Rogi Kallyan Samity: A small lifeline for patients drowning in medical expenses

Monzur Ahmed has been lying on bed no. 11, in ward number 215 at the Dhaka Medical College Hospital, for more than a month. The thirty-year-old swing operator at a garment factory in Narayanganj came to the hospital with a swollen belly, nausea, and stomach ache. 

His health problems started to emerge four months ago, said his wife Marium. 

"Now that he cannot eat anything at all, the doctor prescribed him Kabiven (an emulsion or saline solution administered intravenously) every day," said Marium, attending to her husband at the hospital.  

A single bag of Kabiven costs Tk2,330. Monzur needs Kabiven worth Tk69,900 a month, which is far beyond his family's capacity to pay. 

When Marium informed the doctor about this, the doctors revised the prescription - suggesting Monzur takes a bag of Kabiven every other day. 

But Marium could not afford that either. In the last one month, she managed to buy only four bags of Kabiven. 

In the beginning, she sold her cows and took loans from her relatives to continue Monzur's treatment. Finally, she had to sell 5 decimal land for Tk1 lakh and 80 thousand in her hometown Naogaon. 

By now, Marium has already spent Tk5 lakh for Monzur's treatment and is left with just 10 decimals of land on which she has her house.  

On noticing her plight, one of the doctors at the hospital suggested Marium to go to the Hospital Social Service Office on the premises of the DMCH, to check if they can provide some assistance. Hospital Social Service provides free medicine and other medical services to needy patients for free at hospitals and health centres across the country. 

"I went to the Hospital Social Service Office. They gave me an application form and told me to fill it in. It required a signature of the doctor under whom my husband is taking treatment. I submitted the form to the service office and the next day, I got a bag of Kabiven for free," said Marium.

Like Marium, in the 2021 fiscal year, 7 lakh 33 thousand 677 poor patients got assistance from the Hospital Social Service Offices at 528 hospitals across the country. These hospital service offices receive manpower and funding from the Rogi Kallyan Samity, which is a welfare programme run by the Department of Social Service of the government. 

According to the Department of Social Services officials, the Rogi Kallyan Samity provided Tk20 crore 73 lakh to patients in 2021. That year the samity received Tk20 crore 20 lakh - while the government provided Tk15 crore, the rest 5 crore came from zakat, donations and profits from investments of the Rogi Kallyan Samity. 

This financial assistance, of course, is nowhere near being enough. Due to fund crunch, the Rogi Kallyan Samity desks often have to turn away a large number of patients. 

How it began

In 1958, two social welfare officers started this programme in DMCH for the first time. Since then it has spread, and now the programme runs at 528 hospitals all over Bangladesh. This includes upazila health complexes, district hospitals, medical college hospitals, and private hospitals across the country, as well as the specialised hospitals in Dhaka city. 

Hospital Social Service officials said that if they got more donations, it would help more patients who cannot afford to buy medicines. 

Apart from prescribed and surgery-related medicines, the Samity desks also provide money for transport fare to people who recover from illness but usually are left with no money to return home. They also provide money for carrying dead bodies home.

The officials said that often unsupervised lone patients come to the hospital with no one to look after them and bear the expense for their treatment. The service office then provides them with clothes and other needs. The Samity helps poor patients to buy wheelchairs, crutches, walkers, and blankets in winter. 

Dipika Rani Saha, a Social Services Officer at DMCH, said they bear the expenses for rape victims at the One-Stop Crisis Centre (OCC) and also provide money for chemotherapy and dialysis of the patients. But how much money do they actually give? 

"Recently a patient needed two stents (A stent is a tiny tube used in treating heart disease). For the surgery, the patient's family needed around Tk2 lakh. When the family came to us, I could give only Tk5,000. That's our ceiling, I cannot give more than that to one patient, according to the policy (The policy only applies to DMCH). I had nothing to do", Dipika said.   

How the system works

The service office provides a form which the patients need to fill in. The form also requires a signature from the doctor who is treating the patient and a copy of the prescription attached with it. After submission, the service office sends the application to the hospital medical store, to check if the prescribed medicines are available there. The office doesn't provide medicines that are already available at the hospital. 

"Without the signature of the doctor and the patient, we don't provide any medicine", Dipika mentioned. 

The sources of funding

The funds for the Rogi Kallyan Samity comes from three different sources. Bangladesh National Social Welfare Council provides a portion of the funds. Another portion of the fund is collected from zakat and fitra, while the rest of the money comes from individual and institutional donations.  

In the 2021 fiscal year, the Hospital Social Service Office at Bangabandhu Sheikh Mujib Medical University (BSMMU) received the highest amount of government fund of Tk24 lakh. That year their total fund amounted to around Tk1 crore 18 lakh 32 thousand, including earnings from an FDR of 35 lakh, the hospital's social services officer Begum Sitara Yasmin told The Business Standard. 

The rest of the fund came from zakat, fitra and donations.      

"Zakat and fitra covers almost 50 percent of our fund, which we collect during Ramadan. We have to walk door-to-door to collect the money," said Dipika Rani Saha, the Social Services Officer at DMCH.  

"Generally we save a portion of the money for emergency situations but we have to spend the zakat money within the year," said Dipika, who has been working at the hospital for the last five years.   

Sitara Yasmin said that there is no fixed amount or guarantee that they will get a significant amount of money every year. So generally they have to work with the annual budget so they do not end up spending the entire amount before the year ends.

"This year we have already spent Th60 lakh and the remainder of the money will have to suffice until the next zakat," Sitara f added. 

Similar to the DMCH, the BSMMU hospital service office also provides wheelchairs, crutches, walkers, blankets, wearable clothes like saree and lungi. Many donate food as well.

A drop in the ocean

Wednesday noon, Rashida Begum was waiting at the entrance of the Social Services Office National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) at the capital's Agargaon area.   

From Dinajpur, she brought her father-in-law, who is an auto rickshaw driver, to the hospital after an accident with another auto-rickshaw. He has been admitted at NITOR for the last one month. The doctor had to amputate one of his legs. On Tuesday, the doctor released the patient but she couldn't return as she didn't have any money left to go back.

Hiring an ambulance would cost them around Tk10 thousand, which was impossible. So she decided to go by bus. They would however need three seats so her father-in-law can lie down. 

"I have no one to give me that money. I have been waiting here since yesterday, with the hope that they would give me some," said Rashida. "We need at least two to three thousand takas to take three seats." 
The Social Services Office of the hospital gave her the Tk3,000 she needed.   

NITOR's Social Services Officer Roushanara Khatun, said that they received Tk14 lakh in 2021 from the government. Their total funds stand at Tk1 crore. Sixty per cent of the money came from donations and zakat, including a few corporate donations, including the Akij Group. 

"Every day, on average, 15 people come to us for help but we have to turn away a third of them," said Roushanara Khatun. "Because we have to run the facility the whole year."

"NITOR has 550 non-paying beds, we can support around 150 people," said Roushanara Khatun. 

National Mental Health Institute and Hospital Social Service Officer Kamrun Nahar Begum said that she gets around Tk7-8 lakh annually. They spent Tk9 lakh in the last fiscal yearm, of which Tk5 lakh came from the Bangladesh National Social Welfare Council. 

"Mental hospitals do not have big donors," said Kamrun Nahar Begum. 

The district level hospitals also suffer from fund crunch. According to the 'Household Income and Expenditure Survey (HIES)-2016', Kurigram is the poorest district in the country.

Sukanta Sarker, Social Services Officer at Kurigram Sadar Hospital said that in the last fiscal year, the government provided them with Tk8 lakh. Altogether, the fund amounted to Tk9 lakh 51 thousand.

"I can provide at best Tk2,000 per patient," said Sukanta Sarker, adding that last year he provided Tk11 lakh 43 thousand to poor patients. 

Bangladeshis have to pay 68.50% of their total treatment costs out of their own pockets, according to a report of the Health Economics Unit of the Ministry of Health and Family Welfare.

DMCH Director Brigadier General Nazmul Haque, who is also the chairman of the DMCH Rogi Kallyan Samity, said that most of the people who come to the medical hospital for treatment do not have the resources to sustain for long. They sell their livestock and land to continue treatment. 

"The hospital authority provides food only to the patient, but relatives who look after the patient have to spend their own money," said Nazmul Haque. 

Pointing out that Tk1 crore is very insufficient, he said that they are trying to manage with what they get. We are communicating with large businesses and pharmaceutical companies so that they can contribute to the Rogi Kallyan Samity. He believes they can donate to the Samity from their CSR funds. 

Sabbir Imam, director (Programme) at the Department of Social Service told The Business Standard that the Bangladesh National Social Welfare Council allocates the fund for the Rogi Kallyan Samity. 

"I requested them to increase the fund several times so that more poor people can get support during the crisis," said Sabbir Imam.

Mohammad Jashim Uddin, the executive secretary of Bangladesh National Social Welfare Council said they had to allocate Tk15 crore in the 2021-22 financial year for a total of 528 hospital's Rogi Kallyan Samity's. In the fiscal year, 2019-20, the council provided Tk14 crore 39 lakh.

He said that the government's budget is increasing with time, and so they are also increasing the budget every year. 

"The demand is high. If we could get more funds, we could give more to the poor people." 

Back in the DMCH, Monzur's wife Marium does not know how long she will have to stay at the hospital. 

"At least I got a bag of Kabiven for now. It is a great help for poor people like me. I wish they could help me more," said Marium, standing by her husband's bed.