Better health for all
HEALTH is wealth is an old adage with eternal implication. The maxim of good health is realised more ardently at the time of serious sickness.
The lack of awareness about health and hygiene, absence of appropriate medical care, and lack of food are major reasons for ill health. A person with ill health obviously has no drive or energy to work and is, thus, considered as unwanted in the society and the family itself. More precisely, such a person is looked upon as a liability, not a resource, for the nation.
To concretise the concept of good health as the source of all happiness, there are continuous initiatives to improve the health sector round the world. Bangladesh, with limited resources, is not lagging behind in taking initiatives and bringing changes to improve the health status of its citizens and ensure health care for the needy in particular.
The Constitution of Bangladesh, Article 15(a) and Article 18(1), has provided top priority to public health and nutrition as a state policy of governance. To implement the obligation of the constitution and expectation of the people at large, governments had taken initiatives in the past to prepare a pragmatic health policy for the nation. Accordingly, there were attempts to formulate an acceptable health policy in 1990, 2000, and 2006 to ensure quality medical care and services to citizens.
To maintain consistency with the dramatic improvements in medical science, particularly in
treatment and diagnosis, changes in global and environmental health, requirements of addressing
occupation health and climatic health hazards, it was wisely felt essential to update the health policy.
The need for adjustments was also felt with significant changes in epidemiological, demographic and socio-economic changes, and new challenges of re-emerging and non-communicable diseases, urban health care and access of the of the poor, and gender divide.
The caretaker government has decided to update the health policy and has prepared a draft and put it on the web site, eliciting views of the stakeholders on the policy issues.
The draft health policy defined health as a state of complete physical, mental and social well-being, and merely not an absence of disease or infirmity. Health has been regarded as the index of human development, and is a fundamental right of the population.
The draft contains objectives, principles, and strategies of the policy, besides areas of interventions like good governance issues, human resource and supply management, infrastructure maintenance, health financing, improvement of nutrition status, stewardship role of the government, harmonisation of development partners' support, etc.
The draft policy highlighted the achievements of the health sector, indicating the success achieved in certain areas of the health sector. These are increase in life expectancy at birth, reduction in total fertility rate, success of poliovirus free initiatives, expanded program of immunisation, distribution of Vitamin A supplements, etc. Besides, it has mentioned the awareness generating campaign for oral re-hydration therapy, no smoking, consciousness about the safe drinking water, etc.
Persistent inefficiency in addressing maternal and infant mortality and nutrition status are identified as areas for policy reformation. Besides, challenges in environmental, climatic, occupational and urban health issues, and re-emerging threats of arsenic, HIV, avian flu, are indicated as fields for program support and strategic interventions.
In order to address the current and future challenges, the policy framework as proposed could be categorised in three major areas:
- Continuity of the current programs with more investment and monitoring;
- Addition of new elements and focus on current programs;
- Adaptation of new concepts and program elements to modernise the service delivery and treatment of diseases.
The current programs and projects are basically primary heath care, health education, capability building of the manpower, private and public participation, decentralisation of authority, maternal and child health care, breast feeding campaign, reproductive health care, survey and research etc.
Some of the on-going activities are generating intensive activities for providing client-centered, equitable, accessible and quality health care for all citizens, with special focus on the poor, distressed women and the disadvantaged.
Besides, proposals also emphasised the improvement of the nutrition status, reformation in the operation of private clinics, diversification of the referral system, and more investments in building nursing and paramedics' professionals.
There are also proposals for strengthening the upazilla health complexes, union health and family welfare centres, community clinics, etc., to ensure the participation of local level government. This is felt necessary in view of the u,pazila system being reintroduced where health services would be treated as the transferred subject.
The new elements in the proposed policy are program activities for medical waste management, addressing climate change related diseases, ensuring food safety and quality, strengthening urban health services, etc. Besides, there should be more initiatives to provide services to hard to reach areas, chars, and coastal belt localities.
The proposal stresses the critical role of timely procurement and supply by introducing new institutions for procurement management and setting up a separate MIS system for logistics. Another important feature is the suggestion for publication of a report on the health status annually and updating the health policy periodically.
It is true that the policy indicates the strategy, but there should be projects and programs to translate the same into reality. There should be good governance in health administration, both in the private and the public sector, for which political commitment should be transparent and all allocations should be demand based and balanced ones. There should be participation of health watch groups with regular inflow of information.
There could be arrangements where civil society organisations and human right agencies can interact to ensure accountability and transparency in procurement, supply and providing of services. There are suggestions from civil society organisations to establish permanent committees or create a post of ombudsman for regular health watch.
The expectation is that the National Health Policy shall be meaningful for good health and good governance in the health sector in coming days.
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