Are we getting any better? | The Daily Star
12:00 AM, April 07, 2016 / LAST MODIFIED: 12:00 AM, April 07, 2016

World Health Day

Are we getting any better?

Dr N. Paranietharan, the WHO Representative to Bangladesh since July 2014, in an email interview with The Daily Star, talks about the state of healthcare in Bangladesh, the role of WHO in combating major diseases and what we should be focusing on to ensure better health for our people. Dr Paranietharan is a medical doctor from Sri Lanka with a Master of Public Health degree and post graduate training in leadership and management from the Johns Hopkins University, USA.

Do you think access to healthcare has improved over the years? We still read reports of hospitals in dearth of doctors, medicine, and equipment in the health centres all over the country. How can we ensure better healthcare for our people, based on your experience in other countries?

Bangladesh has made commendable progress in ensuring access to healthcare through a good network of hospitals, upazila health complexes, union-level health and family welfare centres and community clinics over the years. This is well documented and recognised globally. While access has improved, quality of health services needs further improvement. Concerted efforts need to continue so that all health facilities remain fully equipped, adequately staffed, and stocked with essential medicines and supplies all over the country. 

We commend the government for opening up health facilities and expand service availability at the community level. There are many NGOs providing valuable health services along with government facilities. This pluralistic health system with public and private mix is a success story of Bangladesh and can be expanded towards achieving universal health coverage by 2030.

Healthcare is also very costly in Bangladesh for most people? What would you recommend in terms of making it more affordable?

With only $27 per person per year as total health expenditure in 2012, and about two-thirds of these funds coming from out of pocket expenditure, it will be difficult to provide and sustain quality health services at affordable costs. Increased government budget allocation for the health sector is a necessity and it would be good if the government can gradually increase and maintain budget allocation to the health sector to at least 10 percent of the total government budget. 

It is important to invest adequate human and financial resources to prevent both communicable diseases, such as diarrhea, pneumonia, dengue, malaria etc., as well as non-communicable diseases such as diabetes, hypertension, cardio vascular diseases etc. Preventive interventions are cheaper and will result in overall cost savings for the health sector. Creating health workers who exclusively work on preventive activities at district and upazila levels, such as epidemiologists who help with prevention and control of communicable diseases, and midwives and nurses providing preventive and promotive health services at community level, would be a good start.

It is inevitable that the expectations and demands from the citizens will grow along with a rapidly growing economy. Bangladesh's health system needs to rapidly adapt and transform over time to be able to meet the demands of a stable middle income country. As part of the policy and plans to achieve universal health coverage and achieving SDG 3, focus should be at the district, upazila and community levels. 

We commend the government's efforts to launch the 'Health Insurance Pilot for the Poor' (Shasthyo Suroksha Karmashuchi - SSK) scheme, which aims to improve access to hospital inpatient care for the poor by reducing financial barriers and introducing a performance based financing model. When scaled up, this will further improve financial protection and increase access to healthcare for the poorest of the poor in the country.  

Why is diabetes the main focus of WHO this year? How is WHO addressing this disease?

Each World Health Day, WHO focuses on an important health issue in need of more attention and action. Diabetes has been chosen for 2016, as this condition is on the rise. In 2014, 422 million adults around the world had diabetes, a fourfold increase since 1980. 

In Bangladesh, diabetes is a major public health issue of national concern, with almost one in ten adults affected. Sedentary lifestyles coupled with sugary, salty and fatty diet, that are also rich in starchy carbs – including those from white rice and refined flour – are driving the epidemic of Type 2 diabetes, which account for the majority of the condition. Diabetes affects more people in lower income groups compared to other socioeconomic groups in Bangladesh. Furthermore, lower income groups are forced to spend higher proportion of their income on medical expenses to manage their condition, which further aggravates inequity. 

We address diabetes through advocacy, policy, prevention, management and surveillance. For advocacy, we recently released the first WHO global report on diabetes. 

All efforts to prevent and treat diabetes are important to achieve global SDG 3, which has a target of reducing premature mortality from non-communicable diseases (NCD) by one-third by 2030. At the national level, WHO supports governments to put in place policies and practices to prevent and treat diabetes. 

We worked with the Government of Bangladesh to finalise the national action plan for NCD, to reduce the prevalence of modifiable diabetes risk factors – such as overweight, obesity, physical inactivity and unhealthy diet – in the general population. We worked with the government to produce the National Guidelines for the Management of Diabetes Mellitus. WHO also promotes breastfeeding and early childhood nutrition. 

WHO regularly supports studies on risk factors, such as the national survey on non-communicable disease risk factors, using a standardised WHO approach known as STEPwise Surveillance (STEPS) conducted in 2010 in Bangladesh. Results showed that around 83 percent of the survey population had never had their blood glucose measured among other important findings. We will support the government to repeat this survey in 2016/17 in order to measure progress and monitor trends.

We read about a case of a patient contracting the Zika virus in Bangladesh. How much of a threat is it for this country? If there is an outbreak, what strategies have WHO suggested for the government to adopt?

Yes, one case of Zika virus disease has been confirmed in Bangladesh, from a sample collected from Chittagong in August 2014, after we supported the establishment of laboratory capacity to test for Zika virus in Bangladesh. As you know, Zika virus is spread through Aedes mosquitoes, therefore any area where these mosquitoes are found is potentially at risk of an outbreak, including Bangladesh. WHO is providing technical assistance and relevant support to the Ministry of Health and Family Welfare to strengthen preparedness for a potential outbreak situation. Reducing the risk of people being bitten by Zika-infected mosquitoes is the most effective way to prevent people from getting the virus. We advise to scale up vector control efforts and ensure that individuals and communities are aware of how to protect themselves from bites and how to eliminate mosquito breeding sites. This will not only prevent a potential Zika virus disease but also, and more importantly, will prevent dengue and chikungunya infections. 

WHO strongly recommends that people protect themselves from mosquito bites by wearing clothes that cover as much of the body as possible (preferably light-coloured); using physical barriers such as screens, closed doors and windows; using insect repellent; and using mosquito nets while sleeping during the day. At the household levels, people should empty, clean or cover containers that can hold even small amounts of water, such as plastic bottles/containers, buckets, flower pots and tires, so that mosquitoes cannot use them to breed.  

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