Scrutinising the status quo of healthcare: Post-pandemic expectations and realities
The Covid-19 pandemic created an ecosystem conducive to massive health scams and fraudulent activities, most of which were masterminded by few unscrupulous individuals with unchecked power and impunity.
As we complete a year since the Covid-19 pandemic hits the country, the government of Bangladesh has evidently redeemed its image with the successful sourcing and efficient rollout of vaccines in the country. However, in the frenzy of this success, it is imperative to step back and assess the efficacy of the healthcare system across the board.
Right after its emergence, the covid-19 pandemic quite viciously revealed major fault-lines in health care systems operating in many countries, with Bangladesh being no exception. It unraveled an undermined truth which is, burgeoning economies and soaring GDPs are simply not enough to carry the burden of a dysfunctional healthcare system, and crunching superficial numbers in the form of per capita income are of no use if healthcare systems remain incapacitated, as manifested by the acute paucity of medical facilities and amenities for people battling with death during the pandemic.
Looking back at the performance of the healthcare system, it was witnessed that absence of monitoring, infrastructural lapses as well as shortage of essential medical facilities and specialised medical equipment were just the tip of the iceberg. The crisis was further exacerbated by different forms of crimes and irregularities in the healthcare sector, especially in the form of white collar crimes.
However, be it developed or developing countries, public healthcare systems across the world failed to deliver effective services as issues like structural inadequacy, mismanagement, corruption and fraudulence were endemic. In the US for example, the Department of Justice, in partnership with the Department of Health and Human Services found widespread instances of market manipulation, price gouging and distribution of hoarded personal protective equipment (PPE). Quite similarly in Bangladesh, mismanagement coupled with overriding corruption in medical supply transactions, Covid-19 testing and reporting was evidently rampant.
Any discussion encircling corruption embedded within the core of Bangladesh's healthcare system inevitably brings forth the global, yet invariably contextualised debate between public versus private healthcare systems. Over the years, a parallel expansion in the demand for private healthcare has seen the radical proliferation of private hospitals.
One of the underlying causes behind the boom of private healthcare facilities could be the immense pressure on state-subsidised facilities provided by public hospitals, which despite inefficient and substandard services, still draw a huge proportion of the patients from low or middle-income background, who are unable to afford excessive spending on medical care. For the affluent class and those belonging to the upper echelons of society, private hospitals might be the primary preference.
But for many, healthcare still remains a luxury. Out of pocket expenditure as a share of the current health expenditure of Bangladesh increased from 62.5 % in 2004 to 73.9 % in 2018, and is growing at an average annual rate of 1.21% (World Bank, 2018). Nevertheless, the pressing problems faced by those seeking public healthcare however has perpetuated too, with poor service, gross negligence and corruption being some of the highly intertwined issues that have maligned the reputation of public hospitals over the years. The pandemic itself created an ecosystem conducive to massive health scams and fraudulent activities, most of which were masterminded by few unscrupulous individuals who allegedly had a propitious association with influential bureaucratic and political hierarchies, granting them unchecked power and impunity.
Interestingly, what goes unnoticed in the fierceness of this crisis is how these crimes and irregularities share a common pattern. Objective scrutiny into these apparently disconnected crime patterns reveal a common tie to deeply entrenched social and political hierarchies. Almost 50 years ago, prominent sociologist Immanuel Wallerstein hypothesised something akin to this through his world system theory where he claimed that the world is increasingly being dominated by a central and global economic system (the capitalist system) whereby core countries exploit the 'periphery countries' for their advantage, leading to global inequality.
This notion has been quite apparent as we witnessed how the capacity and efficiency of public healthcare systems were undermined by issues like corruption and deviance, while private healthcare capitalized the exigency of the crisis to accumulate profit at the expense of public health and well-being resulting in unequal distribution and deprivation of services.
The fact that developed countries like the US have failed to establish a decent public healthcare system even in today's time says a lot about the priorities and policy frameworks of these nation-states, who, quite ironically, have the highest military spendings in the world.
Naomi Klein through her book 'The Shock Doctrine: The Rise of Disaster Capitalism' further relates how against the context of this increasingly dominant neo-liberal capitalist system, crises like wars, natural disasters or even pandemics are exploited by states and private organizations to instil and establish neo-liberal economic policies like privatization, deregulation and cuts in social services in different countries around the world.
These policies usually come in the form of 'extraordinary or emergency politics' as a shock tactic to serve the corporate interests as the citizens continue to be in a state of overwhelming shock and confusion. Klein also goes on to say that history can be surmised as a 'chronicle of shocks—the shocks of wars, natural disasters, economic crises and their aftermath'—aftermath that she delineates as disaster capitalism characterized by free-market solutions that only end up capitalizing and eventually exacerbating the existing inequalities (Solis, 2020).
Whether or not the healthcare sector will undergo major reform in the post-pandemic context is a question that is yet to be answered. It is indubitable that the post-pandemic Bangladesh healthcare system requires a major overhaul to build resilience for combating future health disasters, which in turn, requires policy-driven interventions.
But if we were to match such ambitious expectations with extant realities, we would find that not much has changed since the emergence of the pandemic. This leads us to the thought that if even a global pandemic cannot force us to take a step back and recognize the underlying inadequacies and disparities of the healthcare system, we certainly need to question the invincibility of the neo-liberal capitalist economy, the perpetuated nature of political patronage and clientelism that continues to disenfranchise the most pivotal stakeholders of a democracy— the mass people.
Lamia Mohsin is working as a Junior Consultant at the Resilience and Inclusive Growth Cluster of UNDP, Bangladesh country office.
Nousheen Sharmila Ritu is an aspiring researcher currently studying in the Department of Criminology at University of Dhaka.