Cross-sector collaboration key to health reforms

The Health Sector Reform Commission has recommended a major overhaul of the health sector, but implementing the proposals will be both challenging and time-consuming, said health experts yesterday.

They said in addition to government agencies, the involvement of political parties, non-governmental organisations, and professional bodies of doctors and nurses is essential to implement the recommendations effectively.

They made the remarks at a workshop on the reform commission's report, which was submitted last week, organised by Bangladesh Health Watch at the BRAC Tower in the capital.

The 12-member commission, led by Prof AK Azad Khan, recommended a range of reforms, including changes in health administration, the enactment and amendment of around two dozen laws, and recognition of primary healthcare as a basic right through a constitutional amendment.

The commission also proposed allocating 15 percent of the national budget to the health sector and creating nationwide networks of pharmacies, diagnostic laboratories, blood supply services, and ambulance services.

Public health expert Abu Jamil Faisel said the commission suggested changes to about 20 health-related laws and policies, along with nearly a dozen others.

"It would take at least five years to implement these changes," he said.

He said the willingness of political parties would be crucial, as some new laws would need to be enacted.

Some recommendations, he noted, lacked clear guidance on how to be implemented. "It would have been better if there were clearer directions for implementation," he said.

Yasmin H Ahmed, an adviser to Bangladesh Health Watch, said the report is very comprehensive, covering all aspects of the sector. However, she pointed out that implementing all recommendations at once may not be possible.

The commission should therefore help authorities in finding practical ways to prioritise implementation, she added.

She also said a pragmatic approach is needed to decide which laws to enact first and which can be deferred.

Yasmin noted that the two divisions of the health ministry currently struggle to work in coordination. Meanwhile, the commission has proposed forming a new health commission, creating a separate health service, and setting up several new offices.

"Are we expanding the bureaucracy?" she asked.

The proposed health commission has been assigned a wide range of responsibilities, she said, adding, "Is there any scope for simplification here?"

She suggested forming a broad platform involving representatives from political parties and professional bodies of doctors and nurses to implement the recommendations.

Prof Mohammad Zakir Hossain, a member of the reform commission, said implementing the recommendations would take between six months and 10 years.

He said the interim government could start the implementation process and carry out many proposals within 8 to 10 months by issuing ordinances and statutory regulatory orders (SROs).

"A technical committee and a separate secretariat would be needed for the process. The commission will assist them if necessary," he added.

Ahmed Ehsanur Rahman, another member of the commission, gave a detailed presentation on financing the health sector.

He said the demographic pattern has changed significantly, with about 40 percent of the population now living in urban areas. Therefore, the pattern of health financing must be adjusted accordingly, he added.

"Bangladesh ranks among the lowest in terms of government health spending. This must be increased significantly," he also said.

Dr Md Khairul Islam, executive committee member of Bangladesh Health Watch; Prothom Alo Special Correspondent Shishir Moral; and Bangladesh Health Reporters Forum President Rashed Rabbi also spoke at the event.