The Ministry of Health and Family Welfare has published the final draft of revised National Health Policy (NHP) on its website recently. After its first introduction in 2000, certain programmes like Sector Wide Approach (SWA), adoption of Essential Services Package (ESP) were reviewed for necessary changes and an updated draft was prepared in 2006 to incorporate the changes in programmes and approach; but it was not finalised. Along with mentioned sectors, different issues have come into the discussion but all were not included or prioritised accordingly during the recent process of updating NHP by current caretaker government.
Health risks due to population burden, climate change, global warming was needed to be addressed appropriately. This is a good initiative to increase work force through public and private sector but the authority concerned overlooked it. Informal system of health service produces below-quality health care for marginalised population by training TBA (Traditional Birth Attendant training session).
This is an example of inequity to assign specialised service for wealthy population and TBA for marginalised. Special attention is being given on women, children and senior citizens. There is no direction about male and adolescents. Does equity and access mean two different systems for two separate group of population? According to the constitution one of the basic rights is health which is established on the base of gender equality, access equality and ethical conduct. These were forgotten long before. As long we set essential services package for the marginalised and specialised service for the rich, we shall not be able to achieve equity and accessibility. The quality of health service cannot be improved overnight for sure, but it is also certain that proper management of the vast workforce would lead to a much more improved health services after a certain period of time.
A regulatory framework for ensuring accountability of service providers to the patient or their superior needs to be prepared. There should be a proper guideline about the referral system. The role of GPs and specialised consultants needs to be defined clearly. The point of health service delivery for urban population is either general or medical college hospitals which are known as hospitals of secondary and tertiary level. On the other hand, place for rural people is health complex. This is inequitable service.
A complete health policy was formulated in the year 2000 following long term five year plans since independence for governing health care system. In case of all five-year plans including the national health policy of 2000, involvement of government; doctors; politicians and people's participation was evident (Osman, F. A. Policy making in Bangladesh, 2004, pp. 148-156).
By recognising Alma Ata in 1978, nationally it was also decided to ensure participation of citizen through their representatives (Osman, F., A. 2004, annex 4.8, p. 372) that is not followed here. It is written in bold strong political commitment at the end of the draft of this health policy.
Developed countries like the United Kingdom, Finland, Spain and developing countries like India and Pakistan usually formulate health policy over a period of time and then implement it for next 10 to 15 years. Policy must not be changed during this period otherwise all efforts and financial investments will be worn out. It is worth mentioning the separation of health and family planning department which was unified later and then separated again. Such lack of planning resulted in failure in achieving targets in both sectors.
In a nutshell, this can be said that this unspecific health policy surely is not going to benefit the general people of Bangladesh. There should be a uniform health care system for every citizen of the country though there could be options for private health care system for the affordable.
People's participation is a well-discussed subject. It would be a big slip-up to come up with any new policy without people's participation.
Countries in whole world have secured participation of all stakeholders including general population in policy-making to attain a sound health care system. That is why it is better to await this effort of updating national health policy and should concentrate to implement existing programmes. Involvement of technical panel including marginalised population and representative from all high risk areas would make the health policy helpful for outlining proper strategy and program for implementation.
Deliberative participation procedures provide means for insuring needs and interests that facilitate setting goals of health care policy and the means of achieving them.

Dr Enamul Hasib is a Research Associate of Unnayan Onneshan and Dr Nasreen Rubaba Khan is Public Health Expert.