Because all our resources are being used up by the pandemic, this situation is creating a considerable gap in the entire healthcare system, predominantly in the essential health services.
According to a WHO report, the pandemic had an unparalleled impact on Bangladesh's vital health services, resulting in an interruption of primary essential health services, from April to May 2020.
The most affected areas were vital maternal and new-born health services, the supply chain of essential drugs for non-communicable diseases (NCDs) such as hypertension, diabetes, mental health, and other chronic diseases.
The report further mentions that after June 2020, the Bangladesh government progressively tried to regularise the essential health services through some initiatives. For instance, the addition of a supplemental workforce (2,500 doctors and 5,000 nurses), the implementation of telemedicine services, and an increase in the number of consultations for patients in need of regular and emergency care.
However, other studies suggest that the crack endured far beyond the lockdown period. A BRAC study conducted in 2020 suggested that people could not take essential health services from the hospitals despite their crying need.
The respondents in the study pointed out that they did not dare take the services due to fear of corona infection or for unfavourable financial situations. Many of the respondents (one in ten) who sought services reported that they encountered problems in receiving services from hospitals.
What did the people turn to as an alternative?
As a substitute, people had to depend on local physicians, quacks, pharmacies and old prescriptions. Telemedicine service also appeared at a certain point.
However, the BRAC study suggests that only 6% of surveyed households took the assistance of telemedicine service during the pandemic (5.3% in rural areas and 6.5% in urban areas). And among those that took telemedicine service, 60.3% of rural level households (35.9% in urban areas) expressed their dissatisfaction over this service.
It means telemedicine did not easily reach all. In other words, it was not that pleasant for people who are less educated and those living in remote locations.
Should we bank on telemedicine for the essential health services during the second wave?
The answer should be yes. This author was a COVID positive patient while writing this piece, who took telemedicine service from private hospitals.
However, it is not that easy for people who are less educated and do not have a smartphone or other necessary devices. It is also a million-dollar question whether the government hospitals are ready to provide telemedicine services.
Unless they are adequately instructed, equipped with essential instruments and organised to deliver service to 'dissatisfied' rural service-seeking people, the gap will be lingering.
As the second wave has emerged in a more destructive form, the government should learn the lessons from the first wave and make telemedicine service more accessible for all. Thus, it will reduce pressure on hospitals for essential health services.
It will not work automatically. Our government should set up telemedicine corners in every hospital and equip them with required doctors and devices to take care of patients. The phone numbers, preferably hotline numbers, with necessary procedures, should be disseminated among all people.
Union Digital Centres (UDCs) can play a dynamic role in this respect. One who has technological constraints can communicate with UDCs first and take crucial assistance. Upazila health complexes and district level general hospitals can be the next port of call if the patients are referred there from the UDCs. Therefore, a well-coordinated referral system should be in place to make the telemedicine service well-functioning.
The existing workforce may not be sufficient to establish this service. Government should recruit more doctors and medical assistants. It can also instruct private hospitals and clinics to introduce telemedicine services accessible to the poor.
The author is a Development researcher working as the Research Coordinator in Advocacy for Social Change department of BRAC [email: [email protected]]
Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.