The sinking healthcare system of Bangladesh
The first step the government can consider to fix the system is ensuring accountability
In light of the recent events, irregularity and inequality in Bangladesh's health sector have been laid bare to not only people in our country but to the whole world. Major international media outlets like CNN, Al Jazeera, New York Times, The Telegraph and Sky news, just to name a few, have reported on the fake coronavirus tests issued by Regent Hospital and others.
This shows not only the level of disregard the authority has towards the well-being of its own citizens, but also sheer negligence on the impact it would have on our reputation to other nations, whose authorities took drastic measures, putting their economy at risk to protect their own citizens.
It is essential for our government to take some radical steps now to resuscitate the catastrophic healthcare system of our country. At present, we are at the mercy of private healthcare and this needs to change and stringent laws need to be implemented to regulate these hospitals.
Studies have shown that the out-of-pocket healthcare expenditure of households in Bangladesh is around 70 percent, which in 1997 was 57 percent. The contribution of the government at the moment stands at around a meagre 23 percent. It might be worth mentioning that the out-of-pocket healthcare expenditures of households in Nepal is 59 percent.
In response to the growing disappointment over the role of public healthcare in Bangladesh due to absence of staff, unavailability of essential supplies, inadequate facilities, etc., privatisation of health sector was considered an alternative. Accordingly, the year 1996 alone saw registrations of 346 private hospitals and clinics, out of which 142 were in Dhaka.
This growth of privatisation was further encouraged to enable people to have access to quality healthcare service within the country, and thus by the year 2000, a 15 percent growth of private hospitals was observed.
In 2000, Syed Saad Andaleeb, former vice-chancellor of Brac University, published a paper, urging to be cautious about such a rapid growth of private hospitals. He predicted that it might lead to unfair pricing, and increase in unnecessary and harmful services to bolster profits which will eventually lead to a decrease in quality of services. Decades of corruption, mismanagement and negligence precisely resulted in that, as was anticipated.
Veteran economist Amartya Sen has drawn a strong parallel of how health equity is central to social justice in a country. He suggested that if an illness is untreated only due to social arrangements of a person, it would lead to serious negative impacts on social justice as it is discriminatory to a group of people.
This is mirrored in a study done by icddr,b which revealed that around 6.4 million people in Bangladesh are becoming poorer every year due to excessive healthcare costs. The burdening costs lead to loss of property, harmful loans, children dropping out of schools, curbing of essentials like food, and an indescribably damaging impact on mental health.
Now that the option to travel abroad for medical treatments is closed due to restriction on air travels, it is time that the wealthier section of our society realises and pushes the government for building a better public healthcare and a well-monitored private health sector. At the moment, even money cannot ensure the availability of proper ICU services in our country.
The first step the government can consider is ensuring accountability. Surely, without insider support, criminals like Shahed would not have been able to not only run an unlicensed hospital but also to manage authorisation from the government to test and treat coronavirus patients. Giving harsh punishments or sentences to these corrupt officials will set a precedent.
Secondly, fixing unethical practices within the system, such as the interaction of pharmaceutical companies and physicians, which is very prominent. Pharmaceutical companies in Bangladesh spend over Tk6,000 crore on marketing every year, and a major chunk of this is utilised as gifts for physicians who prescribe their medicine. Regulators have to look into such malpractices that are rife in our system.
Nonetheless, "corruption" remains the iceberg of our sinking healthcare system. If steps are not taken to eradicate or even reduce corruption, we will end up with millions of people like Shahed infecting our healthcare system to the point of irrecoverable damage.
Rasiqh Wadud is currently doing his PhD in biological sciences at the University of Cambridge with IDB and Cambridge Trust Scholarship. He also works as a lecturer at North South University, but is now on study leave.
