Make it pro-poor thru’ overhaul

The country is failing to provide quality healthcare to all because of deep-rooted corruption and lack of accountability, public health experts and political analysts said yesterday.

They called for an overhaul of the healthcare sector.

Seventy percent of the health expenditure is out-of-pocket and the extremely high expenses have been pushing people into poverty while hundreds of thousands of well-off people are travelling abroad for treatment because they don't trust the health care here.

"The shortcoming of the sector was known to all, but the pandemic has made it more visible. Patients are being denied admission or consultation at hospitals. This is unacceptable. We need a major healthcare reform," Dr Zafrullah Chowdhury told a discussion organised by Gonoshasthaya Kendra at the capital's Gonoshasthaya Nagar Hospital yesterday.

He said the coronavirus will continue to spread during the rest of this month and the outbreak might peak in the next.

Other speakers said it was frustrating that repeated calls for increasing the number of daily tests fell on deaf ears.

In a recent Facebook post, Awami League MP and member of parliamentary standing committee on health ministry Ekramul Haque Chowdhury said several lakh kits have been imported to the country, but they have not been used because of a supplier cartel leader named Mithu. He urged the prime minister to intervene and disband the syndicate influencing the purchase of medical equipment.

At yesterday's discussion, Zafrullah said one of the major factors driving the high out-of-pocket spending was a lack of health insurance schemes.

Citing the example of Gonoshasthaya Nagar Hospital where he was treated for Covid-19 under an insurance policy in the rich category, he said he was in a cabin and the daily cost inclusive of oxygen, medical consultation and medication was Tk 17,000.

At any corporate hospital, the cost would be between Tk 1 lakh and 1.5 lakh, added the founder of Gonoshasthaya Kendra.

"This kind of health insurance policy could be a model to follow."

Other causes of high healthcare costs include numerous diagnostic tests and drug companies paying doctors to prescribe their expensive but not-so-effective products, he said.

"Actions should be taken against those who benefit from drug companies," said the public health expert, who had a significant contribution to the formation of the country's 1982 drug policy that helped flourish today's pharmaceutical industry.

He urged people to form a movement to reform the sector.

Binayak Sen, research director at Bangladesh Institute of Development Studies (BIDS), said that Tk 29,000 crore was allocated for the health sector this year. The amount is about only 2 percent of the GDP while the World Health Organisation recommends it to be 5 percent of the GDP.

There is also a crisis of health infrastructure in urban areas, especially for primary healthcare. If there were ward-level health facilities, people with Covid-19 would not have to rush to the tertiary hospitals, he said.

He said the social safety net was prioritised, but good governance was a major overlooked issue.

Nagorik Oikya Convener Mahmudur Rahman Manna said some 1.5 crore people have been pushed into poverty during the pandemic, making the total to over 4 crore.

When large scale testing is crucial, the government is delaying the approval of a rapid test kit developed by Gonoshasthaya Kendra, he said.

"We are yet to arrive at the peak of the outbreak, but lack of planning and mismanagement have already left us in disarray."

Ganasanghati Andolon Chief Coordinator Zonayed Saki said not going for widespread testing was costing lives. The government might be waiting for herd immunity, but that means a lot of people will die in the process.

As an immediate measure, he recommended at least one lakh tests every day and isolation and treatment of those found infected. Saki suggested immediate formation of a judicial commission to investigate corruption in the health sector and a national expert committee on healthcare reforms.

Gonoshasthya Kendra's Rapid Dot Blot Project Coordinator Dr Mohib Ullah Khondoker said his team wrote three letters to the Directorate General of Drug Administration for fast approval of the rapid test kit that the Bangabandhu Sheikh Mujib Medical University (BSMMU) recommended for antibody tests to assess the portion of the population who developed antibodies after recovering from Covid-19. BSMMU sent its report to the drug administration on June 17.

"Drug administration said they will let us know their decision next week. We don't know why it is delayed," he said.

The BSMMU might start trial of the Gonoshasthaya's antigen test kit next week, he said.

Dhaka University Law Professor Nazrul Islam and pro-environment lawyer Syeda Rizwana Hasan also spoke.