Government must have a clear vision to ensure better healthcare
For this year's World Health Day, the World Health Organization wanted to highlight the importance of building a fairer and healthier world. In terms of fairness, how do you rate our healthcare system? And when it comes to ensuring a healthy population, how would you rate its performance?
What is important for Bangladesh's healthcare sector is to ensure that everyone has access to quality healthcare. That has to be the ultimate goal. If we look at our healthcare infrastructure, we can say that it is quite good in terms of how the system is designed—at the national level we have tertiary specialised hospitals, at district level there are district hospitals, at upazila level there are upazila hospitals and below upazila level there are union health centres and union sub-centres, and so on. The problem is that we are not using this infrastructure correctly, which is why patient satisfaction in most cases is very low.
Our healthcare sector currently has very centralised control. That means that even the clinics at the union level are controlled from the national level and they have no autonomy of their own. Because of that, hospitals starting from the union level all the way down are not being properly monitored or supervised. The staff working in these hospitals are not given the proper training and so the people are reluctant to receive treatment there. Even at the upazila level, people are reluctant to get treatment because there is a shortage of doctors, equipment and support staff who are trained to use the equipment properly, which is causing the upazila hospitals to provide healthcare that is unsatisfactory.
The shortage of personnel and equipment often occur because of trivial reasons. For example, we might see an ambulance not being in service because its tyre is punctured. This could easily be fixed. But the problem is that even small decisions like this oftentimes cannot be taken by the authorities at the lower levels. That is why our healthcare system has to be decentralised. This will give the healthcare authorities at different stages some form of decision-making control. At the same time, there has to be some monitoring and supervisory mechanisms in place to ensure that they are taking appropriate and timely decisions.
Then comes the issue of budget. Bangladesh's healthcare budget is the lowest in the region, and even there we have corruption and pilferage reducing it further. And the health ministry doesn't seem to have the capacity to properly utilise whatever little funds are available. The allocation for the healthcare sector has to be increased and the utilisation of the funds has to get better.
In Bangladesh, we have seen private healthcare grow alongside public healthcare. But there has to be some parity between the two. That is absent. Out-of-pocket expenditure for healthcare is one of the highest in the world. That has to be reduced—and the WHO has been asking the government to bring it down to 30 percent for almost a decade now, without much success. The state has to make healthcare affordable for all, that is its constitutional obligation.
Finally, we don't have an effective reference system. If someone goes to a community clinic and then has to go to a union sub centre, there is no way of referring them from one to the other. If we want to ensure universal healthcare, the first thing we have to do is establish an effective reference system, so that an ordinary villager can be referred to institutions at the tertiary or other levels, should they require that kind of medical attention, and then get referred back for followups at their original location.
A lot of criticisms were directed towards the health sector and related policymakers during the initial days of the Covid-19 outbreak. Do you believe that the authorities and the hospitals have done enough to address those problems and are now better positioned to face what seems like a much stronger-than-expected new wave of the virus?
When the virus first came to Bangladesh, we weren't prepared at all. Our way of addressing it was to react to the virus, so we were always a step behind. One thing we have going for us now is that the number of RT-PCR machines in the country has increased.
When the virus first started spreading, the WHO warned everyone about it and many countries took precautionary measures. Bangladesh, on the other hand, didn't take the WHO's warning very seriously, which is why we had only one RT-PCR machine to begin with. Still, our casualty number wasn't as high as other countries that were better prepared.
Now that a new wave of the virus has arrived, I must say again that we did not really prepare for it, even though we had seen how a second and even a third wave had hit other countries. That is why the death toll and the number of newly infected are increasing daily. Why didn't we prepare for this new wave? That is a political matter and is for the state to answer.
Another factor in addressing the virus is to create awareness. The government has done a brilliant job of making the people aware of many things. Everyone knows that you should wash your hands regularly, wear masks and maintain social distancing to avoid catching the virus. But the problem is, the government never really involved the people when it came to enforcing the health guidelines, and is still not trying. This too was a matter of preparation. How can you defeat this virus without involving the people? You can't! It's not possible for any country, and Bangladesh is no exception.
Where must our focus be, going forwards, in regards to the healthcare sector—should it be on vaccinating the population, ensuring some form of universal healthcare, or something else?
The government can have many priorities when it comes to the health sector. But there are times when it must prioritise some of its priorities more than others. Right now, no matter how many things the government has to focus on, its number one priority must be to reduce the spread of the virus. If we cannot reduce the spread soon, many lives will be lost. And I think it should be the government's number one priority, and also the only priority for now.
So how do we contain the virus? There are some ways that it can be done, and others have done it.
First, the health guidelines have to be followed by everyone. And for that the government must involve the people so that they can automatically do what is required of them. Second, we have to vaccinate 12 crore people, there is no alternative to that, because we have to reach herd immunity. So, the government must encourage the people to get themselves vaccinated as soon as possible.
Now the question can be asked, is the government going down the right path and guiding the people to go along? I would say no. The government has declared that we will have seven days of lockdown. But lockdowns have certain characteristics. When we are leaving the Boi Mela open and allowing private vehicles to operate normally, we are not really in a state of lockdown. Instead, we seem to be in a state of confusion, and what exactly we are trying to do is unclear.
Lockdown means everything should be closed except for emergency services. And people should stay at home no matter what. Most people right now don't even know where they can go and where they should not. The government must have a clear vision of what it wants and also prepare the necessary strategy to achieve that. There is no reason nor room for policymakers to be confused and indecisive about what to do at this stage.