virus by Aedes mosquito, level of resistance of Aedes aegypti and Aedes albopictus to larvicide and adulticide, level of virus virulence etc.Which is the decision of the meeting minutes of the Ministry of Health and family welfare to establish a high-tech molecular laboratory at Department of Entomology in the National Institute of Preventive and Social Medicine, NIPSOM, the premier post graduate institute in public health in Bangladesh. 
Now all that is needed to implement. The establishment of this molecular laboratory  will open the door to unprecedented progress in public health and vector borne disease control in Bangladesh. Maintaining databases or national data repositories for all communicable and non-communicable diseases alike is essential. Citizen's own expenditure on health is constantly increasing. Its regulation requires reforms. According to a study jointly conducted by the South Asian Network on Economic Modeling (SANEM) and the Global Development Institute of the University of Manchester, the average per capita health expenditure has tripled in 2023 to Tk 1,704 per month compared to 2018. However, this increased health care expenditure is not uniform among all classes of people. This expenditure is six times among the rich and double among the poor. The research also shows that many pharmaceutical companies have increased the prices of their medicines on the pretext of the war in Russia and Ukraine. These prices have increased by up to 150 percent. 

The cost of medicines and disease tests and the cost of diagnostic centers prescribed by doctors have disrupted the life of citizens. Through reforms, it is possible to reduce this additional unsustainable expenditure and bring down the per capita health expenditure to Tk 40-50. For this, the government should take control over all the private health sector. Advised prescriptions for various tests of diseases in private hospitals should be kept under proper scrutiny. Categorically children, middle-aged and old people should be created database and stop repeated disease tests. The trend of unnecessary tests and prescriptions should be stopped. Pharmaceutical companies need to stop using expensive packaging. The evil culture of giving expensive gifts must be stopped.

According to Bangladesh Bank data, among the non-food factors that are responsible for our inflation, the main one is the citizens' expenditure on health. Therefore, the main goal is to improve the health index through the reform of the health economy. We know that there are only 0.67 doctors and 0.49 nurses and midwiferies per 1000 citizens as determined by the World Health Organization. Among them 24 percent posts are void. All in all, our health sector is running with 74 percent fewer doctors, nurses and midwiferies than the standards set by the WHO. To reform this sector, first attention needs to be given to manpower. After that ensuring the appointment of specialized doctors according to the category. There is no alternative to specialized doctors to bring public satisfaction in medical care in a well-planned manner. At the same time, serious attention needs to be given to increasing the number of subject specificfaculties associated with medical colleges. The medical colleges are running with the acute crisis of these expert teachers in the private medical colleges. As a result of which the new doctors have to face severe critical situation. There are 107 government and private medical colleges in the country. The total number of seats is 10 thousand 697. Out of these 37 government colleges have 4 thousand 350 and 70 private medical colleges have 6 thousand 347 seats. These private medical colleges are filled with thousands of anomalies. But they are apathetic despite having the opportunity to overcome the crisis.

Infrastructural as well as skilled manpower in private medical colleges. In such a situation, citizen satisfaction with the services received from the doctors passing out from these colleges is very difficult. Deaths of patients in various hospitals, uncoordinated behavior of doctors with patients and their relatives. The exorbitant medical expenses are taking the health sector from bad to worse day by day. Now is the time to break free from this terrible situation. Reforms are therefore needed in all areas. There is an urgent need to reform the health sector by creating an expert panel comprising of doctors, public health specialists, nurses, midwiferies to bring home the benefits of the victory of  5th August student-public movement

The writer is  Professor and Head, Department of Entomology, National Institute of Preventive and Social Medicine, NIPSOM



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