HIGH out-of-pocket expenditure, poor access to quality health care, poorly regulated growth of health care in the private sector, low public investments in health, coupled with rampant corruption, undermine the advancements that the sector has made since independence. Since independence, Bangladesh has made a remarkable progress in many health indicators, especially in infant and maternal mortality rates and life expectancy, but the advancements in the sector have been largely governed by the private sector and mostly in urban areas. Life expectancy, which stood at mere 46.2 years in 1974, has climbed, keeping to the latest Bangladesh Bureau of Statistics data released in 2018, to 72.3 years while the infant mortality rate per thousand live births has come down from 153 in 1974 to 22 in 2018 and the maternal mortality rate per 100,000 live births from 478 in 1991 to 169 in 2018. There has been a significant progress also in reducing the gap between the physician, patient and hospital bed ratios — from one physician per 14,163 people in 1974 to 1,581 and from one hospital bed for 5,651 people in 1974 to 1,169 people in 2018. The country has also achieved a noteworthy progress in improving family planning services, in ensuring safe drinking water and sanitation.
Bangladesh is ahead of most of its neighbours, keeping to a Lancet study, in reaching health care to people, with its Healthcare Access and Quality Index score increasing from 17.8 in 1990 to 47.6 in 2016. The growth of the health sector, however, has largely been chaotic and the benefits of the growth have not reached all. Bangladesh tops South Asian countries in out-of-pocket medical expenditure — with patients needing to pay for 67 per cent of their medical expenses. An unregulated growth of private healthcare facilities — most private facilities are still unregistered and largely remain out of any monitoring mechanism — is believed to have contributed to such a high out-of-pocket expenditure. The allocation for health in the budget has also remained worryingly low. Bangladesh, in fact, stands at the bottom among South Asian countries, with the current health allocation of 2.34 per cent of the gross domestic product. The health sector has also largely failed to cope with the demands for healthcare facilities for critical non-communicable diseases such as cancer, kidney diseases, heart complications and brain diseases. The unavailability of quality health care for critical diseases prompts the affluent to resort to private or overseas hospitals.
The COVID-19 outbreak has exposed the vulnerability of the sector. The government must, therefore, not be complacent about the achievements in health care and must attend to the issues that hold back quality health care for people. The government must work on primary health care, which is regarded as the backbone in health care, and set up community-based general practitioner system to make it a proper referral linkage between patients and secondary or tertiary health care. The government must also regulate private health care.
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