Healthcare facilities beyond the reach of the poor

by Khurshid Anwar | Published: 00:05, Mar 13,2018

 
 

THE incumbents have said on a number of occasions since the Awami League-led government came to power that the incumbent administration would take all possible measures to ensure health for all. However, as it stands, the situation in the health sector remains far from satisfactory. On the one hand, the public healthcare system has sunken into an atrophied state and, on the other, there has been an unplanned growth of private healthcare business, with private hospitals and clinics charging the public exorbitant fees for their services.
New Age reported a few days ago, quoting a patient as saying that he was admitted to the state-owned National Institute of Cardio-vascular Diseases after a massive heart attack and that he was kept in a queue for a month for an open heart surgery, but as no schedule was available he was shifted to a private hospital. The lone specialised cardiac hospital in the public sector is swamped with patients and it takes a long time to get the schedule for an emergency heart surgery because of the queue of patients. The patients who are unable to bear the exorbitant treatment costs of private hospitals have no other choice but to wait for their turns to come.
The annual turnover of privately-run healthcare operators, according to another report, has shot to Tk 2,040 crore in 2005–2006 from Tk 302 crore in 1997. Health experts have warned that this unprecedented growth in private healthcare system indicates rapid commercialisation of public health and that it has caused quality treatment to go beyond the reach of the ordinary people. Patients and their relatives say that limited facilities at public hospitals are forcing people to choose private hospitals for expensive treatment of critical diseases like heart and kidney ailments. There are countless reports on how these commercially-run hospitals, clinics and pathological laboratories are thriving after mushrooming in urban areas in the backdrop of outmoded public healthcare system. Banking, exclusively, on the upper- and middle-class people, these privately-run health institutes are spending lavishly on infrastructures and logistics to ensure better treatment and comfort for the patients, eventually, taking the healthcare costs beyond the capacity of the people at large.
Another New Age report said a few months ago that although the country had one of the best public health infrastructures spread down to the rural areas it was failing to render service to the rural people as appointed doctors were found staying away from union health centres, and that upazila health complexes were being run without adequate number of doctors. That ambulances and X-ray machines often go out of order and that in most of the cases they are never repaired is adding to public woes. According to the report, there are about 1,400 union sub-centres and family planning centres, which are also marked by absence of doctors and non-availability of medicines. The current state of public healthcare system, obviously, does not bolster our confidence about reposing full trust in the government with regard to its much-touted promise of ensuring health for all.
According to Bangladesh Bureau of Statistics, there is one hospital bed for 2,732 patients and one doctor for 3,125 people. The poisonous medicines and adulterated food, drink and medication have created a negative impact all over the country. For example, in 2008, Kala azar broke out in 45 districts and it was reported that seven people had died after taking the medicine Miltefosin. The medicine was tested in a laboratory approved by the World Health Organisation and found to be poisonous. It is known to all that a few years ago some 150 children aged between six months and five years reportedly fell sick after taking Vitamin A capsules and de-worming tablets in a village. According to another report, a child died of complications from Vitamin A plus capsules and de-worming tablets in Munshiganj. It was also reported that 104 personnel in several government hospitals were found involved in mismanagement and corruption, and were penalised.
At the moment, the government is not building any new large hospitals. It is the private investors who are building five-star hospitals. Denationalisation and privatisation campaigns of successive regimes have made the situation worse. Conditions imposed by international financial institutions and multilateral donors have made things more complex. Medical service seems to have become a money-minting machine. Poor tax payers rarely get even standard treatment and their health-related matters have been compromised with the trends of consumerism and commodification. Now the focus of privatisation has been shifted onto district and upazila hospitals in the peripheral region, which include union health centres, sub-centres and community clinics. What is intriguing about it is that to avoid resistance from rural workforce and ordinary people the government is proceeding towards privatising government healthcare facilities bit by bit. In a large hospital, services are being contracted out in pieces. So a policy of commercial fragmentation is being adopted as the multilateral lenders are pressing the government to convert social service sectors into profit-making enterprises. It is the world-wide policy of the so-called ‘neo-liberal’ globalised capitalism. So, these prescriptions are creeping into our socio-economic fabric and beginning to impinge on the poor capacity of the ordinary people to procure healthcare facilities.
The health ministry established a Monitoring and Supervisory Committee on August 31, 2008, in response to the reports of appalling healthcare conditions published in newspapers. To make matters worse, the monitoring by the government for checking the activities at the private hospitals, clinics and diagnostic centres is virtually non-existent now. Regulatory bodies are not capable to monitor the existing private and NGO-run health facilities.
A national and local committee needs to be formed in collaboration with the government and community to run public health services. Tertiary-level hospitals and institutes should be granted autonomy immediately; but they need not be privatised. Elected local government must be involved in the management of local health establishments. In this way, involvement of the community in providing health services can be ensured. At the same time, a new act needs to be formulated to ensure the accountability of, and control over, private hospitals, clinics and diagnostic centres. The main problem in the public health sector is mismanagement, which should be stopped immediately. It, however, would not be wise to blame doctors only for the present situation of the healthcare system. Allegations of corruption against different donor agencies in health sector should be investigated, and their suggestions to go against public interest need to be rejected.
Health is a basic right of the people, which is enshrined in the constitution of Bangladesh. The government, in no way, can avoid its constitutional responsibility of ensuring poor people’s right to healthcare. It must ensure availability of the necessary equipment in public hospitals, increase budgetary allocation and root out corruption at every level in this sector. The fundamental principle of the state is to ensure delivery of primary healthcare and essential healthcare for every citizen when s/he resides within the geographical boundary of Bangladesh. The state shall regard raising the level of nutrition and improvement of public health as its primary duties. The affected stakeholders including people and healthcare providers should raise their voice in unison against any anti-constitutional and anti-public measures. It is people’s resistance which can compel the ruling class to ensure social welfare measures for facilitating health services for every citizen of the country.

Khurshid Anwar is an assistant editor at New Age.

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