COVID-19 exposes healthcare system vulnerabilities

by Shama Obaed | Published: 00:00, May 01,2020 | Updated: 13:49, May 01,2020


People queue to collect subsidised food items amidst the general holiday, ordered as a preventive measure against COVID-19, in Dhaka on April 26. — Agence France-Presse/Munir Uz Zaman

IF YOU cast your mind back a few months and imagine someone telling you that within a few months, schools will be closed indefinitely, all public gatherings will be cancelled, social distancing will be the norm, people will be buying masks, soap and hand sanitisers more than anything else in the world, hundreds of millions of people around the world will be jobless, hundreds and thousands of people will die within weeks and governments will be throwing together some of the largest economic stimulus packages in history, you would say that someone is out of his or her mind. But, guess what? That is exactly what is happening now and even more. It is proved by now that the novel coronavirus knows no gender, no race, no geographical boundaries and no political beliefs.

The realisation that life is going to change for good while it starts taking hold. Like the fall of the Berlin Wall or the collapse of Lehman Brothers, the COVID-19 pandemic is a world-shattering event whose far-ranging consequences we can only begin to imagine today. It has undoubtedly affected every society on the planet, healthcare systems, global politics, people’s way of life, their thinking process and their livelihood, to say the least. Bangladesh is facing the same situation as the rest of the world. According to IEDCR reports, already 60 districts, which include the capital, have had COVID-19 patients. Every day, the death toll is increasing and we are losing lives.

The World Health Organisation on December 31, 2019 heard the first reports of a previously unknown virus behind a number of pneumonia cases in Wuhan in eastern China. Since then, the disease has been detected in more than 200 countries and territories, with Italy, the United States and Spain experiencing the most widespread outbreaks outside China. The first three known cases of new coronavirus patients in Bangladesh were reported on March 8 by the Institute of Epidemiology, Disease Control and Research. Presumably, the government had almost three months to assess, analyse and develop a sustainable plan to combat this virus but the present reality shows a different image.

This virus exposed our vulnerability and our helplessness as citizen as far as health care is concerned. Poor planning and disorganised array of decisions exposed an overly centralised health system, a very weak governance structure and regulatory framework, weak management and institutional capacity in the health ministry, fragmented public services delivery, an inefficient allocation of public resources, lack of regulation of the private sector which employs 58 per cent of all physicians and poor, and in some cases, zero, maintenance of health facilities and medical equipment.

The COVID-19 outbreak has opened our eyes towards the shattered healthcare system. The government has successfully embedded corruption in most of the institutions and sectors over the past 12 years and unfortunately the health sector is one of them. The public health sector is stuck in mismanagement, corruption and lack of integrity of different stakeholders. The Anti-Corruption Commission in a report identified wide ranges of corrupt practices, including unnecessary procurement of expensive medical equipment, aggressive marketing policy of pharmaceutical companies and complicity of government health officials in corruption as main reasons for poor health services. Health-sector corruption appears to have become an integral part of the system.

In recent times, the nation has witnessed serious corruption when the media have exposed the procurement of curtains costing Tk 37.50 lakh at Faridpur Medical College Hospital. But, sadly, we have to hear in the midst of this crisis that all of the 16 ventilators at the intensive care unit of Faridpur Medical College Hospital are non-functional. The hospital’s director Md Saifur Rahman said that in preparation for the new coronavirus outbreak, they recently checked all the ventilators and found all of them to be inoperable.

The media have also exposed various corruption such as that low-quality equipment was bought for Shaheed Tajuddin Medical College and Hospital in Gazipur where the cost was showed to be Tk 175 crore against the low standards of goods. Heavy surgical machines were bought for Tk 4 crore for Rangpur Medical College Hospital without necessity. Tk 6.6 crore was withdrawn and misappropriated in Satkhira Medical College Hospital in the name of buying PACS software-related equipment by submitting forged bills-vouchers without any requisition.

Not only that, around Tk 11.74 crore in the Institute of Health Technology in Satkhira, Tk 15 crore in Noakhali Medical College Hospital, Tk 19.14 crore in the 300-bed Narayanganj hospital, Tk 21.70 crore in Dhaka Medical College Hospital, Tk 65.82 crore in Shaheed Suhrawardy Medical College, Tk 25.71 crore in Dhaka Dental College and Tk 14 crore in the 250-bed Moulvibazar hospital have been spent on buying several machines and equipment. An MRI machine was bought at Shaheed M Monsur Ali Medical College Hospital in Sirajganj for Tk 9 crore against the actual price of Tk 2.8 crore, as the media reported early November 2019. An Anti-Corruption Commission investigation revealed that at least Tk 1,000 crore has been plundered by some unscrupulous officials in collaboration with relevant contractors in the name of purchasing and supplying various machines for at least 27 hospitals and medical college hospitals in the past two financial years. When we witness a lack of preparedness and professionalism in this tough time of combating COVID-19, we are compelled to look into these irregularities in the heath sector that has become a norm for the past 12 years.

While answering journalists regarding the preparation to tackle the situation in Bangladesh, the heath minister said that the government had started taking preparation since January. If that is the case, then why are there not enough ventilators and ICU beds in hospitals? Why are there not enough PPEs for healthcare workers, including physicians, nurses and others? Why have 324 physicians already been infected with the new coronavirus? Why is not enough COVID-19 testing done? Why was the IEDCR the only facility for COVID-19 tests even a week ago? Why are regular patients with other health concerns hardly getting any treatment anywhere and in some cases dying without treatment? There are too many pertinent questions at the moment that the health minister’s briefings do not answer.

We have seen a freedom fighter, Almas Uddin, a brain haemorrhage patient, dying because he was denied treatment in several places. His family took him around to different hospitals after he had finally died in a public hospital after 16 hours. A pregnant woman gave birth to her child on the street in Gaibandha because no hospital or clinic would admit her over the fear for novel coronavirus. These tragic events depict the gruesome picture of healthcare services in the time of the novel coronavirus.

If we glance at the events of a couple of months, the health minister, Zahid Maleque, on March 10 said that his government was fully ready to tackle the situation. In an interview, he said, ‘Medical teams have been deployed at airports and land ports. Those coming from abroad are undergoing tests. The government is alert to the situation.’ But the reality was unfortunately otherwise. We have heard that Bangladesh is facing a challenge in screening the passengers to know if they have high temperature. The Dhaka airport director AHM Towhid-ul-Ahsan said on March 10, ‘There were three scanners, but only two were functioning. The one in the general passengers’ area broke down due to overflow of passengers.’ According to the airport officials, the government procured seven thermal scanners in 2014 for screening travellers at ports of entry but six of them are out of order now. This shows that the health minister was not aware of the situation.

While public health experts and governments around the world were scrambling to understand, track and contain the spread of the novel coronavirus in February–March, international flights were still coming to Dhaka in full swing from China, Italy and other European countries with minimal or no screening at the airport. Initially, some Bangladeshis who came back from Italy and China were kept at the Ashkona Haji camp although they complained that the authorities were not supplying enough food for them and the environment inside the camp was dirty with mosquito infestation. On March 15, 142 people returned from Italy who were also taken to the Ashkona Hajj camp but after they had complained about the unsanitary condition there, many of them were allowed to go home with advice for self-isolation. But health experts expressed serious reservations about the action. One cannot help but wonder if this decision has actually contributed to the spread of the virus rather than controlling it.

Lack of coordination, disorganised plans and inconsistencies in decision making become prominent when the health minister, who heads the national committee on coronavirus, says that authorities were making various decisions in fighting the COVID-19 crisis without informing him or his ministry of the issues even though he was the chief of the national committee on coronavirus. He is gradually being known for making more legendary statements. In one of his briefings, he said, ‘There are 500 ventilators in government hospitals and 700 ventilators in private hospitals and, moreover, 300 more are in the “pipeline”’ although he did not mention how many ventilators are dedicated for the treatment of COVID-19 patients. On the contrary, the new coronavirus control room at the health services directorate general shows that there are only 45 ventilators for COVID-19 patients. In a time when the government of the day boasts every day of the so-called development and boosting economy, this does paint a grim picture.

Even if we take the health minister’s statement as a fact, how comfortable are Bangladeshis with 500 ventilators? Five hundred ventilators mean one ventilator for every 3.5 lakh people. Now let us take a glance at other countries. India has one ventilator for every 30,000 people. Pakistan has one ventilator for every 86,000 citizen, the United States has one ventilator for every 20,000 citizens and Germany has one ventilator for every 3,200 citizens, as the media reported towards the end of March. The heath minister has, however, stated that many developed countries do not have as much ventilators as we have. In that case, he must have better information than we do and he owes it to the citizens to let them know of it. Undoubtedly, these unscrupulous statements increases fear, confusion and distrust among people.

Regarding combating COVID-19, the World Health Organisation has a simple message for all countries: ‘Test, test, test, every suspected case’. That way, people who have been in close contact with those who test positive can be identified and tested as well. Dr Maria Van Kerkhove, the technical lead for WHO Health Emergencies Programme, added that countries need to increase the number of laboratories, the availability of test kits, and the number of people who can conduct the tests. Unfortunately for the citizens of this country, Bangladesh has tested an alarmingly low number of suspects considering its high population. With a population of more than 160 million, the country has one of the lowest number of tests in the world, according to data compiled by Worldometer. If we study some examples around the world, Canada has so far performed 740,859 tests which is 19,629 tests per 1 million citizens. India has so far run 716,733 tests which is 520 tests per million citizens. Germany has so far performed 2,072,669 tests which is 24,738 tests per million citizens whereas Bangladesh has so far performed 54,733 tests which is 332 per million citizens. So, obviously concerns continue to grow, with experts urging the government to focus on increasing daily tests to ensure a successful fight against the outbreak.

Another instance of the difference between the harsh reality and the health minister’s fictional statement is when he told the media, ‘Hospitals in and outside Dhaka have been prepared, along with safety measures having been taken for the physicians. That is why the number of infected people is so less in the country.’ The reality is that COVID-19 patients and suspects are facing hurdles on a regular basis. A good number of people are not able to have themselves tested for lack of planning and strategy of the health ministry and the health services directorate general. Many complained that they were trying to contact the Institute of Epidemiology, Disease Control and Research through its hotlines but repeatedly failed. When people were lucky to get connected, IEDCR officials told them that it might take three to four days for them to collect samples because of the long queue.

Dhaka South City Corporation waste management official Khandaker Millatul Islam died, as the media reported, with COVID-19 infection on April 23 at his house after his family’s request for help fell on deaf ears. North South University student Sariah Tul Qarim’s father died of COVID-19 and her mother has also tested positive. Her father developed the symptoms and his condition deteriorated and they informed the IEDCR on April 12 and asked for help the following day, but the agency’s officials replied that it would take days before they could come. There is also substantial doubt about the quality or authenticity of the test kits being used. A banker, Mostoba Shahriar, died recently after being affected with the new coronavirus in spite of his first two test results having been negative. These incidents are unacceptable in a country where the government is claiming ‘development’ in every sector.

The nation also did not forget the health minister’s absence and inaction during the worst outbreak of the mosquito-borne disease dengue in 2019 when the number of dengue patients and deaths broke all past records. The dengue outbreak’s severity was underlined by the absence of the health minister, whose whereabouts were the cause of consternation among citizens. Although experts blamed ineffective pesticides and lack of dengue prevention and preparedness for the outbreak, the minister, however, claimed that time that dengue was being tracked every second of the day.

Undoubtedly, there should be good governance in health administration, both in the private and the public sector, for which the political commitment must be solid and transparent because we all know that the combination of a deadly virus, inadequate planning and incompetent leadership can place people on an unknown and worrisome path.


Shama Obaed is an organising secretary of the Bangladesh Nationalist Party.

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