A simple and clear message for our healthcare

The world's developed countries such as Italy, Spain and the UK spend around 10 percent of their GDP in their healthcare sectors which is almost double the minimum requirement suggested by the WHO. The USA spends three times more than the WHO requirement.

Yet, their hospitals are struggling to handle their Covid-19 patients as the coronavirus pandemic rips through these countries uncontrolled, killing thousands of people and devastating their economies.

Their governments have come up with trillions of dollars in stimulus packages aimed for post pandemic economic recovery.

Economists and medical experts keep urging them to spend more to fight the health crisis for the sake of spurring economic growth and for fighting the possible second wave of the pandemic in coming months.

Let us turn our gaze inwards for a moment. The share of our health budget remains below 1 percent of our GDP – only 0.9 percent, lowest in South Asia, though we are now one of the fastest growing economies in the world.

This low allocation is even lower than the target of 1.12 percent of our GDP set out in Bangladesh's 7th five-year plan that ends this year. Hence, out-of-pocket expenditure on healthcare in Bangladesh is 71.9 percent of the current personal health expenditure, which is the highest in South Asia, according to the CPD, a policy think tank.

As a result of such low allocation and neglect, our public healthcare system is one of the weakest in the world and was already vulnerable even before such a large scale virus outbreak.

"Vulnerability of our healthcare system has been exposed during the real crisis," said Dr Iqbal Arslan, a professor at Bangabandhu Sheikh Mujib Medical University. 

Referring to the crises in some advanced economies in Europe, he said: "Advanced countries that spend large amounts of money for health care are scrambling to contain the spread of the virus and treat their patients. Now imagine what will be our response if we were to face such a large-scale health crisis."

Professor Muzaherul Haque, a former advisor of WHO, says our healthcare system does not have the capacity to face a large scale medical crisis.

Arslan, also secretary general of Bangladesh Medical Association (BMA), said the healthcare sector is suffering from acute shortage of manpower such as doctors, nurses and technicians due mainly to the poor budget allocation.

Ideally, the doctor and nurse ratio should be 1:3. But we have less than one nurse per doctor. Every doctor should have five auxiliary support staff. We have less than one.

Our government on Sunday announced a stimulus package of around Tk73,000 crore to recover the country's economy from the pandemic fallout. But no special package was announced for increasing public expenditure for the healthcare sector.

Prime Minister Sheikh Hasina, however, yesterday announced special insurance and stimulus for the doctors, nurses of government hospitals and health officials along with field administration officers, law enforcers and relief workers for their frontline roles at the time of the coronavirus pandemic.

Her announcement may help boost up morale of the front line fighters in this battle against the virus.

How vulnerable is our healthcare?

After the first coronavirus positive patient was detected in Bangladesh, the appalling situation of the healthcare sector soon became apparent.

Although we had a three-month time period to gear up after the virus was first reported in China in January, our healthcare system could not prepare itself for the eventuality. Labs were not ready to increase the number of testing. Shortage of protective gears and masks for doctors and nurses was acute.

In many hospitals, doctors reportedly refused to treat patients with complaints of difficulty in breathing and cold, which are similar to symptoms of coronavirus infection. They did not want to expose themselves to infection risk as they were not provided protective gears. Out of fear, people also stopped visiting hospitals for treatment and regular check-ups.

Patients of non-communicable diseases such as cancer, kidney and heart problem, are also suffering from lack of treatment in the period of pandemic.

This newspaper, at the end of March, reported that many doctors and nurses at upazila hospitals were using decade old personal protective equipment (PPE) to treat patients coming there with fever, sneezing, coughing and other symptoms.

Local livestock departments received those around 10 years ago, in 2011, during the bird flu outbreak. People in charge of disposing of infected birds had been given the equipment during the time.

Big push needed

The present vulnerable situation in the healthcare sector has developed over the years.

Low budgetary allocation over the decades is one major indicator that tells a story about its real strength.

Take the allocation in the last decade. Allocation remained in between 4 to 6 percent of the total budget since 2010. Even in the first half of the decade, the allocation witnessed a decline as it reached 4.3 percent, down from 6 percent.
The rest of the half decade recorded an up and down trend. The current fiscal year saw the lowest allocation – only 4.9 percent – in the last five years.

Every year medical experts denounce the low budgetary allocation and demand higher public expenditure in this sector. But their calls always fall on deaf ears.

Now, the chickens have come home to roost.

The irony we are witnessing now is that the sector left underfunded for decades has now become the most important for the whole nation and the country. It is now the first line of defence against the pandemic that has forced us to shut down our economy to save the lives of the citizens by containing the spread of the virus.

The other sectors that have always got higher budgetary allocations every year are now depending on this long neglected sector for their survival.

But our healthcare system is not equipped to take this massive shock of the coronavirus pandemic, according to experts.

"The coronavirus pandemic that pushed the life and economy into a complete standstill also exposed the fragile state of the country's health system, which needs to be fixed to restore people's confidence in it," said economist Dr Ahsan H Mansur, executive director of Policy Research Institute.

Dr Zahid Hussain, a former lead economist of the World Bank Dhaka office, suggests that the government should invest more in the healthcare system to make it robust enough to absorb future medical crises.

Professor Muzaherul Haque, a former advisor of WHO, also thinks there is no alternative to more public spending in the health sector to survive from any future pandemic.

The CPD, in its proposals to the revenue agency for the next budget, said that the pandemic situation emphasised the need for higher allocation for the health sector.

"Those who make budgetary allocation should consider the importance of the healthcare system and this should be reflected in the next budget," said Professor Iqbal Arslan.

Why do economists speak for the health sector?

Economists have made one thing precisely clear: large scale public expenditure in health care helps avert the impact of pandemic and spur economic growth.

Penny Goldberg, an economics professor at Yale University and former chief economist of the World Bank Group says the priority of economic policy should be to contain the healthcare crisis.
"Move massive resources to the healthcare sector. Take measures to increase the supply of masks, sanitizer, respirators and ventilators," she says.

As many as 40 top economists including IMF chief economist Gita Gopinath and former US President Barack Obama's top economic adviser, Jason Furman, in an ebook published by the World Economic Forum, urged the governments to increase healthcare spending to fight the current pandemic.

Spending about $3.4 billion a year on improving human and animal emergency medical preparedness would yield $30 billion of annual benefits, according to WHO.

The advantages could be even greater, since major outbreaks can leave long-lasting scars on an economy.

Diseases shrink the labour force by sending people to convalesce at home, reducing their ability to work, or, in the worst case, killing them. A 1 percent increase in life expectancy results in a 5 percent increase in per-capita GDP, according to one analysis, writes Bloomberg columnist David Fickling.

Take the cases of Sierra Leone and Liberia that were the worst hit by the Ebola epidemic in 2014. The two African countries have still not recovered to the levels of income per capita they enjoyed before the epidemic.

The message is simple and clear: the burden of poor health impoverishes the economy.