Taming coronavirus rampage: Now it's time to put private hospitals to test | The Daily Star
12:00 AM, March 27, 2020 / LAST MODIFIED: 01:05 PM, March 27, 2020

Taming coronavirus rampage: Now it's time to put private hospitals to test

Bangladesh’s private healthcare setup has expanded manifold over the decade, attracting thousands of crores of taka in investment. Today, it is a perfect complement to the stretched public healthcare system.

Over the last few days, Health and Hope Hospital has put a restriction on the number of attendants with a patient to just one, at any time of the day.

It has pasted a guideline for proper hand washing and introduced hand rub just at the main entrance to ensure that everyone cleans their hands before entering the healthcare facility -- a measure the private hospital has taken to prevent the contagion of the exponentially communicable coronavirus.

At the time of writing, the lethal, pneumonia-like disease has affected 44 people and claimed the lives of five since it was first reported on March 7.

The 16-year hospital is not an isolated case.

About one-fourth of a kilometre away is the sprawling Square Hospitals, which has also taken such measures. And so did the state-of-the-art Apollo Hospital in Bashundhara residential area.

"We are taking down the travel history of any patient coming to us for treatment," said Mahmud Hossain, senior manager of Health and Hope.

The 80-bed hospital is one of the 200-bed private hospitals and clinics that have cropped up on Panthapath, Green Road and greater Dhanmondi area of Dhaka city over the last three decades.

The inadequate number of public hospitals in comparison to the population and their lacking facilities and services have drawn private investors to the business of medicare since early 1980s.

Since then, private investors poured in thousands of crores of taka to set up state-of-the-art hospitals, clinics and diagnostic centres.

The private healthcare sector is growing and attracting investment from home and abroad, thanks to the expanding income for steady growth of the Bangladesh's economy, rising health awareness and a burgeoning middle-class who are now demanding -- better and quality services.

For example, Impulse Hospital in Dhaka began operation in September 2017 and 33 more firms have got no objection certificate from the Directorate General of Health Services (DGHS) to set up hospitals, clinic and diagnostic facilities.

Of late in February, Evercare and UK's CDC Group said it would take over majority stakes of Apollo Hospital Dhaka's owner STS Holdings.

The transaction value, which remains undisclosed, is said to be in the neighbourhood of thousand crores of taka.

The industry's annual turnover of would be $6 billion -- which is double that of the annual pharmaceutical market -- and it is growing at 25 per cent every year at the very least, according to AM Shamim, managing director of Labaid Group, one of the biggest private sector healthcare providers.

Beginning in 1989 with a diagnostic centre in Dhaka, Labaid today operates 30 diagnostic centres, a 350-bed cardiac hospital and a specialised hospital.

People's predisposition has evolved, he said.

"Once, many were desperate to get a cabin in Dhaka Medical College Hospital for caesarean delivery. Now, none of them go there."

People now head straight to the doctors' if they are unwell, which was not the case before. Self-consciousness and awareness have increased.

"So, there is a gap in the market," Shamim added.

So much that the Bangladesh Investment Development Authority (BIDA) has put healthcare as a potential sector for investment.

It said Bangladesh has about $2 billion of untapped healthcare market.

The demand for health care is growing 21 per cent annually, according to BIDA.

The reason being, the demand for healthcare services is accelerating because of increasing purchasing power of the growing middle and upper middle classes, it said

Bangladeshis spend about $2.04 billion in a year for medical treatment abroad, which is 1.94 per cent of the country's total GDP, according to BIDA.

Including Labaid's healthcare facilities, the country has 5,000 private hospitals and clinics, according to Directorate General of Health Services' (DGHS) Health Bulletin 2018.

In 2007, the number of private clinics and hospitals was 1,000, and they had 16,000 beds, just half the total beds in public sector hospital, showed official data.

Sector insiders said the pace of establishment of medical centres by private sector rose at the turn of this century, facilitated by government's patronisation, particularly withdrawal of value-added tax on diagnostic services and duty benefit to import diagnostic and hospital equipment.

Today, because of expansion, private healthcare providers have treatment facilities for diseases such as heart, kidney and liver.

Once people used to go to India or Thailand for bypass surgeries, said Md Mainul Ahasan, secretary general of the Bangladesh Private Clinic and Diagnostic Owner's Association (BPCDOA).

Now, that surgery can easily be performed in Bangladesh.

Only a section of affluent people goes abroad for the surgery.

"We have had a lot of development and we are advancing," said Ahasan, also the managing director of Green Life Medical College & Hospital.

Before, diagnostic tests for a number of diseases were not available.

"Today, whole body scanning is possible here," he added.

Private healthcare providers cater to 64 per cent of the treatment in Bangladesh, said ABM Haroon, managing director of Samorita Hospital, one of the oldest private hospitals in the country.

"The rest is done by the public sector," said Haroon, also senior vice president of Bangladesh Private Clinic and Diagnostic Owner's Association (BPCDOA).

The Health Bulletin 2018 showed that private sector hospitals and clinics have 90,600 beds, whereas hospital beds under the DGHS were 53,000.

There is a need for the private sector to expand further to provide affordable healthcare to people in the low-income bracket, said Ahasan, who is a physician by training.

More hospitals are also needed to discourage people from going to India for treatment, he said.

"There is still enough opportunity in the market. The number of patients is huge. So, there will be no shortage of treatment seekers if big hospitals come with quality doctors," he added.

Haroon said investment is particularly necessary outside of the metropolitan cities such that residents can get better healthcare services.

Investment to develop more nursing institute is necessary as well, he said, while calling upon the government to declare it a thrust sector.

Despite the expansion of private medical care services, a large number of people still go outside for treatment because of confidence deficit.

"A section of the highly-affluent population will always go abroad in their quest for better treatment," said Rumana Huque, professor of the department of economics at the Dhaka University.

But the middle-income group will stay here for treatment if regulation and monitoring are strengthened to ensure quality care by the private sector.

Haque, who follows the healthcare system in Bangladesh, suggested the government to fix standards or certain criteria for hospitals and clinics to follow so that the authorities can monitor the quality of care.

"This will increase the confidence of people."

Non-communicable diseases such as diabetes, hypertension, kidney and heart diseases are increasing and treatment of the diseases cost quite a lot.

As the government does not have enough resources to ensure treatment for the country's huge number of population, the private sector will always plays an important role in this regard, according to Haque.

"But the government has to ensure treatment for the low-income and poor people at free of cost. At the same time, the government has to take responsibility to ensure primary healthcare."

Many jobs will be created if the government encourages the private sector.

But the government has to regulate and monitor so that the private sector improves the quality of care and they do not operate only for profits.

If anything, the government must encourage the private sector for the sake of pandemics, as the country is now facing.

"We need response or readiness of the private sector as well. The government cannot provide care to such a huge population," Haque added.

BPCDOA President Md Maniruzzman Bhuiyan said the private sector played an important role in the treatment of dengue fever last year.

And those private healthcare providers that have pathologies with all categories of facilities are capable of testing coronavirus and treating patients with COVID-19, he said.

"We have already called upon the private hospitals to open isolation unit. Already, some hospitals have opened such and collected Personal Protective Equipment (PPE) for treatment. We can start diagnosis once testing kits for the virus are available," he added.

DGHS Director (Hospital & Clinic) Aminul Hasan said private hospitals have not been given permission to test for COVID-19 -- yet.

"But we have asked them to open isolation units. They will identify patients as per case definition and keep the patients in isolation units if required and inform IEDCR (Institute of Epidemiology, Disease Control and Research) for diagnosis."

However, the health office has not fixed any rate for treatment of COVID-19 positive patients, Intensive Care Unit (ICU) support. 

"They will try to charge liberal rates out of their own conscience," he added.

The government should involve the private sector to fight the coronavirus pandemic holistically because they account for the majority of the healthcare system in Bangladesh, said Lenin Choudhury, chairman of Health and Hope.

The country has a total of 143,400 hospital beds and the private sector accounts for 63 per cent of the total, according to DGHS.

Of the ICU beds in the country, the majority are in the private sector, according to Choudhury.

Private hospitals have started collecting PPEs by themselves.

"The initiative from the government to involve the private hospitals is not visible enough. We have seen that India has already involved private labs for testing of coronavirus."

If the virus spreads to the wider population, it will be necessary to dedicate some ICUs of private hospitals for treatment of COVID-19 patients.

"And the government should give instructions now. The private sector healthcare providers have the capacity to provide treatment for the disease."

They would be enthusiastic participants if the government frames the guidelines, instructions and necessary support.

"And Health and Hope also wants to participate," he said.

The private medical care provider has already opened isolation unit along with many others to join the fight to against the deadly virus.

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