[🇧🇩] Healthcare Industry in Bangladesh

[Saif]

Source : https://www.thedailystar.net/business/economy/news/full-fledged-cancer-treatment-facilities-need-the-hour-3655501

Full-fledged cancer treatment facilities need of the hour

High-quality cancer drugs are produced in Bangladesh. Oncologists and physicians are also available. However, the country is lagging in putting in place an adequate number of full-fledged facilities to treat patients suffering from such diseases.

The missing link exists although cancer patients are on the rise in Bangladesh in line with global trends and hospitals and clinics have flourished.

Cancer is already a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths. The most common cancers are breast, lung, colon, rectum and prostate cancers, according to the World Health Organisation (WHO).

Cancer cases are expected to rise 77 percent by the middle of the century, the International Agency for Research on Cancer (IARC), a specialised branch of the WHO, said in February, highlighting the growing burden of the disease.

There are predicted to be more than 35 million cancer cases during 2050, up from the estimated 20 million in 2022, the agency said.

The increase reflects both population ageing and growth, as well as changes to people's exposure to risk factors. Tobacco, alcohol and obesity are key factors, along with air pollution.

Currently, Bangladesh has 13 lakh to 15 lakh cancer patients, while around two lakh new patients are diagnosed with the diseases each year, figures from the National Center for Biotechnology Information showed.

There are around 240 oncologists in Bangladesh. Treatment is available in 19 hospitals, and 465 beds have been set aside for chemotherapy at the oncology and radiotherapy departments.

"There is no shortage of oncology surgeons or specialists in Bangladesh," said Prof Golam Mohiuddin Faruque, president of the Bangladesh Cancer Society.

Besides, locally manufactured generic versions of oncology drugs are similar to the products made by multinational companies in terms of quality.

"However, there is a lack of radiation therapy facilities at hospitals as it is very expensive," he said, adding that it costs around Tk 40 crore to set up such units.

Currently, 40 radiotherapy facilities, including those at government hospitals, are available against the need for 300, Faruque said. Private hospitals treat 67 percent of cancer patients while the rest receive services from state-run hospitals.

According to Faruque, patients could see an oncologist for only Tk 10 at a government hospital or for Tk 1,000 to Tk 1,500 at a private hospital.

Drugs have also become easily available during the last decade as pharmaceutical companies have taken initiatives to manufacture oncology products. "As a result, the cost of treatment has come down by two-thirds during the decade," Faruque said.

Since the number of cancer patients is rising, the government is building treatment facilities in eight divisional hospitals, which may be commissioned next year.

Training general physicians on cancer warning signs and setting up early detection centres at medical colleges and the district level are underway. Piloting of cervical cancer vaccination has recently been completed.

The International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), BRAC, Ahsania Mission Cancer Hospital, Bangabandhu Sheikh Mujib Medical University, Bangladesh Cancer Society, ASHIC Foundation, Amader Gram, AK Khan Healthcare Trust, and Chattogram-based Cancer Support Society (Cansup) run programmes for early detection.

Bangladesh has agreed to reduce premature mortality from cancer as part of the 2030 UN Agenda for Sustainable Development.

Industry people say improving the cancer treatment scenario overnight is not an easy task. However, policymakers should show their interest in expanding the facilities and pushing the agenda forward since cancer diseases have huge health and financial impacts.​

 

[Saif]

Bangladesh and Belgium sign MoU on cancer care and research

A Memorandum of Understanding on cooperation in cancer care and research has been signed between Bangladesh and Belgium.

en.prothomalo.com

Bangladesh and Belgium sign MoU on cancer care and research
Diplomatic Correspondent
Updated: 16 Jul 2024, 11: 51

A MoU on cooperation in cancer care and research has been signed between Bangladesh and Belgium.Courtesy

A Memorandum of Understanding (MoU) on cooperation in cancer care and research between the National Institute of Cancer Research and Hospital (NICRH), Bangladesh, and Bordet Cancer Institute at Hôpital Universitaire de Bruxelles (HUB), Belgium, was signed on Monday in Brussels, says a press release.

Bangladesh ambassador to Belgium, Luxembourg and the European Union, Mahbub Hassan Saleh, signed the MoU on behalf of NICRH.

Meanwhile, deputy chief executive officer, HUB Francis de Drée, chief medical officer, HUB Jean-Michel Hougardy and physician-in-chief of the Bordet Institute Chloé Spilleboudt signed the MoU on behalf of HUB.

The MoU aims to foster strong partnership between these two institutions for conducting joint research activities and bringing specific expertise on cancer care through capacity building and infrastructure development.

This MoU will be a tool for collaboration in cancer research, including basic, epidemiologic, prevention, diagnosis, screening, treatment, cancer control and survivorship research.

Bordet Cancer Institute has been an internationally reputed multidisciplinary medical institution in Belgium for more than 75 years, dedicated entirely to the fight against cancer.

This institute offers patients leading-edge diagnostic and therapeutic measures in the prevention, screening and active treatment of all types of cancer.

The Institute also carries out important research activities which every year leads to major discoveries, as well as providing high-level, specialized university training.

The MoU is the result of three years of discussion and negotiation between both sides, facilitated by the Bangladesh Embassy in Brussels.

Sharing details of the state-of-start facilities available at the Jules Bordet Institute, Francis de Drée said he and his team are very enthusiastic to start the collaboration with Bangladesh.

Expressing happiness at the signing of the MoU, ambassador Mahbub Hassan Saleh said that this MoU paves the way for Bangladesh to take a significant step forward in cancer treatment and research, as the country, under the dynamic and visionary leadership of Prime Minister Sheikh Hasina, moves towards building a knowledge-based society leading to achieving her vision of a 'Smart Bangladesh' by 2041.​

 

[Saif]

Healthcare accessibility in rural BD

Healthcare accessibility remains one of rural Bangladesh's most pressing and complex challenges. The country's rural population, which constitutes most of its populace, faces significant barriers to obtaining adequate healthcare services. These barriers stem from many factors, including geographica

thefinancialexpress.com.bd

Healthcare accessibility in rural BD
MATIUR RAHMAN
Published :
Jul 16, 2024 21:43
Updated :
Jul 16, 2024 21:43

Healthcare accessibility remains one of rural Bangladesh's most pressing and complex challenges. The country's rural population, which constitutes most of its populace, faces significant barriers to obtaining adequate healthcare services. These barriers stem from many factors, including geographical isolation, inadequate infrastructure, shortage of healthcare professionals, and socio-economic constraints. Despite various initiatives by the government and non-governmental organisations to address these issues, Bangladesh's rural healthcare landscape continues to struggle with these multifaceted problems.

Geographical and infrastructural challenges are not just obstacles but daily struggles for rural residents in Bangladesh. The rugged terrain, including rivers, hills, and poor road conditions, makes reaching healthcare facilities daunting. The underdeveloped transportation network and the lack of proper roads and reliable means of transportation in many villages further exacerbate the problem. This geographical isolation forces many rural residents to undertake long, costly, and time-consuming journeys to reach the nearest healthcare facility.

The inadequacy of healthcare infrastructure in rural areas is a problem and a crisis. Many rural health centres are poorly equipped and lack essential medical supplies and equipment. The buildings are often in disrepair, and there is a significant shortage of basic amenities such as clean water, electricity, and sanitation facilities. This inadequate infrastructure severely hampers the ability of these centres to provide quality healthcare services to the rural population.

Another significant barrier to healthcare accessibility is the stark disparity in the distribution of healthcare professionals between urban and rural areas in Bangladesh. Most doctors, nurses, and other healthcare workers prefer to work in urban areas, where they have better career prospects, higher salaries, and access to modern facilities. This preference has resulted in a severe shortage of qualified healthcare professionals in rural areas, exacerbating the healthcare accessibility issue.

The lack of healthcare professionals in rural areas means that many health centres are understaffed and unable to provide comprehensive healthcare services. Patients often have to wait for long periods to receive treatment, and the quality of care they receive is usually substandard. The shortage of healthcare professionals also means that rural health centres cannot provide specialised services, forcing patients to travel to urban areas for specialised care.

Socioeconomic barriers also play a significant role in limiting healthcare accessibility in rural Bangladesh. Many rural residents live in poverty and cannot afford the cost of healthcare services. Even when healthcare services are available, transportation, medication, and other related expenses can be prohibitive for many rural families. Additionally, many rural residents lack health insurance, further exacerbating their inability to access healthcare services.

Education and awareness also play a crucial role in healthcare accessibility. Many rural residents are unaware of the importance of seeking timely medical care and are often reluctant to visit healthcare facilities due to cultural beliefs and practices. There is also a lack of awareness about preventive healthcare measures, which leads to a high prevalence of preventable diseases in rural areas.

Despite these challenges, various initiatives have been taken by the government and non-governmental organisations (NGOs) to improve healthcare accessibility in rural Bangladesh. The government has launched several programs to improve healthcare infrastructure, increase the number of healthcare professionals in rural areas, and provide financial assistance to low-income families for healthcare services.

One notable initiative is the Community Clinic Project, which aims to establish community clinics in rural areas to provide primary healthcare services to the rural population. These clinics are staffed by community health workers who provide essential healthcare services, including maternal and child healthcare, immunisation, and treatment for common illnesses. The government has also implemented programs to train and deploy more healthcare professionals in rural areas and improve rural health centre infrastructure.

NGOs have also played a significant role in improving healthcare accessibility in rural areas. Many NGOs have launched programs to provide healthcare services to underserved rural populations, including mobile health clinics, telemedicine services, and health education programs. These initiatives have helped to bridge the gap in healthcare accessibility and have provided much-needed healthcare services to rural residents.

Technology has the potential to revolutionise healthcare accessibility in rural Bangladesh. Telemedicine, in particular, has emerged as a promising solution to the healthcare challenges faced by rural populations. Telemedicine allows healthcare professionals to provide medical consultations and treatment to patients in remote areas through digital platforms. This can help to overcome the geographical barriers to healthcare accessibility and ensure that rural residents have access to quality healthcare services.

Mobile health clinics are another innovative solution implemented in rural areas. These clinics travel to remote villages and provide essential healthcare services to rural residents. They are equipped with medical supplies and equipment and staffed by healthcare professionals who offer various services, including medical consultations, immunisations, and health education.

Mobile technology for health education and awareness is essential in improving healthcare accessibility. Mobile health applications can provide rural residents with information on preventive healthcare measures, treatment for common illnesses, and the importance of seeking timely medical care. These applications can also help raise awareness about government and NGO healthcare programs and services available to rural residents.

Community involvement and empowerment are crucial for improving healthcare accessibility in rural Bangladesh. Engaging the community in healthcare initiatives can help ensure that rural residents' healthcare needs are met and that they have a voice in the planning and implementing healthcare programmes.

Community health workers play a vital role in this regard. These workers are often members of the rural communities they serve and are trained to provide essential healthcare services and health education. They act as a bridge between the healthcare system and the community, helping to raise awareness about healthcare services and encouraging rural residents to seek medical care.

Empowering rural residents through health education and awareness programmes is also essential. These programmes can help educate rural residents about the importance of preventive healthcare measures, the benefits of seeking timely medical care, and the availability of healthcare services. Empowering the community in this way can help to overcome cultural barriers to healthcare accessibility and ensure that rural residents are better informed about their healthcare options.

Healthcare accessibility in rural Bangladesh remains a complex and multifaceted challenge. Geographic isolation, inadequate infrastructure, a shortage of healthcare professionals, and socio-economic barriers all contribute to the difficulties faced by rural residents in accessing healthcare services. However, various initiatives by the government and NGOs and the use of technology offer promising solutions to these challenges.

Improving healthcare accessibility in rural Bangladesh requires a concerted effort from all stakeholders, including the government, NGOs, healthcare professionals, and the community. By addressing the geographical and infrastructural challenges, increasing the number of healthcare professionals in rural areas, reducing socio-economic barriers, and leveraging technology, it is possible to bridge the gap in healthcare accessibility and ensure that rural residents have access to the quality healthcare services they need.

The journey to achieving healthcare accessibility in rural Bangladesh is long and challenging. Still, with continued effort and collaboration, it is possible to create a healthier and more equitable future for the rural population.

Dr Matiur Rahman is a researcher and development worker.​

 

[Saif]

The bane of out-of-pocket health expenditure

A study carried out recently by a researcher at the Bangladesh Institute of Development Studies (BIDS) shows that "Out-of-Pocket (OOP) expenditure is one of the most noteworthy payment strategies for healthcare in Bangladesh and the share of the same has been increasing alarmingly." The findings we

thefinancialexpress.com.bd

The bane of out-of-pocket health expenditure
SYED MANSUR HASHIM
Published :
Jul 16, 2024 21:47
Updated :
Jul 16, 2024 21:47

A study carried out recently by a researcher at the Bangladesh Institute of Development Studies (BIDS) shows that "Out-of-Pocket (OOP) expenditure is one of the most noteworthy payment strategies for healthcare in Bangladesh and the share of the same has been increasing alarmingly." The findings were presented at a programme titled "Catastrophic Health Shock and Improvement in Bangladesh: Insights HES-2022."

For several years, OOP has come up for discussion as patients in the country are constantly being squeezed out of their savings while trying to meet healthcare costs. Indeed, Dr. Razzaque who conducted the research stated at the event that "54.40 per cent of OOP money is spent on purchasing medicines while diagnostic cost is 27.52 per cent, 10.31 per cent cost for consultation and 7.77 per cent expenditure for transport cost." What the latest survey reveals is that due to this excessive OOP expenditure, about 6.13 million people were pushed below the national poverty line in 2022. It is a large number of people. While the health minister has stated that the government is working towards a law titled 'Health Protection Act', the question is how long will that take?

Granted that the minister has not been in the chair long, but experience shows that business interests and profit generation in the health sector is an entrenched practice that operates on the principle of maximising earnings at the cost of patients. Again, would a piece of legislation automatically translate into action? One can easily draw parallels with the market for foodstuffs across wholesale and retail markets in the country, where several laws exist to protect consumer rights, but have they been effectively enforced to protect consumers from wilful manipulation of prices? Sadly, the answer is no.

There has also been talk about introduction of healthcare insurance. This would be a move in the right direction. There are many examples of such insurance schemes that have worked in other parts of the world, but how would the authorities go about enforcing it? The problem in Bangladesh is not having requisite laws, but their enforcement. Again, as the minister has stated many times before, no radical change can be expected overnight. Agreed. But, the pace of change must be expedited because people are being made to suffer inordinately and these malpractices have been going on for decades. There are various stakeholders involved here from manufacturing of medicines to their prescription at heath institutions to the prices of drugs.

The lack of oversight on these and institutions that carry out tests and the fact that most of the Grade A health institutions and health practitioners are largely in urban areas, mean that patients living rural areas must travel from far and wide to come to the cities, pay hotel bills, transportation, etc. to get those services. These are all facts of life and every Bangladeshi knows the score. There is nothing that they can do about it. It is up to the state to care for its citizens in a manner that puts a patient over profit and above unbridled greed. Malpractices manifest themselves in every facet of the healthcare system in absence of a rule-based system. Yes, the minister is correct when he says the entrenched system of fleecing patients cannot be changed overnight, but at least he can try to do something. Time is money and people have been pushed beyond tolerance levels with runaway inflation affecting every facet of their lives. They need relief now.​

 

[Bilal9]

In the health and health systems ranking of countries worldwide in 2023, by health index score, Bangladesh scores well above most larger countries in South Asia (except Sri Lanka).

Health index of countries worldwide in 2023 | Statista

In 2023, Singapore ranked first with a health index score of 86.9, followed by Japan and South Korea.

www.statista.com

 

[Saif]

Healthcare costs mustn’t make people destitute

Holistic approach required to reduce out-of-pocket health expenditures

www.thedailystar.net

Healthcare costs mustn't make people destitute
Holistic approach required to reduce out-of-pocket health expenditures

A research finding has confirmed our fear that many people are facing poverty because of high healthcare costs in Bangladesh. A study by the Bangladesh Institute of Development Studies (BIDS), according to this daily, showed that approximately 6.13 million people were pushed below the national poverty line in 2022 because of out-of-pocket health expenditures.

The findings also revealed that more than half the population faces financial difficulties while seeking medical services in hospitals and that a large portion of the healthcare cost is spent on medicines. This is no surprise since many people in Bangladesh visit a pharmacy for basic ailments and buy medicine based on the shopkeepers' recommendations instead of consulting physicians, who are often not available at primary healthcare centres in unions and upazilas. Even when doctors are available, the poor quality of services at health facilities and the high cost of private ones often discourage people from seeking professional help. There is also a tendency among health professionals to overprescribe drugs and write brand names of medicine in prescriptions as a favour to pharmaceutical representatives who shower doctors with incentives.

The most disheartening part is that while out-of-pocket health expenditure continues to rise for the public (from 68 percent in 2020 to 73 percent in 2021), a portion of the health sector allocation remains underutilised. Plus, a significant portion of the allocation is spent on the salaries and wages of staff and health professionals, which often do not benefit patients directly. Although the health minister hinted at introducing a government-based health insurance system, many other ills in this sector need to be fixed to reduce people's healthcare burden. First, our focus needs to shift from curative to preventive care. Then the shortage of doctors and other health professionals must be resolved by instituting proper incentives and monitoring systems at duty stations. Policies and regulations should be introduced and implemented strictly to prevent the over-prescription of drugs, unethical practices of pharmaceutical companies, and regulate fees at private healthcare facilities. Corruption and inefficiencies in health sector procurement processes must be checked. Besides, a well-developed patient referral system will also decrease costs, stopping people from unnecessarily visiting specialists and paying higher fees. Only an overhaul of the entire sector, not just ad hoc measures, can re-establish people's trust in the health sector and reduce healthcare costs.​

 

[Saif]

Make healthcare an affordable dream

Why are out-of-pocket healthcare expenses still so high in Bangladesh?

www.thedailystar.net

Make healthcare an affordable dream
Why are out-of-pocket healthcare expenses still so high in Bangladesh?

VISUAL: STAR

There can be no excuse for why people's out-of-pocket (OOP) healthcare expenses are still so high in Bangladesh, except perhaps a lack of political will to match commitments with action. The situation warrants deeper scrutiny, especially after a report by the Health Economics Unit of the health ministry highlighted a stark contrast between government spending on healthcare and expenses borne by citizens. While the government is paying less and less, citizens are paying more and more, with about three-fourths of the overall health expenditure borne by the latter. This is really disturbing.

OOP expenses, it can be noted, are people's share of the expenses for medical care that aren't reimbursed by public or private insurances. A decade ago, the government had set a target of bringing OOP expenses down to 32 percent, and also increasing government expenditure to 30 percent by 2032. But halfway through that deadline, the situation has rather become worse. For example, in 2018, 2019 and 2020, the share of government in the national healthcare expenditure was about 28, 26 and 23 percent respectively, while the share of citizens was about 64, 66 and 69 percent respectively, as per the Bangladesh National Health Accounts (BNHA) 1997-2020 report. The World Health Organization (WHO) paints an even bleaker picture, saying OOP in 2020 was actually 74 percent of Bangladesh's national health expenditure.

This progressive downward spiral is the opposite of not just the government's own pledge in this regard but also the general practice in much of the comparable countries. The question is, why is the government so reluctant to spend in such a vital sector? Its reluctance was on full display when only 5.43 percent of the proposed budget for FY2022-2023 was earmarked for the health sector. The unfair burden imposed on citizens, as well as the rising cost of healthcare in general, means that many families are being pushed below the poverty line.

The rising cost of healthcare services is another worrying matter. The biggest contributor to this is the cost of medicine, followed by that of diagnosis. As per the BNHA report, of the total OOP expenses, about 64.6 percent is spent on medicine, 11.7 percent on laboratory charges, and 10.8 percent on doctors. The high prices of medicine are mostly propelled by unethical and unnecessary practices in the sector. Aggressive marketing, lavish packaging, and gifts for physicians are some of the reasons reportedly driving up prices. Unless the authorities take effective action to arrest this trend, the situation may worsen further in the coming years, especially as Bangladesh will have to pay more to import Active Pharmaceutical Ingredients as soon as it graduates into a middle-income country by 2026.

We must not let things deteriorate any further. Healthcare should be affordable for all, especially the poor, and the government has a huge role to play in this. Not only should it increase its own spending but it should also take steps to keep prices of medicine and diagnosis down, so that the overall cost of healthcare becomes bearable for citizens. The time to act is now.​

 

[Saif]

Healthcare in Bangladesh need not be so costly

The towering and ever-increasing cost of healthcare is a constant headache for people in the country.

www.thedailystar.net

Healthcare in Bangladesh need not be so costly

Solving the healthcare puzzle for Bangladesh's 170 million citizens is not a one-day job. FILE PHOTO: AMRAN HOSSAIN

The right to healthcare is enshrined in the Constitution of Bangladesh. However, despite considerable development in this sector over the last decade, the nation is still far from ensuring quality healthcare for all.

The towering and ever-increasing cost of healthcare is a constant headache for people in the country, making on-demand, quality healthcare virtually out of reach for most. The fact that almost 70 percent of all healthcare costs in Bangladesh are paid out of pocket, and that public spending on healthcare in this country as a percentage of GDP is the lowest in South Asia, only exacerbate this problem. In addition to low public spending, there are other factors contributing to the high cost of healthcare that need to be understood with their nuances.

A significant portion of the healthcare budget fails to reach target citizens due to corruption, wrong priority setting, and sub-optimal implementation. The combined effect is an acute lack of accessibility to points of care. A large number of facilities (such as community clinics) are sitting idle due to lack of resources, whereas a few specialty centres (such as public medical colleges or district hospitals) are beset with overcrowding and poor service delivery. This forces people, especially lower-income groups who are more likely to flock to subsidised government facilities, towards private healthcare providers, creating a heavy burden on their finances.

Meanwhile, every year, an average of 700,000 people travel abroad for healthcare needs, spending a mammoth Tk 350 crore. Although patients going abroad spend around Tk 5.5 lakh on average, in many instances this cost can be substantially higher, especially for complicated and lengthy procedures. Besides, treatment expense in countries like Singapore can reach up to 10 to 15 times of what it costs in Bangladesh, while in India it can cost two to three times more. So, pursuing treatment abroad can severely dent people's finances, even for those with higher incomes.

Also, for conditions requiring lengthy treatments, like cancer, patients and their attendants often have to stay away from family and work for extended periods of time, thus negatively impacting their professional positions. This is an indirect cost of seeking treatment abroad, which again adds to the burden of already high healthcare costs. Plus, especially among middle- and lower-income individuals, discontinuation of treatment due to socioeconomic reasons or a lack of awareness is common. Incomplete treatment means the patient, in all likelihood, will fall ill again from the same or related cause(s), thus incurring a huge waste of resources.

Due to the absence of a comprehensive and consistent regulatory regime surrounding healthcare and a national accreditation system for health service providers, the pricing of health services becomes arbitrary.

Also, due to the lack of national health insurance, there is no large purchaser (either insurance companies or the government) that can bargain with health service providers to set rational pricing of services. Thus, health service market in the country is dominated by providers who put individual consumers under a heavy burden of differing prices.

As individuals, we have important roles to play in acquiring control over healthcare costs, such as keeping all our medical and health records in one place, putting aside at least three percent of one's monthly income for future health needs, having a doctor or a healthcare worker as a friend to get advice from for sudden healthcare needs, getting a health check-up every year and focus on prevention, maintaining a proper lifestyle to prevent and manage lifestyle diseases like asthma, diabetes and hypertension, and adhering to doctors' advice from the early stages of any disease.

However, to solve the healthcare problem at the national level, the government needs to undertake some initiatives.

Making public sector spending efficient

It is important to bring transparency to the process by ensuring accountability and the involvement of stakeholders, especially health professionals. Similarly, introducing a healthcare official for the job and streamlining the regulatory structure surrounding healthcare will make the sector more transparent and efficient. If done properly, an additional one to two crore people, especially from lower-income strata, can be brought under healthcare services.

Health insurance and universal health coverage

This could be a system to which everyone contributes according to their means, while the government gathers both public and private resources in a unified manner to ensure on-demand, essential health services for all.

Activating community clinics

Managing thousands of community clinics spread across Bangladesh properly, with community involvement and proper training, can be a real game-changer.

Building and maintaining trust in our own healthcare system

A nationwide healthcare accreditation system could be implemented to monitor quality as well as classify providers into service bands (A, B, C, etc). This will ensure that services are provided as per the respective charter and also allow the government to set prices for healthcare services in a comprehensive manner.

Proper referrals and keeping electronic medical record (EMR)

Introducing a well-organised referral system backed by an NID-based, interoperable EMR will create a first line of health service providers in the form of community clinics and general physicians, who will be the primary custodians of individuals' health at the grassroots level. This will take care of the bulk of their healthcare needs at a minimal cost while only referring a small number of patients (who require specialised care) to the district- or national-level facilities.

Solving the healthcare puzzle for Bangladesh's 170 million citizens is not a one-day job. It will require clear-eyed national planning led by the government in conjunction with private and non-profit players—with national interest at its core—implemented in a sustained, transparent, and non-partisan manner over 5 to 10 years' time with the participation of individuals, who are our primary concern.

Dr AM Shamim is the founder of Labaid Group.​

 

[Saif]

Dhaka hospitals need urgent support

They are struggling to provide necessary care to patients

www.thedailystar.net

Dhaka hospitals need urgent support
They are struggling to provide optimal care to patients

VISUAL: STAR

The updates coming from several government hospitals in Dhaka in the aftermath of recent violent clashes are quite concerning. These hospitals, treating people injured during the unrest centring the quota reform movement, are struggling to provide optimal care due to the sheer number of incoming patients, as per a report in this daily. Clearly, these and other public hospitals in major cities need proper support from the authorities.

According to our report, the hospitals in Dhaka, especially the Dhaka Medical College Hospital (DMCH), have been stretched thin since July 18, when violent attacks spread out across the city. People were injured with shotgun bullets or pellets as police and Border Guard Bangladesh (BGB) troops shot at protesters and alleged infiltrators. At the DMCH, some 1,071 people wounded by sharp weapons, bullets and/or pellets sought treatment between July 15 and 22. Most of these victims—ranging from teenagers to middle-aged individuals—said they were merely bystanders or commuters and not associated with the protests or clashes. All the patients currently admitted at the DMCH were injured critically and had to undergo surgery. Overwhelmed by the surge, the hospital had to prematurely discharge those who had come in before the start of the violence to make room. The situation is similar at Shaheed Suhrawardy Medical College Hospital (SSMCH), NITOR, and the National Institute of Ophthalmology.

Healthcare services in general have been facing a massive disruption due to the ongoing situation. Due to the nationwide internet shutdown, which came into effect on July 18 night, private medical colleges, hospitals and diagnostic centres have been unable to provide services, according to another report in this daily. All online healthcare services have been out of reach as well. These facilities and services cater to a significantly large number of people in Bangladesh.

Given the unprecedented levels of violence, deaths and destruction seen over the past week, it is understandable that hospitals would get overwhelmed to some extent. However, as we have said numerous times before, an emergency service sector like healthcare must always have contingency plans anticipating all kinds of crisis. We urge the government to urgently mobilise all resources needed for the DMCH and other hospitals so that they can provide the best possible treatment to patients. The medical professionals who worked tirelessly in such a high-stress situation deserve some compensations as well.

The limited restoration of internet services is a positive turn of events; this means private healthcare facilities and online services can get back to doing their job. We expect the authorities to extend the necessary logistical and technical support to all healthcare service providers so they can help people without disruption.​

 

[Saif]

Health sector needs attention on an urgent basis

The interim government must focus on purging partisan influences from the public healthcare sector.

www.thedailystar.net

Health sector needs attention on an urgent basis
The interim government must focus on purging partisan influences from the public healthcare sector

VISUAL: STAR

A Prothom Alo report on the politicisation of the public health sector portrays a grim picture of how far the rot has spread. The report details how partisanship has pervaded the sector—from medical academia to healthcare services to projects under the health ministry—ensuring absolute dominance of the erstwhile ruling party. But Awami League was not the only one to have spread its tentacles; BNP also did the same while in power, and it seems the party is trying to do it again after the fall of the former.

Reportedly, after forming government in 2009, Awami League and its affiliates placed loyal officials in various health-related institutions. One example is the Bangabandhu Sheikh Mujib Medical University (BSMMU), where five consecutive vice-chancellors appointed since 2009 have either been a member of pro-AL Swadhinata Chikitsak Parishad (Swachip) or directly involved with AL politics. The same goes for pro-VCs, proctors and others in top positions. Political recruitments were also seen at 37 other public medical colleges. Elsewhere, at the 495 upazila health complexes, only officials loyal to AL were appointed as upazila health officers. Thus, loyalists were favoured in leadership positions at every level of the public healthcare sector—from the grassroots to the top—whether they were qualified or not. In the process, AL deprived anyone with suspected links to BNP and even deserving nonpartisan candidates.

During BNP's rule in 2001-2006, it was the pro-BNP Doctors Association of Bangladesh (DAB) that dominated public-sector recruitments, choosing party loyalists in important positions, and thus depriving those even remotely affiliated with AL and its politics. During the times of both regimes, those who were not affiliated with either party or their politics have suffered, and the lack of competent leadership eventually plunged the sector into an unprecedented crisis.

In the aftermath of Sheikh Hasina's fall, it seems BNP is focused on repeating the same cycle. As many as 173 doctors who were recruited in BNP's time, and deprived of promotions throughout the AL rule, were all promoted in one day—on August 8. The Prothom Alo report suggests that the spate of promotions is still going on. Frustrated DAB members are cornering relevant authorities, staging protests in various medical institutions, and in some cases even vandalising public hospitals.

We understand the frustration of pro-BNP doctors and medical professionals, but their attempt to forcefully claim what they think they deserve cannot be acceptable. Political partisanship is one of the root causes behind the ailing public health sector, and it's time to do away with it. Otherwise, much-needed reforms in the sector will continue to elude us. To restore discipline in this vital sector, we urge the interim government to be strict and judicious about all appointments and promotions. Only those who are qualified and deserving should get preference.​

 

[Saif]

We must be bold with health sector reforms

While we have made significant achievements, complacency cannot be allowed

www.thedailystar.net

We must be bold with health sector reforms
While we have made significant achievements, complacency cannot be allowed

VISUAL: SHAIKH SULTANA JAHAN BADHON

The health sector holds an important place in a nation's development. The past few decades have witnessed some remarkable strides in Bangladesh's health sector. However, this has largely stalled since 2010. Between 1990 and 2010, Bangladesh reduced its maternal mortality ratio from 600 per 100,000 live births to 194, an astonishing achievement. After almost a decade, however, there has been little improvement. Such stagnation was similarly observed in several other indicators of a nation's development.

It is said that we harvested the "low-hanging fruits" well. Bangladesh is committed to reducing the maternal mortality ratio to 70 by 2030, but given the current situation, this seems like an unachievable target. To attain progress, we need to focus on the more difficult, "high-hanging fruits." Civil society activists and health experts repeatedly highlighted this challenge to the previous government, but sadly, serious efforts were not made. Instead, a sense of complacency prevailed. The result was that any idea suggesting reform faced resistance.

The anti-discrimination movement has inspired the nation and sparked hope among the masses. It has given us a chance to rethink our future. In the health sector, we now have an opportunity for comprehensive reform. If we want to move forward in line with the times, we must be ready to tackle some difficult tasks.

We know, for instance, that good governance is a major issue for development in Bangladesh. Poor governance leads to many problems, and the health sector is no exception. The absence of doctors in health centres is a perennial issue. The corruption that surfaced during the Covid pandemic is still fresh in our memory. We know these issues arise due to the lack of accountability and poor management. The private healthcare sector has become a behemoth without any control whatsoever, harbouring severe inequalities. In 1982, an ordinance was passed giving special priority to the private sector, but it has not been updated since. There is no clear regulatory provisions to control them, leading them to get away with unethical and illegal practices. Despite the presence of the Bangladesh Medical and Dental Council which was established decades ago to monitor the professional behaviour of doctors, many still engage in unethical practices without facing any consequences.

One of the benchmarks for countries that have made significant progress in health is their investment in primary healthcare. Bangladesh's primary healthcare system extends from upazilas to unions and community clinics. Ignoring the primary level and focusing on urban-based big hospitals is an action equivalent to nurturing social inequality. Increased investment in primary healthcare with an effective referral system would significantly reduce the pressure on urban hospitals.

Another significant drawback in our healthcare system is poor investment. Currently, the government's spendings on healthcare is one of the lowest globally: only 0.7 percent of the GDP. With such meagre investment, it is impossible to imagine modern healthcare. We have seen to our dismay that two of the important pillars of human development, health and education, were among the lowest priorities for the previous government. Our neighbour Sri Lanka, which is far ahead of us in most indicators, spends nearly four times more on health than we do in Bangladesh. Even the small funding that the health sector gets is not fully utilised, with the utilisation rates remaining below 80 percent. One of the main reasons for this is the lack of adequate capacity in the ministry of health, whose inefficiency in drafting a proper budget, planning, and utilising funds is very well-known. The lack of vision is yet another reason. A "poverty of vision" seems to have gripped the ministry. If we want to emerge as a prosperous nation, our health planners must have a clear vision befitting the health system of a developing country, and our budgets should be framed accordingly.

One of the benchmarks for countries that have made significant progress in health is their investment in primary healthcare. Bangladesh's primary healthcare system extends from upazilas to unions and community clinics. Ignoring the primary level and focusing on urban-based big hospitals is an action equivalent to nurturing social inequality. Increased investment in primary healthcare with an effective referral system would significantly reduce the pressure on urban hospitals.

In addition, another significant issue plaguing Bangladesh's healthcare system is its human resources. Doctors, nurses, and midwives are in severely short supply. To address this crisis, the previous governments licensed new institutions in both the public and private sectors which contributed in alleviating the crisis to some extent. However, there is no effective mechanism in place to ensure the quality of these institutions. Similarly, we need to focus on research. Recently, Bangladesh Health Watch published an extensive research-based book documenting Bangladesh's first 50 years, which shows how Bangladesh has surpassed its neighbours in various health indicators. One of the findings revealed that in recent years, Pakistan has been able to overtake Bangladesh in health research.

The previous government had expressed its commitment to achieve Universal Health Coverage (UHC). Unfortunately, it never felt the need to explain in detail how this would be done or where the additional funds would come from.

The recent uprising is a massive achievement, with tremendous sacrifices made by students and common citizens. We know that every crisis also presents an opportunity. After World War II, the European countries built their health systems on the ruins of war, ensuring free healthcare for all citizens. In the 1990s, after a horrific genocide, Rwanda launched its UHC programme. As I see it, the student revolution has similarly given us a golden opportunity to overhaul our broken health system. Experts have agreed on what needs to be done. This can be broadly divided into five actions: i) establish a high-powered permanent national health commission to create and monitor a roadmap for implementing UHC nationwide; ii) establish a national health security office to ensure accountability in the health system by separating the ministry of health's roles as a "purchaser" and "provider"; iii) ensure good governance and proper management; iv) increase healthcare investment to two percent of GDP, with increased priority for primary healthcare; and v) enhance the quality, efficiency, and oversight of institutions involved in professional health education and research.

I believe that if we follow this path, we will confidently move towards achieving our national goals. While we have made significant achievements, complacency cannot be allowed and must be kept at bay. To bring about a real and lasting change, there is no alternative to reform. This is something the student leaders have repeatedly emphasised. The interim government must take a bold stance and move towards reforms in the health sector that lead to the public being served.

Ahmed Mushtaque Raza Chowdhury is convener at Bangladesh Health Watch, and professor of population and family health at Columbia University, New York.​

 

[Saif]

Healthcare in tatters: Health workers must go to the distressed

When it is not possible for the distressed people to come to the Upazila Health Complexes for treatment, then the health workers themselves have to reach out to them. More medical teams should be sent to the affected areas on an urgent basis. Sending only the medical teams won’t do, they should...

en.prothomalo.com

Healthcare in tatters: Health workers must go to the distressed
Editorial Desk
Published: 01 Sep 2024, 19: 02

Healthcare experts had warned already that various water-borne diseases will spread out in the flood affected areas as soon as the water recedes. Especially there looms the risk of a diarrhoea outbreak in these areas due to the lack of pure drinking water. And that’s exactly what happened in reality.

The healthcare system we have here is the one where the patients are required to go to the hospitals, clinics and physicians. The physicians or the health workers do not go to the patients. This might be acceptable under normal circumstances.

But that seems no longer a possibility for many during natural calamities like floods and cyclones. Though the water has receded in many areas the road communication could not be restored yet. In Bangladesh, Upazila Health Complexes are the main support for reaching out health care at the grass root level.

However the problem is that these establishments lack in the necessary manpower, infrastructure, equipment and medicines. The condition of the community clinics that were established to reach out healthcare to remote areas during the Awami League government’s regime is also of the sort that even if they do have the wish to provide healthcare they lack the capability. Besides, not all the villages have clinics either. And, the villages where there is a clinic are visited by the people seeking health care from the surrounding villages.

The communication system in some districts of the eastern region has been completely destroyed by to severe floods that continued for several days this time. There is not even a way to go to the next house let alone the next village. As reported in Prothom Alo, people in the flood affected areas started suffering from diarrhoea, skin diseases, fever, cold and cough as soon as the flood water receded. Plus, sores and skin rashes are being noticed on the hands and feet of many.

Since the flood situation continued for nine days, the elderly and the children are suffering more from fever, cold and diarrhoea in Feni, Noakhali, Lakshmipur and Cumilla districts. Residents of the affected areas complain that many of the community clinics are closed due to waterlogging. The ministry of disaster management and relief has stated that a total of 619 medical teams are working in 11 districts to provide medical services to people in the flood-affected areas.

Then where are these many medical teams are working? Are their activities limited only to the side of the roads and the highways?

Civil surgeon in Feni, Md Shihab Uddin has also admitted that the number of diarrhoea cases is very high in the flood affected areas. The number of patients has increased in all hospitals of the upazilas as well as of the districts. For the time being there is not that much shortage of saline and ORS for diarrhoea.

According to the office of the civil surgeon in Lakshmipur, as many as 40 community clinics and three sub-health complexes on the union level have been submerged underwater. Strong efforts are being made to provide good treatment to the people affected by the flood at various places including the shelters.

The in-charges of all the hospitals and clinics are providing records of how many patients they have received. However, they are saying anything on how many patients they reached out to. When it is not possible for the distressed people to come to the Upazila Health Complexes for treatment, then the health workers themselves have to reach out to them. If there are some issues with boats in this case, those have to be solved as well. Plus, arrangements have to made quickly so that the closed down community clinics can be reopened as soon as the water recedes.

More medical teams should be sent to the affected areas on an urgent basis. Sending only the medical teams won’t do, they should also have the necessary medicines and medical supplies. There should not be even a single day of delay, especially in the areas where there has been a diarrhoea outbreak already.​

 

[Saif]

Bold, pragmatic measures can revitalise Bangladesh’s health sector

Investment in the health sector must unquestionably be enhanced with the objective of major overhauling.

www.thedailystar.net

Bold, pragmatic measures can revitalise Bangladesh’s health sector

FILE VISUAL: SHAIKH SULTANA JAHAN BADHON

Bangladesh, with a population of over 17 crore, is the eighth most populous country in the world. With the annual population growth rate of around one percent, it is likely to stabilise at around 240-250 million, posing considerable challenges for Bangladesh given its small land area and other resource constraints.

From high fertility (TFR of over six) until the mid-1980s, fertility declined to 3.3 during 1994-2000, and further to 2.3 by 2011. However, it has stalled at that level since then. The family planning programme achieved commendable success until 2011, with the contraceptive prevalence rate (CPR) rising from around four percent in the 1960s to 61.2 percent in 2011, but it has remained almost unchanged (64 percent in 2022, according to Bangladesh Demographic and Health Survey) since then. This is on account of several factors, including, but not limited to: i) decline in the relative share of longer-acting and permanent methods (LAPM), from 32 percent of modern method use in 1994 to only 14 percent in 2022; relying on temporary methods rather than accepting LAPM by women who have completed their family size poses a major problem for the efficiency of the programme; ii) Relatively high unmet need for contraception (10 percent); if users of traditional methods (nine percent) are considered, the total unmet need for modern methods was 19 percent in 2022; iii) relatively high discontinuation, implying huge system loss for the programme (around half of the users stop using a method within 12 months of starting its use; and iv) erratic interruptions in supplies of contraceptives.

Since independence, Bangladesh has achieved considerable success in most health indicators, though there are inequities based on the socioeconomic status of the population. The infant mortality rate (IMR) declined from 144 deaths per 1,000 live births in 1971 to 25 in 2022, though it is higher than in Sri Lanka, Nepal, Maldives and Bhutan. The under-five mortality rate declined from 223 to 31, but it is higher than in Sri Lanka and Maldives. The maternal mortality ratio (MMR) declined from 574 deaths per 100,000 live births in 1990 to 176 in 2017, but it is higher than the average MMR in South Asia (157 in 2017), and also higher than in India, Sri Lanka, Bhutan and Maldives. Over the past five decades, there has been a rise in life expectancy from 45 years to around 74 years, but it is lower than in Sri Lanka and Maldives.

Between 1990 and 2019, the total number of people with non-communicable diseases (NCDs) increased from 9.55 crore to 14.5 crore. Deaths due to NCDs increased, with 14 of the top 20 leading causes of death in 2019 due to such diseases, with stroke at the lead. If this trend continues, management of the increased burden of NCDs will be a considerable challenge for the country's healthcare system. Cost-effective, multisectoral efforts are needed to prevent and control NCDs, promote healthy lifestyle, and prevent premature mortality and disabilities. There has been a substantial decline in deaths due to communicable diseases—malaria, dengue, AIDS, tuberculosis and diarrhoea—though they still remain significant causes of illness and premature deaths. Bangladesh is also a high-risk country for emerging communicable diseases as a result of its high population density and poverty.

Although there has been considerable decline in child and maternal malnutrition, it continues to be a serious public health problem in the country. Also, there are sharp differences in child malnutrition based on mothers' education and household income.

Women of reproductive ages are vulnerable to chronic energy deficiency and malnutrition, the major risk factors for adverse birth outcomes. The double burden of malnutrition is becoming more prevalent among Bangladeshi women. Those with uneducated husbands, those with little or no education, and those belonging to less well-off households, especially from rural areas, are more likely to be underweight than women in other groups, while overweight is higher among the educated and those belonging to relatively well-off households. High rates of maternal malnutrition and low birth weight (LBW) can lead to a high burden of NCDs in adult life. The prevalence of LBW in Bangladesh is around 16 percent, similar to that in India and Pakistan, but higher than in Nepal and Sri Lanka. LBW is inversely associated with mothers' education, household income, and occupation.

In addition to problems specific to population, health and nutrition, there are several constraints that cut across all three of these sub-sectors. Quite importantly, there is an apparent lack of political commitment, affecting the overall healthcare sector. This is clearly evident from i) low investment in the health sector (less than one percent of GDP), the lowest in South Asia; ii) high out-of-pocket (OOP) expenses—about 70 percent—the ever-rising cost of healthcare making quality healthcare services virtually out of reach, especially among the poor; iii) both the health and population policies of 2012 not updated for 12 years; iv) human resource problems—inadequate staffing, lack of trained staff, absenteeism at different levels, one of the worst nurse-physician ratios in the world; v) lack of coordination among various actors and stakeholders, resulting in duplication, inefficiency, wastage, and gaps in service delivery; vi) bifurcation of the Ministry of Health and Family Welfare into two divisions, thereby further hampering coordinated service delivery from the Directorate General of Family Planning (DGFP) and Directorate General of Health Services (DGHS); vii) lack of effective coordination between the health ministry and the Ministry of Local Government, Rural Development and Cooperatives, thereby adversely affecting urban healthcare delivery services; viii) lack of effective monitoring and supervision; and ix) lack of transparency and accountability at different levels of the programme.

Bold and pragmatic reform measures should be undertaken to revitalise the entire health sector to overcome the constraints identified above in order to improve access, quality, and sustainability of healthcare services to people, with special consideration given to the poor and the needy. Investment in the health sector must unquestionably be enhanced to around two percent of GDP, together with enhanced spending capacity of the programme with the objective of major overhauling of the sector, wherever needed, such as in human resource-related issues, procurement, and helping reduce OOP. Likewise, allocation to the education sector should be enhanced to raise not only enrolments but also—and more importantly—to improve quality of education at different levels, with special consideration given to female education. The latter will help reduce child marriage and raise child-bearing age as well as female employment.

The outdated health and population policies should be updated, taking into consideration both demographic and epidemiological changes as well as socioeconomic changes that have occurred during this period. Pragmatic mechanisms should be put in place to ensure effective monitoring and supervision, meaningful coordination among all actors and stakeholders in the programme, including between the health and local government ministries, and address issues related to the lack of accountability and transparency at different levels of the programme. To give further impetus to political commitment, a high-level body—a national health council—should be formed under the leadership of the head of the government, to review progress and constraints, and provide oversight to programme activities, at least biannually. The council should include concerned stakeholders, including high-level professionals from relevant disciplines.

Barkat-e-Khuda, PhD, is a former professor and chairman of the Department of Economics at Dhaka University.​

 

[Saif]

WB points out myriad issues in healthcare

The World Bank has committed to giving Bangladesh $400 million for implementing the next five-year plan for the health sector, which is estimated to cost around $9 billion.

www.thedailystar.net

WB points out myriad issues in healthcare
Commits $400m to Dhaka for the next five-year plan

The World Bank has committed to giving Bangladesh $400 million for implementing the next five-year plan for the health sector, which is estimated to cost around $9 billion.

The government expects $2.3 billion of it to come from multilateral and bilateral partners, including the World Bank (WB), the Asian Development Bank (ADB), and the Japan International Cooperation Agency (JICA).

According to finance ministry officials, negotiations with the WB were completed on Monday, and the first round of talks with the ADB and JICA also concluded.

Officials of the Economic Relations Division of the finance ministry said they would soon finalise each development partner's contribution to the plan. The government would foot the rest of the bill.

The plan, titled "Health, Nutrition, and Population Sector Development Programme (HNPSDP)", is renewed every five years. The current plan is set to expire in June next year.

Experts said the existing budget for health is insufficient and that the sector has struggled to effectively use the funds allocated to it.

In recent review of the health sector, the WB said, "Bangladesh's Health, Nutrition, and Population (HNP) sector faces numerous challenges, including maintaining immunisation coverage, improving child nutrition, enhancing the quality and reach of services, reducing socio-economic and regional disparities, addressing emerging health challenges, and strengthening financial management in the health sector."

Syed Abdul Hamid, health economics professor at Dhaka University, said the current health system is ineffective, preventing people from truly benefiting from it.

"The main issue is that the sector lacks sufficient funding. We are unable to even fully utilise the limited funds. The money is often inefficiently spent," he told The Daily Star, adding that corruption was a major issue too.

The World Bank has identified several challenges, including the slow pace of poverty reduction amid widening inequality, as well as malnutrition.

It noted that even though the maternal mortality ratio has declined to 143 per 1,00,000 live births, it is still more than double the global Sustainable Development Goal target of 70.

It observed that malnutrition threatens health outcomes and human capital. Nearly one in five women in Bangladesh is undernourished, one in three women aged 15-49 is anaemic, and one in six babies is born with a low birth weight, it said.

Improving the quality of antenatal care by including measures like multiple micronutrient supplementation could help prevent these poor outcomes, stated the WB.

Action is urgently needed as Bangladesh is also vulnerable to climate change, which threatens to exacerbate malnutrition and increase the risk of climate-sensitive non-communicable diseases, it said.

"Underlying these trends is a low-quality health system," the WB said, adding that maternal health services suffer from poor quality, with issues like inadequate midwife support during childbirth, overuse of cesarean sections, and ineffective referral systems for timely care of complications.

The WB further mentioned that "primary healthcare facility performance is about 60 percent", contributing to a high rate of preventable complications, increased reliance on more expensive and climate-intensive services, and a high out-of-pocket payment rate of 68.5 percent.

Prof Syed Abdul Hamid held the sector's inefficient management accountable for these issues and suggested that recruitment for managerial positions needs to be overhauled, with rigorous training provided for both managers and supporting staff.

He advocated for block allocations for public hospitals to address emergency crises and recommended involving the private sector for repairs of machinery.

Hamid also called for streamlining the medicine supply chain, strengthening Essential Drug Company Ltd., increasing dedicated drug storage capacity, overhauling the rural healthcare sector by consolidating health and family planning services under a single framework, and establishing primary healthcare services in urban areas.

To reduce out-of-pocket expenses, he suggested lowering medicine consumption, regulating pharmacies, and controlling drug prices.​

 

[Saif]

Bangladeshis spend $4b annually for healthcare abroad

DCCI Senior Vice President Malik Talha Ismail Bari says in a seminar on outbound healthcare tourism

www.thedailystar.net

Bangladeshis spend $4b annually for healthcare abroad
DCCI Senior Vice President Malik Talha Ismail Bari says in a seminar on outbound healthcare tourism

Bangladeshis spend around $4 billion abroad every year for healthcare, according to Malik Talha Ismail Bari, senior vice president of the Dhaka Chamber of Commerce and Industry (DCCI).

This is due to a lack of specialised treatment, trust on doctors and advanced technology within the country alongside costs being comparatively lower abroad, he said.

Bari, also a director of United Hospital, was delivering a keynote paper through a presentation at a seminar, styled "Reversing the Outbound Healthcare Tourism", at the DCCI today.

There are 5,461 private hospitals and clinics in Bangladesh, of which 1,810 are within Dhaka division, he said.

People in rural areas are deprived of quality and adequate healthcare services while pressure is created for an influx of patients at healthcare facilities in Dhaka.

Limited infrastructure, a lack of skilled workforce, quality and safety concerns, low doctor-patient ratio and long waiting periods are some of the bottlenecks to access advanced healthcare in Bangladesh, he added.

Bari informed that Bangladesh allocated Tk 30,125 crore, or 3.78 percent of its national budget, for public healthcare in fiscal year 2024-25.

Pre-capita health expenditure, or annual government spending for healthcare per person, is $110 in Bangladesh whereas $401 in South Asia, he said.

Patients sometimes go abroad for healthcare services due to a lack of facilities, trust and comfort and reversing this trend requires formulation of a proper plan and identifying the bottlenecks, said National Professor AK Azad Khan.

"Since medical science is an ever-changing process, we need to have a proper curriculum to adopt the best technological advancements," said Khan, also president of the Diabetic Association of Bangladesh.

He also stressed on the standardisation of laboratories, adequate budgetary allocation, facilitating more research and strengthening the Bangladesh Medical and Dental Council (BM&DC), which is the regulatory authority for medical and dental education in Bangladesh.

Trust is a crucial factor when considering this sector's development, said Rezaul Karim Kazal, professor of the obstetrics and gynaecology department at Bangabandhu Sheikh Mujib Medical University.

Quality hospitals should be established in rural areas for wider coverage alongside customised services for all types of patients, he added.

Only doctors should be appointed through Bangladesh Civil Service for the public health administration to be run efficiently, said Syed Abdul Hamid, professor at the Institute of Health Economics of the University of Dhaka.

Moreover, a "health service commission" should be formed similar to the Bangladesh Judicial Service Commission, which assess the suitability of persons for entry-level appointments as assistant judges or judicial magistrates, he added.

Liaquat Hossain, registrar of the BM&DC, suggested that the national policy for registering foreign doctors to practice in Bangladesh could be simplified.

Of the 1,34,000 doctors in Bangladesh, only 33,000 are in public service, said Abul Bashar Md Jamal, a former professor of surgery at Dhaka Medical College Hospital.

However, over 10,000 foreign students are studying in different public and private medical colleges here, he added.

Members of middle-income households are increasingly seeking healthcare services abroad, mainly for a lack of confidence and satisfaction, said DCCI President Ashraf Ahmed.

Only a few types of advanced treatments, such as robotic surgery, are available locally, he said.

The trend can be reversed by outperforming regional competition, ensuring customer satisfaction and enhancing quality of medical services, reliability and branding initiatives, he added.

"We need to be more open to foreign doctors, nurses, medical technologists and other specialists," opined Ahmed.​

 

[Saif]

Accessibility of healthcare in Bangladesh

What should be the government’s main role in health service delivery?

www.thedailystar.net

Accessibility of healthcare in Bangladesh

While the public health infrastructure in rural areas is considerable, this infrastructure needs an upgrade for maintaining quality PHC services. FILE PHOTO: STAR

Health is a fundamental human right and all citizens, regardless of their socio-economic status, have the right to enjoy optimal health. This article emphasises on the issue of equity in health systems. It underlines the importance of a comprehensive multisectoral approach to improve the health system. Though Bangladesh has an adequate health infrastructure, a cause for concern is the uncontrolled growth in the private health sector. The challenge is to regulate the mushrooming private sector from exploitative cost of treatment. The aim is to ensure that the disadvantaged and vulnerable population have better access to basic healthcare without the current back-breaking cost.

The government needs strengthen the Primary Health Care (PHC) system in partnership with the NGO sector. The NGOs lead the way in community-based initiatives and outreach at the grassroots. Utilising the private sector is also a priority but needs coordination and regulation. At the macroeconomic level, initiatives need to be undertaken that nudge the Bangladesh Ministry of Health and Family Welfare (MOHFW) towards reform and the adoption of new evidence-based practices that strengthen the health information system.

While the public health infrastructure in rural areas is considerable, this infrastructure needs an upgrade for maintaining quality PHC services. The quality of services remains a major issue, areas that need urgent attention is lack of investment in facilities. There is also an imbalance between availability and placement of human resources in the healthcare system. Frequent staffing mismatch in relation to demand-supply affect efficiency. The regulatory process to implement policies and laws is slow and often delayed in operation.

As Bangladesh becomes increasingly urban, the government's role in establishing a PHC infrastructure to deliver services in urban areas appears to be lackadaisical at best. Most commentators want to see the government considerably strengthen and fulfil its governance role in overseeing and monitoring aspects of health services. The government also needs to coordinate critical strategic developments, especially around the financing of this sector.

This begs the question, what should be the government's main role in health service delivery? Both the NGO and private sectors could be given specific tasks that are quantifiable to assess progress. They can develop guidelines and operational plans to help the ministry, donors, NGOs and the private sector work in a more coordinated manner.

Meanwhile, health experts in Bangladesh have felt a dire need for greater inter-ministry and intra-ministry coordination and collaboration. This is especially true between the Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP), and between the MOHFW and the Ministry of Local Government, Rural Development and Cooperatives (LGRD). With the latter being responsible for urban health, there is a need to decentralise the urban health system whereby city corporations can take primary responsibility for the health of urban people.

Some sector experts recommend a full-scale reform of the MOHFW with a modern structure and practices that make it fit to guide and govern the development of a modern PHC system in Bangladesh. Any serious changes within this ministry can only be brought about by decisions at the highest level of government. The latter, however, is mainly interested in wielding political power, rather than pushing bureaucratic reform and healthcare for the poorest.

The health system in Bangladesh needs dynamic leadership that is prepared to design and enforce evidence-based policies and programmes. The stewardship of the health system must have a strategic vision and determination to improve and strengthen both the public and private health sectors of the country. Equity must be the overarching guiding principle underpinning the health system.

A starting point for reform would be to ensure that a wider range of health personnel are included in health planning: women and men with an understanding and experience of PHC needs at community, union and upazila levels. People with requisite qualifications and expertise should be hired. Increasing representation of women in management and decision-making within the MOHFW should also be a priority, along with serious efforts to institutionalise gender equality. This would help improve understanding, thinking and practices across operational units and departments.

Similarly, there is a need to expand and develop the non-doctor health cadres to meet the basic needs of PHC. Such paramedics and non-medical professionals need training, and support for acting as the first-line service providers. They also need support for clear career paths and further personal growth. Nurses and medical technicians are two key professionals that require investment and augmentation by way of better training.

The current referral system at the primary care level also needs to be strengthened through capacity building. The current dynamic climate around healthcare in Bangladesh offers opportunities to explore the possibilities for more equitable financing mechanisms, especially for the poorest. A more inclusive and equitable health system will never be achieved if out-of-pocket expenditure on health is as high as 67 percent, as is now. This is pushing an estimated five million people into deeper poverty each year.

To facilitate strategic communication, policy advocacy to push the universal primary healthcare approach is needed. This can be achieved through regular engagement and convening with the senior leadership at all levels to support government efforts in formulation of Human Resources for Health (HRH) action plan. This will go a long way in implementation of the HRH strategy and action plan to bolster HRH production, mobilisation, deployment, and retention of human resources. The goal is to improve HRH competencies to deliver high quality health services.

If the expertise of personnel in the MOHFW, such as those at the Health Economics Unit of the DGHS, can be harnessed with field workers having exposure and understanding of ground realities, as well as innovators from the NGO and private sectors, the vision of an efficient healthcare system in Bangladesh can become a reality. For that to materialise, a strong leadership with necessary political will is essential.

Dr Md Khurshid Alam Hyder is public health specialist.​

 

[Saif]

Priorities for Bangladesh’s health sector

Crucial steps are needed in the health sector for lasting change.

www.thedailystar.net

Priorities for Bangladesh’s health sector
A healthcare reform roadmap for the interim government

VISUAL: HEALTH REFORM

The interim government has set a reform agenda for itself. In early September, six commissions were established to address reforms in various cross-cutting areas, including the constitution, electoral system, judiciary, anti-corruption, public administration, and police. The heads and other members of each commission were also named. In mid-October, four more commissions on health, media, labour, and women were formed. The formation of these commissions has been widely welcomed, with expectations that they will lead to meaningful and lasting changes in their respective areas.

The interim government has recently completed 100 days. As expected, the demand for a "roadmap" for the transfer of power through parliamentary elections is gaining momentum. There is no concrete announcement from the government yet, but some have suggested that elections could possibly be held by December 2025. This leaves about 400 days from now. Within this short timeframe, only a few substantive reforms can be carried out. A myriad of reforms is needed, but which ones will be prioritised? In my opinion, the commissions should focus on areas that are impactful and can be meaningfully completed within the government's tenure.

One important sector requiring urgent reform is health. Public health experts have been voicing their concerns and frustrations about the state of this sector. With the new opportunities created through the July movement, there is hope for significant changes in the health sector as well. I am confident that the relevant commission will thoroughly examine the issues paralysing this sector and propose impactful reforms. Below, I outline a few ideas which, if implemented, could help the country progress towards the national goal of universal health coverage (UHC).

Investing more in health

The government spends only 0.7 percent of GDP on health which is the second lowest globally. This is circumscribed by the government's inability to spend even this meagre amount. Good health cannot be achieved without good investment and optimum spending. The commission should recommend more money for the health sector, but more importantly, how to spend the additional money for achieving UHC.

Creating accountability

There is a demand for establishing an independent National Health Security Office (NHSO), which would enhance accountability by separating the service delivery function of the Ministry of Health and Family Welfare (MoHFW) from its purchasing function.

Free drugs for all

Bangladesh has one of the highest rates of out-of-pocket (OOP) expenses in healthcare, most of which are for drugs. Despite the country's near self-sufficiency in medicines due to a thriving pharmaceutical industry and government production, free drugs and contraceptives provided through community clinics are often in short supply. Introducing free drugs within a specified timeframe could significantly reduce OOP expenses and health inequities.

Restructuring healthcare administration

The current administration under the MoHFW is divided into several directorates (DGs), many of which are artificially and irrationally created. Primary health care (PHC)—encompassing basic curative, preventive, and promotive services—is delivered at the upazila level and below, up to community clinics. Unfortunately, PHC is deprioritised under the current system, with poorly defined roles, accountability, and financing. Establishing a separate directorate general for PHC would be beneficial. Additional DGs could be created for tertiary hospitals, medical education and research, drug administration, and other areas.

Strengthening community participation through youth engagement

The July movement demonstrated the value and potential of involving youth in development. Community engagement is a critical health system building block. Management committees exist for almost every facility, from district hospitals to community clinics, with civil society members included, at least on paper. Unfortunately, most of these committees are dysfunctional and have not met in years. Introducing youth representatives could revitalise these committees. Similarly, regulatory bodies like the Bangladesh Medical and Dental Council (BMDC) could benefit from youth participation.

Regulating the private healthcare sector

The private sector now caters to over half of the population's health needs but remains largely unregulated. Since the ordinance on private healthcare was promulgated in 1982, no significant updates have been made over the past 42 years. The interim government has an opportunity to address this by revisiting and modernising regulations.

Establishing a permanent health commission

The current commission cannot address all necessary reforms within the given timeframe. Once its work is complete, it would be prudent for the interim government to establish a high-powered, independent, and permanent health commission. This body would create a national health vision, tackle corruption, and plan and monitor progress towards UHC. One important task of the permanent commission could be revisiting the health policy recommendations made by Dr Zafrullah Chowdhury and colleagues in 1990, which emphasised decentralisation and remain highly relevant for Bangladesh.

Leaving a legacy through dengue management

The spread of dengue in Bangladesh is alarming. Despite this, definitive steps to contain this preventable menace are lacking. Kolkata has successfully managed dengue—why not us? Although the interim government is preoccupied with various challenges, focused attention on this issue could save hundreds of lives and alleviate the suffering of millions. The recent focus on treating those injured during the July movement is commendable. Similarly, successful dengue management could be a lasting legacy for the interim government.

Ahmed Mushtaque Raza Chowdhury is convener of Bangladesh Health Watch and founding dean of the James P Grant School of Public Health.​

 

[Saif]

Reform for equitable primary health care

New Age, a Dhaka-based leading English language daily newspaper, is a major source of news of Bangladesh and international affairs

www.newagebd.net

Reform for equitable primary health care
29 November, 2024, 00:00

A health commission incorporating public health managers and local government institutions could manage tax funds to procure and regulate healthcare quality and coverage, writes Abu Muhammad Zakir Hussain

REFORMS are expected to address problems in quality and quantity coverage or target attainment or both. Problems may be due to poor planning, budgeting, management and leadership skills, including weak supervision for quality and poor monitoring for quantity. Good management should consider human resource development and management; the management of medicine, logistics, technology and information; physical structures; and services. One fundamental aim is to ‘leave no one behind’, addressing equity, the fulfilment of health needs of all, which needs appropriate and adequate financing.

Financing for universal coverage

PUBLIC tax-based Beveridge model, which allows people to buy private insurance, funds health care in many western countries. Besides public hospitals, governments recruit private hospitals as well, when necessary. Primary health care is given through individual general practitioners or groups of such people, contracted by local public bodies. Social health insurance is an approach where premiums are paid by the management and the staff. For the jobless, premiums are covered by public taxes. National health insurance is universal health coverage, funded by pooled insurance premiums but managed by contracted organisations.

Out-of-pocket payment is the most regressive and inefficient method of healthcare procurement as it is not based on informed decision and has no negotiating power. The purchase of care by a single purchaser chosen from multiple providers offers price negotiating powers to the purchaser, besides imposing favourable purchasing conditions that benefit service receivers. A single management entity accrues a smaller administrative cost.

The Bangladesh government also organises healthcare services through public taxes. But the tax base is inadequate for universal health coverage, especially in urban areas. To address this problem partly, local government institutions must allocate at least 15 per cent of their budget for health care. Additional taxes, eg, sin tax must be channelled to health care. Two per cent tax should be levied on health services on certain foods, drinks and private vehicles, which have adverse health implications. Fund might also come from co-payment from patients through registration fees for all, at all levels, as per the economic status of service seekers, which would also prevent the moral hazard. A portion of the corporate social responsibility from entrepreneurs should also be realised for health services. The finance ministry should fund local government institutions directly to enable them to undertake their health responsibilities.

A health commission with national, divisional, district and upazila offices, incorporating public health sector managers and local government institutions may be entrusted to manage the tax fund to procure and regulate healthcare quality and coverage by the public sector and the private sector. The combined entity should also participate in planning, budgeting, monitoring, review and public hearing at all levels.

Healthcare financing should be needs-based and the internal rate of return should dictate the priority of budgeting. Budget heads should be (1) human resources, its management and development, (2) planning and budgeting, (3) financing and accounting, (4) public communication, (5) knowledge and information management, (6) service and programme management, including clinical care, (7) incentive, (8) medicine, (9) vehicles, machines, supplies and equipment, (10) technology and innovation, ((11) sustainable and user-friendly physical structure, (12) renovation, maintenance and repairs, (13) stakeholder engagement and (14) operational costs, including transport costs for supervisory travel.

Addressing in-service inefficiency

ON THE fringe. three categories of service providers have been entrusted with providing primary healthcare services. But their services are not complementary. The community health care providers are wrongly supposed to provide alone all sorts of stationery services at community clinics which overburdens them. The field staff may be given the same responsibilities while dividing their target population equally. This will enable the catering of more necessary services at the entry, the community clinics. A task group should develop an efficient terms-of-reference for them.

Operational budget for these fringe staff is nominal and fixed for all weathers, distances and conditions which compels the poorly paid staff to spend additional money on travel especially in hard-to-reach areas. Community health care providers pay electric bills for community clinics from their salary. Although 65 local influential form community groups and community support groups to support community health care providers and bear the coast of repairs and maintenance of community clinics, they are hard to find around. They are also alleged to demand medicine from community clinics, which comes free. It is warranted that the community support groups should be abolished. It is also warranted that the operational costs for community clinics should be sent to the upazila health and family planning officers on a yearly basis.

Planning flaws at unions and solutions

THE union health sub-centres, 1,260 in number, are the most inefficiently managed health care units in the sector. All of them should have adequate office space for an assistant health inspector and other required officials, who will provide outpatient-based preventive, promotive and limited curative care, primary diagnostic services and normal delivery services. They will be given through medical officers — two although WHO recommendations 15 — a medical assistant, a midwife, a medical technologist, a pharmacist, a guard and a support staff. All of them, except the last two, should have separate office/clinic and residential arrangements as per entitlement. The last two officials will be selected from among local people.

Assistant health inspectors and medical officers should also function as supervisors for community clinics. Besides, medical officers should also provide consultation services for waiting patients enlisted with the community clinics. Adequate travel and food allowances should be allocated for them to cover travel to distant clinics. A 20 per cent top-up needs to be added to the salaries of medical officers and 10 per cent for other non-local staff to attract them to stay in unions. No private practice or collaboration with the private sector by them should be allowed. If the conditions are not abided by public-sector service providers, local general practitioners or these people and providers of other categories as a team with due skill mix may be contracted in or out.

Contracting the general practitioners will have to be needs-based, efficient, based on the number of people to be served and the illnesses to be treated by complexity. The qualifications and readiness of general practitioners and their chambers should be assessed for contracting. What additional support, including training and logistics, will be required by the general practitioners to be contracted will have to be assessed before contracting. Information is also required if chambers of general practitioners will need to be renovated or supported with logistics. A law will be required for these sorts of contracting. The process of buying services from the private sector, including general practitioner services, should be left with the divisional level, which will be participated in by the upazila and district level management and public bodies concerned.

A public-private partnership scheme may be thought of, conversely, where general practitioners or groups of general practitioners will finance the construction or renovation of union health sub-centre complexes on government land (concession), operate and transfer the sub-centres after the contract period is over, to the government. The government may then again invite all local general practitioners to submit bids which will then require a lower bid amount.

At this point, we advise the government to reign in the infrastructural duplication between family planning and health departments. Both the departments have medical officers and medical assistants providing maternal and child health services in unions. To prevent duplication, family planning personnel should cater the same services from those 3,300 unions where there are no health department facilities.

Equitability of clinical, public health services

UPAZILA public health units will be responsible for planning, budgeting and implementation of locally planned activities and nationally bestowed programmes, undertake personnel management and the management of logistics, physical facilities, information, training, monitoring, review and supervision and submit performance and expenditure reports for all the three primary healthcare tiers. Public engagement will be ensured at each level in planning, budgeting, review, public hearing and community awareness.

The upazila clinical and diagnostic care may be tagged to district hospitals, where upazila health and family planning officers will have no role. Upazila health and family planning officers will act as field, community clinic and union-level top planners, implementers, reviewers, supervisers and monitors. It would include disease prevention and control activities through disease surveillance and vaccination. They would also assess and address patient complaints, pharmacovigilance, polypharmacy, induced care, patient and provider safety, and adverse effects of vaccines, service coverage, health communication, staff attendance in all kinds of health facilities, all health-related procurement, all health management information and the regulation of both the public and the private sector health facilities in upazilas and unions.

They should be supported by a medical officer for disease control and prevention, a nutritionist, a health-related communications officer, a management information officer, a logistics officer and an accountant. A mirror image functioning is also warranted at district and divisional levels for primary healthcare services. Local level planning, both activities and budget, may be developed within a given ceiling at unions, upazilas, districts and divisions.

The family planning department has maternal and child welfare centres in districts and upazilas and in a few unions. These are duplications. Maternal and child welfare centres are not at the centre of patients’ interest as district hospitals and upazila health complexes with expert service providers are available nearby. Maternal and child welfare centres should come under a unified system of care under the health department.

Resource management

Human resources: Allocation for adequate and appropriate human resources with right kind of service provider mix for a given epidemiological profile at a given location should be a priority. The World Health Organisation suggests 4.45 service providers as a minimum per 1,000 population to attain Sustainable Development Goal 3. The organisation also suggests a skill-mix ratio of 1:3:5 physician: nurses: paramedics. The WHO proposition would lead to a staggering estimate. We suggest that our efforts are driven towards recruitment along this line, starting with 10 per cent of the estimates now.

We recommended the provision of technical personnel for urban areas from the ministry of health and family welfare and administrative and support staff from the local government, rural development and cooperatives ministry. This should be the practice for urban primary health care. Additional fund for urban primary health care should come to local government institutions from the finance ministry directly. Planning, budgeting and implementation review of urban primary health care should be the combined responsibility of local government institutions, health and family welfare ministry and the local government, rural development and cooperatives ministry.

Line/programme directors and their assistants will have to be deployed based on their proved experience, educational qualification and leadership quality and should be selected through interviews by a board to be constituted of five superior officers and guest selectors who have required qualifications in the relevant field and are well known for their honesty.

Logistics: Human resources and logistics should be complementary to each other and based on local needs. Appropriate skills must be ensured to handle the allocated logistics before procurement. Assessment of local needs should be a requisite for any deployment and procurement. An equitable availability of resources could address all the health needs of the population on every location. Logistic support for urban areas should come from the health and family welfare ministry through its divisional, district and upazila primary healthcare offices.

Additional health facility: If need be, private hospitals, clinics and diagnostic centres might also be contracted when warranted. The situations for such contracting will be clear in writing, eg, in emergency or overloaded situation. The contracting conditions, i., payment conditions should be clear. The conditions should be reflected in their licensing conditions.

Improving quality and coverage

Medicine: Medicine is the most important commodity that service seekers appreciate. The existent list should be reviewed and updated every five years. There should never be any incidence of stockout of enlisted medicines. It is necessary that use of the medicine given at community, union and upazila levels is monitored and the quality of prescription is supervised by clinical experts. Fund for medicine in urban areas should come from local government institutions and the finance ministry should top this to ensure the remaining fund from government revenue.

Technology: A table of necessary equipment, furniture, vehicle, supplies and the other relevant tools should be available at three tiers of primary health care and at the district and the divisional offices relevant for urban primary health care. This list should be reviewed and updated every five years. The latest available technology, eg, software-based automated data recording and transmission, telemedicine, e-medicine etc should be ensured inasmuch as possible that would ensure efficiency.

Physical facilities: Physical facilities should be distributed equitably with efficient designs. Adequate and appropriate offices, residence and clinic spaces should be available to relevant officials as per eligibility of the positions that either exist now or will be created in future. Four-room community clinic archetype facilities should be developed throughout the country. But the number of such facilities should be based on population dispersal and density. While in urban areas, one such facility may suffice for 50,000 people, in hard-to-reach areas, one may be necessary for 2,000 to 3,000 people. Health facilities owned by other sectors, usually in urban areas, should be checked for their use and, if necessary, a corner of such facilities may be used as a community clinic or equivalent to a union health facility.

A continuous availability of electricity and safe water should also be ensured by the government at all tiers. It is also necessary to ensure that the health facilities and their basic amenities should ensure sustainability and disaster adaptability. Every health facility/office should be comfortable for officials and for waiting service seekers, or patient attendants, suitable for different ages and sex. At least two cleaners should be recruited at union health facility, and one at each community clinic, selected through contracting, to be held at divisional level in the presence of the relevant civil surgeon, urban health and family planning officers and one local public representative. In urban areas, additional physical facilities should be built by the local government institutions. Any shortfall in this regard should be met up by the finance ministry.

Community engagement: Since the engagement of the community has been suggested, adequate fund — budget for snacks and tea for meetings, for example — should be needed to bring them into the system. Every health facility should have a public management body composed of upazila and union chair as per relevance and local healthcare providers. These should replace the older ones.

Orientation, training and continuous education: The personnel promoted to a position should always be given training to suit the newly assumed position. The orientation and training should be preceded with a need assessment exercise and the training or orientation curriculum be organized according to its findings. As part of capacity build-up, seminars should be organised at union and upazila levels to be participated by the community and union level workers every month. Community workers would bring complex cases to the discussion table, for solution or referral by attending medical officers.

Patient-centred services: Every healthcare worker at upazilas, union and community levels should know of the various quality indicators and parameters. Induction and refresher trainings should be organised for them, that should emphasis on service quality and competency.

Supervision: Supervision has to be done through some structured protocol and job-related tools. Clinical audits would be warranted for medical prescription.

Monitoring and supervision: Monitoring might be conducted online. It has to be continuous or episodic, according to the applicable tier. A standing monitoring framework should be developed and used. Dedicated monitors may be recruited from among retired officials, the private sector or private individuals with required experiences. Selection would be through an interview board composed of officers. Their contracting should be based on an agreed terms-of-reference.

Various groups of monitors should be deployed for different purposes, ie, for the monitoring of the fulfilment of contracting conditions in various fronts, eg, covenant on free services to 10 per cent of the poor service recipients in private hospitals; the submission of service-related information by private service providers and hospitals and other functions mentioned. The monitoring teams or groups would be supervised and monitored by the urban health and family planning officers, civil surgeons and divisional directors. Adequate allowances but only for supervisory and monitoring and, in rare cases, travels should be ensured for supervisers of upazila and union levels.

Other management functions: Management decision should be evidence-based. This is a culture that needs to be developed fast. Managers should learn how to manage programmes, personnel, finance, logistics, information technology and software and contracts. Healthcare management should be gender- and poverty-sensitive and emphasise improving community awareness on family planning, adolescent care, disease prevention and nutrition improvement and other services mentioned. A government order should be in order in this regard. Management and review meetings should be supported with adequate logistics and fund.

Regulation of clinical and diagnostic services: Health and performance related information should cover both the public and the private sector. Urban health and family planning officers, civil surgeons and divisional directors should be entrusted to monitor, not supervise, licensing conditions only for the private sector and other performances and services, mentioned. Leaving these responsibilities to the hospital management will ensue a conflict of interests.

Innovation, change and learning: No de novo action or recommendation that brings in any change in the system should be adopted ever, without unbiased piloting and job analysis. The condition of efficiency and reduction in price and cost in services delivery should be ensured. The catchment area of each facility of all tiers should be mapped which would also help to line up the referral system. Every family and its members should be registered with the help of a unique number. Community-based birth, death and marriage registration by age and sex should be a priority to assess the impact of the healthcare interventions and goal attainment.

Referral and transport: Strong emergency and critical care services should be ensured at referred sites. High-level health facilities should also be able to provide care for complicated non-communicable diseases as per competence. Health services should be available round the clock in referred facilities. A penalty fee should be applied to those who seek care at higher levels without referral. Ambulances may be of different types based on the topography of a location, eg, boats, three-wheelers, pedalled four-wheelers, etc and should be free for every registered family. Except motor ambulances, other types may be given to local entrepreneurs to run and maintain, conditional to their use as an ambulance, when necessary, on a priority basis. Public bodies, linked to the health facilities, may be entrusted to monitor their use.

Incentive: The health sector should develop a culture of incentivising good performance annually. The incentive may be monetary or non-monetary. Monetary incentives may be given as a top-up of the salary. It may also be recognition given at public meetings at district and national levels. Contrarily, non-performance should make a staff liable to punitive action, eg, the degrading of salary by one or two steps. Transfers should never be considered a punishment.

Abu Muhammad Zakir Hussain is a former director, Primary Health Care and Disease Control, former director of IEDCR, DGHS, former regional adviser of SEARO, WHO and former staff consultant, Asian Development Bank, Bangladesh.​

 

[Saif]

Separated conjoined twins leave BSMMU for home

The authorities of Bangabandhu Sheikh Mujib Medical University on Sunday released conjoined twins Nuha and Naba, who were separated successfully through a series of critical surgeries...

www.newagebd.net

Separated conjoined twins leave BSMMU for home
Staff Correspondent 26 November, 2024, 01:14

The authorities of Bangabandhu Sheikh Mujib Medical University release twins Nuha and Naba from the BSMMU in Dhaka on Sunday after they were separated successfully through a series of critical surgeries. | Press release

The authorities of Bangabandhu Sheikh Mujib Medical University on Sunday released conjoined twins Nuha and Naba, who were separated successfully through a series of critical surgeries.

As a result of combined efforts of the various departments’ of the BSMMU, they were released after 2 years, 7 months, and 20 days through five successful surgeries, said a press release on Monday.

The BSMMU academic pro-vice-chancellor Professor Dr Md Shahinul Alam, pro-VC for administration Professor Dr Md Abul Kalam Azad, pro-VC for research and development Professor Dr Md Mujibur Rahman Hawlader, treasurer Professor Dr Nahrin Akhter, registrar Professor Dr Md Nazrul Islam, director for hospital Brigadier General Dr Md Rezaur Rahman, paediatric surgery department professor Dr AKM Zahid Hossain, among others, were present on the occasion at the BSMMU in Dhaka.

Born on March 21, 2022, and admitted to the BSMMU on April 4, the daughters of Nasrin Akhter and

Alamgir Hossain, residents of Shibram Kanthalbari village in Kurigram Sadar, Nuha and Naba, were conjoined at the back and bottom.

Neurosurgeons led by Professor Dr Mohammad Hossain, paediatric surgeons led by Professor Dr AKM Zahid Hossain, anaesthesiologists, and specialists from various departments, doctors, and nurses had worked to treat Nuha and Naba.

The university administration had also been keeping a close eye on them and had provided necessary assistance.

So far, 3 pairs of conjoined babies have been separated at the BSMMU, and preparations are underway to separate another pair of conjoined twins, added the press release.​

 

[Saif]

Stop unethical practices in health sector

Over diagnosis through excessive tests and unnecessary medication prescribed by some doctors is a common complaint. It is widely alleged that these doctors prescribe many redundant tests and costly medicines more to oblige to diagnosis centres and medicine manufacturers than to benefit patients in

thefinancialexpress.com.bd

Stop unethical practices in health sector
Atiqul Kabir Tuhin
Published :
Nov 30, 2024 20:58
Updated :
Nov 30, 2024 20:58

Over diagnosis through excessive tests and unnecessary medication prescribed by some doctors is a common complaint. It is widely alleged that these doctors prescribe many redundant tests and costly medicines more to oblige to diagnosis centres and medicine manufacturers than to benefit patients in exchange for gifts or commissions.

A swarm of pharmaceutical representatives can be found crowding hospitals, clinics, and other medical facilities, often gathering in front of doctors' rooms despite long queues of patients. They even dog patients as they leave doctors' chambers to check or take photograph of prescriptions - seemingly to verify whether their influence on the doctors is yielding results.

This is a manifestation of how aggressive the ever increasing numbers of medical representatives has become in pushing the sales of their products and pressuring doctors to prescribe them. Many of them are high-salaried with attractive perk and packages. They are under obligation to fulfil their district or zonal sale quota. The contribution of these pharmaceutical salesmen to healthcare is not clear. Often the pressure and persuasion to get the prescription written their way take the shape of inducement, with gifts offered in both tangible and intangible forms.

Owing to intense competition most drug companies give more attention to promotional activities than to research and quality control. However, it is beyond question that Bangladesh has drug producers who are internationally known for maintaining high standards. But even their position will be adversely affected if the dishonest elements are allowed to carry on with their business.

The patients have to bear the brunt of it all as treatment gets costlier. What is more, substandard drugs are marketed and prescribed, thanks to the manufacturer-salesman-physician nexus. Reports carried by the media from time to time indicate that there are fake companies engaged in manufacturing spurious drugs that can cause irreparable damage to the human body. Allegation has it that some of doctors prescribe substandard medicines to patients in exchange for valuable gifts.Because of unscrupulous conduct of a few, the practitioners of the noble profession are suffering from an image crisis.

The activities of the low quality drug producers and the dishonest doctors are a direct threat to public health. Their fraudulent practices have made the people in general- who do not have access to good treatment facilities-even more helpless.

Of late the Ministry of Health and Family Welfare has banned pharmaceutical company representatives from hospital premises as part of its plan to improve hospital management. This is a praiseworthy decision. But some of the doctors exhaust their time and energy attending private clinics which leaves them with too little time for government hospitals which are their main responsibility and for which they are paid out of tax payers' money. Many, therefore, believe that merely barring drug company representatives from hospital premises is unlikely to yield the desired outcome without stricter enforcement of rules and regulations.Recommendations by some experts include introducing the system of mentioning generic names in the prescription to stop aggressive marketing of pharmaceutical companies.

But above all, a lot more are expected from the doctors. They are in a profession where the slightest deviation from ethical standards means great suffering to the people. They must not forget that human life is more valuable than those valuable gifts. The doctors may follow some finest examples of dedication on the part of some revered members of their own profession, in which case no regulating body or external agency will be required to put them on track.​

 

[Saif]

SWAp’s effectiveness for Bangladesh’s health sector

Exploring alternatives to SWAp in Bangladesh’s health sector is a pressing discussion.

www.thedailystar.net

SWAp’s effectiveness for Bangladesh’s health sector

There is an urgent need for a comprehensive overhaul of Bangladesh’s health system. PHOTO: ORCHID CHAKMA

UHC Forum is a coalition of health sector practitioners, advocates and academics dedicated to a strategic push on the universal health coverage (UHC) agenda. UHC Forum Health Debates is one of its flagship activities carried out in partnership with the Power and Participation Research Centre (PPRC). This op-ed is derived from the health debate on the Sector Wide Approach (SWAp) modality adopted for health sector planning and implementation since 1998.

The Sector-Wide Approach (SWAp), introduced in Bangladesh in the late 1990s, sought to improve the health sector by uniting the efforts of government, donors, and NGOs under a unified national plan. The strategy proved effective in several areas—enhancing coordination, reducing duplication and ensuring more efficient use of resources. It fostered a government-led approach, empowering the Ministry of Health and Family Welfare (MOHFW) to take ownership of health programmes and make decisions that align with national priorities. The pooling of funds from various donors simplified financial management and allowed for a more harmonised implementation of health services. Moreover, SWAp contributed to capacity building by strengthening institutional frameworks, enhancing local expertise, and promoting evidence-based policymaking. However, SWAp also faced substantial challenges. Key stakeholders, such as the private sector and the Ministry of Local Government, Rural Development and Co-operatives, were excluded from planning processes, limiting its scope and effectiveness. Centralised decision-making created bureaucratic delays, slowing programme implementation. Additionally, larger donors, such as the World Bank, exerted disproportionate influence, at times, prioritising global agendas over local needs. The risk of mismanagement also grew as pooled funding lacked adequate oversight and accountability mechanisms.

To address these shortcomings, I advocate transitioning to a new model, termed Sector-Wide Inclusive Planning and Evaluation (SWIPE) to integrate private sector actors, and decentralised planning and budgeting to the district level.-----Dr Abu Jamil Faisel is a public health expert.

There is an urgent need for a comprehensive overhaul of Bangladesh's health system. The existing dual-budget structure, which separates operating and development budgets, lacks coherence and prevents effective symbiosis between routine operational costs (staff salaries, fuel and utilities, repair and maintenance, travel, etc), and development costs for new infrastructure development and health service improvements.

The Health Population and Nutrition Sector Program (HPNSP) under SWAp brought advantages such as faster decision-making, delegation of authority to health managers, health workforce capacity building, improved coordination, monitoring and supervision. However, critical issues remain unresolved. Universal health coverage, elimination of healthcare discrimination, substantial improvements in healthcare quality, avoidance of verticalisation in healthcare delivery, and the reduction of out-of-pocket expenses continue to elude the system.

The fragmented and verticalised delivery of healthcare services limits integration and patient-centred care. Bangladesh's age-old health systems have many inherent defects. The HPNSP or any similar prescription will not remedy it. Bangladesh urgently needs a serious and massive overhaul of its health systems in overall structure and processes to enable it effectively meeting the population's health needs through integrated primary healthcare, sustainable universal health coverage, health sustainable development goals (SDGs), and client satisfaction.----Professor Dr Abul Kalam Azad is former director general of health services.

Exploring alternatives to SWAp in Bangladesh's health sector is a pressing discussion, given the challenges faced in achieving sustainable programme outcomes. One of the critical considerations is whether it is time to pivot back to the original revenue-based system or implement a hybrid model that leverages the strengths of both approaches. The revenue-based system, rooted in direct budget allocations, could potentially offer more flexibility and control for domestic health programme funding. Ensuring financial sustainability remains a key focus as stakeholders debate these alternatives. The path forward must address how Bangladesh can maintain or enhance programme effectiveness without depending heavily on SWAp, which, while comprehensive, often leads to dependency on external funding and complex coordination issues.

A well-articulated roadmap is essential for transitioning from SWAp to a new or modified system that prioritises local ownership and resilience. The government must lead with robust policy frameworks, while development partners can assist with technical expertise, transitional funding and access to global best practices.
-----Dr Md Aminul Hasan is a health system expert.

SWAp has played a pivotal role in shaping Bangladesh's health sector, improving coordination, ownership, and resource management. However, its limitations, including rigidity, donor dependency, and exclusion of key stakeholders, necessitate a reimagined approach.

Hybrid models, public-private partnerships, national health insurance schemes, and decentralised planning offer pathways to address these challenges. As Bangladesh works toward achieving universal health coverage and the health-related Sustainable Development Goals by 2030, a collaborative, inclusive, and forward-looking strategy will be essential.

Health system reform requires technical solutions, strong political will, and a commitment to equity and sustainability. While reform is essential, political will and strategic intent are critical in driving meaningful health sector reform. Bangladesh's health system requires a clear focus on necessary and actionable reforms. The challenge lies in crafting precise recommendations and mobilising the political leadership needed to implement them effectively. Without sharp, actionable strategies, opportunities for impactful reform may be missed. It is essential to foster collaborative efforts across stakeholders to address systemic gaps and meet the health aspirations of the population.-----Hossain Zillur Rahman is executive chairman of Power and Participation Research Centre (PPRC) and convener of universal health coverage (UHC) Forum.​

 

[Saif]

Three examples of badly-run public hospitals

Prioritise recruitment and efficient management

www.thedailystar.net

Three examples of badly-run public hospitals
Prioritise recruitment and efficient management

We are appalled by the findings of a report by The Daily Star on three hospitals run by the Dhaka South City Corporation (DSCC), highlighting an acute shortage of staff and underutilised facilities, which cause unnecessary suffering for patients. In a city where accessible healthcare is increasingly out of reach for ordinary citizens, it is unacceptable that these public hospitals offer substandard services. This is a direct result of neglect and apathy from the Directorate General of Health Services (DGHS) and the Ministry of Health, a situation that has worsened over decades.

These hospitals are vital for low-income and lower-middle-class communities, as they offer subsidised healthcare. However, patients are forced to wait for hours due to the severe shortage of doctors, nurses, and other essential staff. As patient numbers rise, one hospital operates with half the required manpower. For instance, Mohanagar General Hospital, which installed ICU units and high-flow oxygen equipment during the Covid pandemic, cannot use them because there are no trained personnel. The surgery department has been non-functional since 2015, and high-dependency unit (HDU) beds installed in 2021 remain unused. Many posts are vacant, further crippling the hospital's ability to function.

A similar manpower crisis exists at Dhaka Metropolitan Children's Hospital, where the paediatric surgery department has been inactive since 2012, and 40 of the 100 beds remain unused. Nazirabazar Matri Sadan is also grappling with a shortage of doctors and essential medicines.

In all three hospitals, staff are spread too thin, leaving patients without the necessary medical care. Despite repeated official letters sent to the health ministry and DGHS, no action has been taken. These hospitals reflect the dysfunction plaguing public healthcare across the country, with severe staff shortages making them nearly non-functional. The DGHS and health ministry have ignored the needs of these hospitals for years. Why has this been allowed to continue? What happened to the allocated budgets? If they were insufficient, why wasn't more funding provided?

The healthcare system, especially in public hospitals, continues to be marked by gross inadequacies. And the conditions at these hospitals are a perfect example of that. We urge the interim government to immediately investigate these issues and take corrective action. The recruitment of medical personnel should be a top priority, along with the training of staff to operate specialised equipment. Meanwhile, strict management oversight is necessary to ensure that no resources go underutilised. Access to healthcare is a basic right, and the government must restore functionality to these hospitals as soon as possible.​

 

[Saif]

A wake-up call for Bangladesh to reform its healthcare

India’s visa restrictions on Bangladeshi nationals, while initially perceived as a barrier, could serve as a wake-up call for Bangladesh to strengthen its healthcare system and regain the confidence of its patients.

www.thedailystar.net

A wake-up call for Bangladesh to reform its healthcare

India's visa restrictions on Bangladeshi nationals, while initially perceived as a barrier, could serve as a wake-up call for Bangladesh to strengthen its healthcare system and regain the confidence of its patients. With as many as 3.5 lakh Bangladeshis seeking medical treatment in India annually, the restrictions offer a unique chance for local providers to address systemic issues and retain patients who would otherwise travel abroad. Experts urge Bangladesh's health authorities to rise to the occasion and rebuild trust among its citizens.

This systemic overhaul is especially urgent given the personal struggles of individuals like Sanjida (not a real name), a Mirpur resident, who faced a critical health challenge in 2020. After undergoing surgery at Dhaka's Green Life Hospital to remove an ovarian cyst, her biopsy reports delivered devastating news: she had cancer. Advised to start chemotherapy, she followed her oncologist's recommendation for additional tests, only to realise that the tests she had completed earlier had been overlooked. It became apparent that her doctor's approach was perfunctory at best. Terrified and disillusioned, her family decided to seek treatment abroad.

Sanjida travelled to Mumbai's Tata Memorial Hospital, where doctors reviewed her medical history and conducted fresh diagnostics. They concluded that the surgery in Dhaka had been incorrect. With an appropriate operation, her cancer could have been addressed earlier. After another surgery and three rounds of chemotherapy in Mumbai, she returned to Dhaka. Today, she takes regular medication and visits India every six months for follow-ups. Reflecting on her ordeal, Sanjida laments the inattentiveness and unprofessionalism she experienced in Bangladesh's medical system, contrasting it with the care she received in India.

"Even with the high cost of living and transportation, Indian hospitals are more affordable and trustworthy than those in Dhaka," she said.

Sanjida's story is not unique. Retired government officer Shahidur Rahman, 69, sought cardiac care in 2019 after experiencing chest pain. Diagnosed with three heart blockages at two leading hospitals in Dhaka, he was advised to undergo stent placement. Sceptical, Shahidur travelled to Bengaluru to consult Dr Devi Shetty, a renowned cardiologist. Additional tests revealed no blockages, and he was prescribed medication instead. Since then, Shahidur has lived without chest pain and has lost faith in Bangladeshi healthcare providers.

A CRISIS OF CONFIDENCE

The healthcare industry in Bangladesh is dominated by the private sector, which has seen significant growth in tertiary hospitals and diagnostic centres.

The stories of Sanjida and Shahidur are emblematic of a deeper issue -- a healthcare system grappling with a crisis of trust. On the surface, Bangladesh's healthcare infrastructure appears robust. The country boasts 566 public hospitals, which include 37 state-run medical colleges providing hospital services, and around 5,000 private medical facilities. Private sector investment has led to the growth of tertiary hospitals and diagnostic centres, creating an illusion of progress. Yet, beneath the numbers lies a stark reality: many Bangladeshis still feel compelled to seek treatment abroad, believing that local facilities cannot meet their needs.

The reasons for this exodus are manifold. Experts point to rushed consultations, diagnostic errors, steep treatment costs, and a perceived indifference from medical professionals. Many patients complain of being treated like mere numbers -- hurried through appointments with little to no time for questions, clarification, or reassurance. This lack of a personal touch often proves just as alienating as the more tangible deficiencies. In contrast, some patients argue, India has built a reputation for offering not only medical expertise but also a level of care that feels holistic and humane.

Bangladeshi patients primarily travel to India for cardiology (14 percent), oncology (13 percent), gastroenterology (11 percent) and other complex issues, according to a 2023 study published by the National Library of Medicine. The same report found that India's healthcare infrastructure -- including skilled specialists and comprehensive follow-up care -- attracts an estimated 3 lakh to 3.5 lakh Bangladeshi patients annually. Kolkata, Chennai, Vellore, and Mumbai are the most frequented destinations.

"Bangladesh's healthcare system lacks sufficient skilled physicians and technologists, especially for complex diseases like cancer and organ transplants," said Rumana Huque, a health economist and professor at Dhaka University. "While we have capable doctors, they are overstretched and unable to provide the level of care patients expect."

Bangladeshis spend over $5 billion annually on medical treatment abroad, with India and Thailand as top destinations. Yet, Huque emphasised, many of these expenses could be curtailed if local healthcare providers improved their practices.

Tamzeed Ahmed, a clinical and interventional cardiology specialist at Evercare Hospitals Dhaka, observed that the past two to three months have seen an uptick in patients seeking consultations in India. This trend persists despite India's visa restrictions.

Meanwhile, Md Esam Ebne Yousuf Siddique, chief operating officer of Square Hospitals, highlighted the uncertainty surrounding the long-term impact of these restrictions. He noted that, over the last three years, Square Hospitals has not recorded any significant fluctuation in patient numbers, suggesting that the effects of visa restrictions on local healthcare utilisation may still be unfolding.

SYSTEMIC CHALLENGES AND PATIENT DISSATISFACTION

Patients often cite Bangladesh's under-resourced diagnostic facilities and dismissive medical culture as significant deterrents. Even private hospitals equipped with advanced technology struggle due to a lack of trained personnel to operate it effectively.

Syed Abdul Hamid, a professor at the Institute of Health Economics, Dhaka University, pointed out that poor diagnostic accuracy, inadequate consultation time, and indifferent behaviour from medical professionals erode trust. "Doctors in India excel in patient communication, providing detailed explanations and emotional support. This starkly contrasts with the rushed consultations typical in Bangladesh," he said.

During the Covid-19 pandemic, when international travel was restricted, Bangladeshi patients had no choice but to rely on local healthcare providers. Many received quality care, proving that the country's medical system can deliver when adequately supported. However, the lasting perception of neglect and inefficiency continues to push patients abroad.

CALLS FOR REFORM

Industry leaders acknowledge the gaps. AM Shamim, founder of Labaid Hospital, admitted that while Bangladeshi doctors are technically skilled, they must improve their bedside manner and spend more time with patients. "We have the capacity to treat complex illnesses, but patient trust is eroded by behaviour and insufficient consultation time," he said.

Similarly, Prof Md Moazzem Hossain of Aichi Medical Group called for systemic reform. "We need skilled technologists, uniform cost structures, and better regulation from the Directorate General of Health Services," he said. "Patients need to feel confident in their care, and hospitals must prioritise patient-centred service over immediate profits."

India's visa restrictions, while inconvenient, offer Bangladesh a rare opportunity to reflect and reform. It's a chance to rebuild confidence, invest in patient-centred care, and address the systemic flaws that push patients abroad. Without addressing these issues, experts warn, the country risks perpetuating a reliance on foreign medical services -- a dependency both costly and avoidable.​

 

[Saif]

Looking back 2024: Corruption, poor service keep hurting health sector

Quality healthcare for people remained elusive throughout 2024 while the sector saw massive allegations of corruption and maltreatment in the first half of the year.

www.newagebd.net

Looking back 2024: Corruption, poor service keep hurting health sector
Rashad Ahamad 05 January, 2025, 00:19

Quality healthcare for people remained elusive throughout 2024 while the sector saw massive allegations of corruption and maltreatment in the first half of the year.

The second half of the past year that ended Tuesday was marked by massive demonstrations by health sector employees to press home their demands after the fall of Awami League government on August 5.

Health rights activists and patients said that no significant improvement was noticed in the health sector in the past year as people suffered to get services.

They demanded health sector’s legal reform, a pragmatic master plan, transparency, accountability and adequate budgetary allocation for the improvement of the sector.

Dhaka University’s Institute of Health Economics professor Syed Abdul Hamid said that the student-led July movement in 2024 created a huge scope for improvement, but still there was no visible impact.

He emphasised the health sector reform commission’s recommendation, legal reform, patients’ safety and service providers’ security for the development of the sector.

At the beginning of the year, a number of patients, including children, had died in alleged maltreatment that compelled the health department to conduct nationwide drives.

The Directorate General of Health Services closed on various grounds at least 1,600 hospitals and clinics in a month-long drive.

Sector people said that the healthcare institutions which were shut for different unlawful activities during the drive were back to operation again.

Runa Khatun, a resident of Sadullapur in Gaibandha, said that getting physician in a district- or upazila-level government hospital was very rare in her district while the physician was available in private medical facilities.

Janaastha Sangram Parishad convener Faizul Hakim Lala said that the ousting of a regime was a remarkable achievement in 2024 that created hope among the people for a new journey.

He urged for removing discrimination among the villagers and the city dwellers.

He also urged to ensure the presence of physicians at work stations and regular posting denying any political or other influences.

He said that the authorities must evaluate merit and qualification in posting.

He suggested decentralising the healthcare and producing adequate number of healthcare givers like doctors, nurses and technicians.

Public health campaigner Lenin Choudhury said that the DGHS was the first department which was formed after the independence of the country, but the department failed to place a comprehensive plan for the people’s health.

‘The DGHS is doing everything on an ad hoc basis,’ he said, adding that they needed a comprehensive plan and its proper implementation.

He said that a healthcare system sustained on five pillars, including promotive, curative, rehabilitative and palliative.

The government should give emphasis on the healthcare system that includes all of them, he said.

He said that the government promised to set up a 10-bed ICU facility in every district, but the service was still not available.

Rights activists said that healthcare was still expensive that the common people could afford.

They demanded reducing out-of-pocket healthcare expenditure.

The out-of-pocket healthcare expenditure in the country rose to 73 per cent in 2021 while it was 68.5 per cent in 2020, according to the Bangladesh National Health account.

Of the total out-of-pocket spending, 54.40 per cent was spent for purchasing medicines, 27.52 per cent for diagnosis, 10.31 per cent for consultation and 7.77 per cent for transport.

About 64 lakh people in the country get poorer every year due to high medical costs, according to a 2010 research by the icddr,b.

The government failed to control the prices of lifesaving drugs as the manufacturers have been increasing the drug prices at will over the years, rights activists said.

They said that the government had also a little control on the prices of medical equipment.​

 

[Saif]

Campaigners seek free healthcare

The Health Sector Reform Commission in 50 days of its formation is still gathering information and opinions on several focal areas such as service improvement while public health campaigners and medical practitioners demand free healthcare at all public health facilities...

www.newagebd.net

Campaigners seek free healthcare
Sadiqur Rahman 09 January, 2025, 00:28

The Health Sector Reform Commission in 50 days of its formation is still gathering information and opinions on several focal areas such as service improvement while public health campaigners and medical practitioners demand free healthcare at all public health facilities.

The latters expect sharper surveillance of overall health facilities, effective corruption-control measures and rational distribution of logistics between urban and rural healthcare centres.

The interim government formed the 12-member Health Sector Reform commission on November 18, 2024 for submitting necessary reform proposals in 90 days to make the country’s healthcare services people-oriented, accessible and universal.

Commission member Muzaherul Huq, also a former senior adviser to the World Federation for Medical Education, recently told New Age that the commission identified several focal areas for reforms.

‘We are gathering information and opinions from related professionals at grassroots-level and urban healthcare centres where marginalised people often visit for medical treatment. Our mission is to propose necessary improvements of the facilities so that patients can access better healthcare,’ Muzaherul said.

The commission has been analysing the autonomy of upazila health complexes, at least for procuring crucial logistics, and strong monitoring over its expenditures, he said.

The commission has also been talking to teachers and students at institutions of public health, medical science and nursing training, and paramedics and technicians to gather suggestions on the improvement of the health and medical science education, he said.

‘Improving the facilities for continuing education or professional training would be another focal area,’ said the commission member, adding, ‘widening scopes for research on the related fields would be focused.’

About corruption in the health sector, Muzaherul said that the issue had already been identified by several local and international organisations.

He said, ‘We will definitely recommend necessary measures to check corruption. At the same time, we will recommend conflict management procedures to minimise patients’ grievances and safety for the health practitioners as well.’

Public health campaigners have, however, demanded that the commission must recommend completely free medical facilities, including diagnosis and supply of medicines, at all public hospitals.

Faizul Hakim, the convener of the Janaswastha Sangram Parishad, a platform for raising voices against irregularities in the public health sector, said, ‘The government must bear the people’s health expenditures. I won’t recommend health insurance to facilitate insurance businesses.’

Non-practicing allowance for the physicians at public hospitals, limiting fees at physicians’ private chambers, strict surveillance over the services and expenses at the private hospitals and diagnosis centres, and a functional and independent Bangladesh Medical and Dental Council are among Faizul’s recommendations.

‘Corruption has paralysed the health sector, cornering the patients and their distressed families. Recommendations should come to check corruption anyhow,’ Faizul demanded, adding that the commission must come up with a white paper investigating the alleged corruption during and after the Covid pandemic.

‘Irregularities in procuring corona vaccines must be investigated.’

Public health and preventive medicine specialist Lenin Chowdhury said that reform proposals must include a comprehensive healthcare plan combining public health and treatment, defining rights and responsibilities of private clinics and practitioners, monitoring the quality of medical colleges and training institutions, a short-mid-long-term road map for manpower recruitment in the health sector and experts-led health ministry.

‘The insolvent patients need a safety net. Moreover, there must be a guideline for bringing poverty-ridden patients under a universal healthcare system,’ Lenin said.

Commission chief Professor AK Azad Khan, also the president of Bangladesh Diabetic Society, said that the commission continued discussing with key stakeholders, including common citizens.

‘We would prepare a precise draft of reform proposals at the end of this month,’ Azad said.​

 

[Saif]

A public cancer hospital in crisis

Prolonged equipment failure at NICRH is unacceptable

www.thedailystar.net

A public cancer hospital in crisis
Prolonged equipment failure at NICRH is unacceptable

VISUAL: STAR

It is deeply concerning that the National Institute of Cancer Research and Hospital (NICRH)—the country's premier public facility for cancer care—is failing to provide radiotherapy treatment due to prolonged equipment failure. For over 19 days, according to a report by The Daily Star, all six radiotherapy machines at the hospital have been out of service, forcing cancer patients to delay their treatment at the risk of their conditions worsening or spreading.

NICRH is not just another healthcare facility; it is a lifeline for many patients, especially those from poor backgrounds, who rely on its subsidised services. For such a vital institution to go even a single day without functioning radiotherapy machines is thus unacceptable. That the current paralysis has dragged on for nearly three weeks only shows the gravity of the situation. In fact, the equipment failure has been a persistent problem for NICRH: one of the machines has been out of order for two years, and another for over a year. How has such a critical problem been allowed to continue unchecked for so long?

For many cancer patients, seeking treatment at private clinics is not an option due to the exorbitant costs involved. They rely on NICRH for affordable care. When that care is delayed, they face harrowing choices—some borrow or exhaust their life savings to seek private treatment, while others are left with no option but to wait, risking their lives as cancer progresses.

Reports of similar incidents paint a grim picture of recurring dysfunction at NICRH. Last year, Prothom Alo reported that all of the hospital's radiotherapy machines had malfunctioned. At that time, even the X-ray machine was out of order for two weeks. These repeated breakdowns are symptomatic of a broader systemic failure in public healthcare, at the core of which lies a disturbing culture of indifference and irregularities. Instead of prioritising urgent repairs or replacing outdated equipment, hospital authorities have shown a complacent attitude, waiting for external interventions that rarely come in time.

For many cancer patients, seeking treatment at private clinics is not an option due to the exorbitant costs involved. They rely on NICRH for affordable care. When that care is delayed, they face harrowing choices—some borrow or exhaust their life savings to seek private treatment, while others are left with no option but to wait, risking their lives as cancer progresses.

We urge the health authorities to address this crisis immediately. The radiotherapy machines at NICRH must be repaired or replaced immediately, and measures must be taken to prevent such prolonged disruptions in the future. The possibility that certain vested quarters may be deliberately sabotaging these machines to drive patients towards private facilities must also be thoroughly investigated. The health directorate's long-standing failure to properly oversee public hospitals like NICRH also must be rectified.​

 

[Saif]

Healthcare system needs a thorough shakeup

That the country's healthcare system is plagued by a lot of discrepancies and inadequacies does not require any elaboration. Volumes have been said and written on this particular issue over the years but to no avail. Speakers at a debate programme organised in the city late last week came up

thefinancialexpress.com.bd

Healthcare system needs a thorough shakeup
Published :
Feb 08, 2025 22:34
Updated :
Feb 08, 2025 22:34

That the country's healthcare system is plagued by a lot of discrepancies and inadequacies does not require any elaboration. Volumes have been said and written on this particular issue over the years but to no avail. Speakers at a debate programme organised in the city late last week came up with a wide range of suggestions and recommendations including establishment of a regulatory body for streamlining the healthcare sector. The debate programme coincided with the government initiative to reform the sector. It may be mentioned that the interim government last November formed a Health Affairs Reform Commission to recommend reforms with the objective of making health services more accessible and universal. The core recommendation of the programme was the establishment of a regulatory body to standardise pricing, enforce quality accreditation and form a grievance mechanism for the patients.

Though there are several health-related agencies under the Ministry of Health and Family Welfare, those have hardly any control over cost of treatment, especially in private hospitals and clinics. These private healthcare outlets fix treatment charges whimsically. They do not bother to take into consideration the paying capacity of the poor and low-income people. In view of this, the speakers at the debate programme underscored the need for enacting a comprehensive health law and creating a central regulatory authority to oversee private sector engagement in health services. Patients usually do not have the scope to know beforehand how much they will have to spend for a specific treatment. For lack of effective control, pharmaceutical companies arbitrarily fix prices of medicines and increase them quite frequently. These are some of the reasons why expense for treatment is so high in Bangladesh. It is because the treatment cost remains much beyond commoners' affordability. The speakers at the programme raised concern over the high financial burden on the patients. The proposed regulatory body may devise mechanism for price control by distinguishing between actual medical cost and that charged by many healthcare outlets out of unethical commercial motive.

Healthcare services in Bangladesh are much below international standard. People do not have that much faith in the country's healthcare system. This loss of confidence prompts thousands of patients to opt for treatment outside the country at the expense of hard-earned foreign currencies from the state exchequer. Enforcement of quality accreditation is also vitally important for ensuring service quality of hospitals, laboratories and doctors. Establishment of a grievance mechanism for patients until now was an alien idea in the country. Very often patients are subjected to various forms of harassment but the victims have nowhere to go to lodge complaints for redress. The proposed grievance mechanism is expected to be a relief for the health service seekers. Similarly, public-private partnership in healthcare service is a unique idea in Bangladesh. So, serious efforts should be made to translate that idea into reality.

The Health Affairs Reform Commission has its own recommendations for streamlining the country's healthcare system. The authorities concerned are also expected to incorporate experts' suggestions if those are not already covered by the Reform Commission. Such an integration of suggestions and recommendations will hopefully free the archaic medical service system and make it accessible to common people.​

 

[Bilal9]

Bangladeshis spend $4b annually for healthcare abroad

DCCI Senior Vice President Malik Talha Ismail Bari says in a seminar on outbound healthcare tourism

www.thedailystar.net

Bangladeshis spend $4b annually for healthcare abroad
DCCI Senior Vice President Malik Talha Ismail Bari says in a seminar on outbound healthcare tourism

View attachment 10882

Bangladeshis spend around $4 billion abroad every year for healthcare, according to Malik Talha Ismail Bari, senior vice president of the Dhaka Chamber of Commerce and Industry (DCCI).

This is due to a lack of specialised treatment, trust on doctors and advanced technology within the country alongside costs being comparatively lower abroad, he said.

Bari, also a director of United Hospital, was delivering a keynote paper through a presentation at a seminar, styled "Reversing the Outbound Healthcare Tourism", at the DCCI today.

There are 5,461 private hospitals and clinics in Bangladesh, of which 1,810 are within Dhaka division, he said.

People in rural areas are deprived of quality and adequate healthcare services while pressure is created for an influx of patients at healthcare facilities in Dhaka.

Limited infrastructure, a lack of skilled workforce, quality and safety concerns, low doctor-patient ratio and long waiting periods are some of the bottlenecks to access advanced healthcare in Bangladesh, he added.

Bari informed that Bangladesh allocated Tk 30,125 crore, or 3.78 percent of its national budget, for public healthcare in fiscal year 2024-25.

Pre-capita health expenditure, or annual government spending for healthcare per person, is $110 in Bangladesh whereas $401 in South Asia, he said.

Patients sometimes go abroad for healthcare services due to a lack of facilities, trust and comfort and reversing this trend requires formulation of a proper plan and identifying the bottlenecks, said National Professor AK Azad Khan.

"Since medical science is an ever-changing process, we need to have a proper curriculum to adopt the best technological advancements," said Khan, also president of the Diabetic Association of Bangladesh.

He also stressed on the standardisation of laboratories, adequate budgetary allocation, facilitating more research and strengthening the Bangladesh Medical and Dental Council (BM&DC), which is the regulatory authority for medical and dental education in Bangladesh.

Trust is a crucial factor when considering this sector's development, said Rezaul Karim Kazal, professor of the obstetrics and gynaecology department at Bangabandhu Sheikh Mujib Medical University.

Quality hospitals should be established in rural areas for wider coverage alongside customised services for all types of patients, he added.

Only doctors should be appointed through Bangladesh Civil Service for the public health administration to be run efficiently, said Syed Abdul Hamid, professor at the Institute of Health Economics of the University of Dhaka.

Moreover, a "health service commission" should be formed similar to the Bangladesh Judicial Service Commission, which assess the suitability of persons for entry-level appointments as assistant judges or judicial magistrates, he added.

Liaquat Hossain, registrar of the BM&DC, suggested that the national policy for registering foreign doctors to practice in Bangladesh could be simplified.

Of the 1,34,000 doctors in Bangladesh, only 33,000 are in public service, said Abul Bashar Md Jamal, a former professor of surgery at Dhaka Medical College Hospital.

However, over 10,000 foreign students are studying in different public and private medical colleges here, he added.

Members of middle-income households are increasingly seeking healthcare services abroad, mainly for a lack of confidence and satisfaction, said DCCI President Ashraf Ahmed.

Only a few types of advanced treatments, such as robotic surgery, are available locally, he said.

The trend can be reversed by outperforming regional competition, ensuring customer satisfaction and enhancing quality of medical services, reliability and branding initiatives, he added.

"We need to be more open to foreign doctors, nurses, medical technologists and other specialists," opined Ahmed.​

What needs to happen is for these talking heads stopping to "talk shop" and actually put in a "prescription" for concrete steps ( pun intended).

With mandatory temporary subsidies to set up specialized hospitals if necessary.

BS has gone on long enough while incompetent govt. idiots twiddle their thumbs with all these medical dollars go outside of the country.

If India can set up these substandard hospitals in Kolkata and Chennai area, there is no reason we cannot.

Also - we should set up some kind of necessary re-certification every year to train and certify doctors.

We need guarantees that our doctors are trained beyond a certain standard and fake doctors are weeded out.

 

[Saif]

What needs to happen is for these talking heads stopping to "talk shop" and actually put in a "prescription" for concrete steps ( pun intended).

With mandatory temporary subsidies to set up specialized hospitals if necessary.

BS has gone on long enough while incompetent govt. idiots twiddle their thumbs with all these medical dollars go outside of the country.

If India can set up these substandard hospitals in Kolkata and Chennai area, there is no reason we cannot.

Also - we should set up some kind of necessary re-certification every year to train and certify doctors.

We need guarantees that our doctors are trained beyond a certain standard and fake doctors are weeded out.

Our doctors are busy with their private practice and hardly have enough time to take care of their patients. The picture of all the public hospitals are the same.

 

[Bilal9]

Our doctors are busy with their private practice and hardly have enough time to take care of their patients. The picture of all the public hospitals are the same.

Agreed. Doctors are licensed. Govt. has the power to revoke those licenses.

So - if doctors do not abide by the rules (like take care of their patients in public hospitals per agreed rules), govt. has to revoke their licenses. This is exactly what they do in India. Why can't we?

Govt. has to realize that the money they spent to train doctors must have a proper return.

Becoming a doctor should not be a guarantee to print money - like it is now.

 

[Saif]

Universal health coverage: a reality or mirage?

The aspiration for universal health coverage (UHC), where everyone can access the necessary healthcare without facing financial hardship, remains a distant dream due to the excessive commercialisation of the health sector and a disproportionately high out-of-pocket healthcare expenditure. The UHC e

thefinancialexpress.com.bd

Universal health coverage: a reality or mirage?
Published :
Feb 16, 2025 23:00
Updated :
Feb 16, 2025 23:00

The aspiration for universal health coverage (UHC), where everyone can access the necessary healthcare without facing financial hardship, remains a distant dream due to the excessive commercialisation of the health sector and a disproportionately high out-of-pocket healthcare expenditure. The UHC envisions both comprehensive service coverage for the entire population and financial protection against the high costs of medical care. While Bangladesh has made significant progress in expanding healthcare facilities, financial protection remains a major challenge. According to a World Bank study, over 73 per cent of total health expenditures in Bangladesh are borne directly by households, one of the highest in the world. This extremely high out-of-pocket spending has severe consequences. According to a study by the Bangladesh Institute of Development Studies (BIDS) soaring out-of-pocket healthcare expenses pushed 61 lakh Bangladeshis, or 3.7 per cent of the population, into poverty in 2022. Experts in a recent view exchange meeting have called for implementing a robust regulatory framework, ethical pricing mechanisms, and stronger supply chains to address the issue.

For Bangladesh to progress on the financial protection agenda, two key actions are necessary. Firstly, a significant increase in the health budget is essential. The World Health Organization suggests allocating at least 15 per cent of the total budget to the health sector, but Bangladesh allocates only around 5.0 per cent. The country's health budgetary support is one of the lowest in the South-East Asia region. The less a government spends on health, the higher out-of-pocket payment is sure to be. So, increased budgetary allocation is indispensable, particularly for ensuring access to healthcare for the poor, vulnerable, young, old, and informal workers - in essence, the majority of the population.

Secondly, the government must ensure optimum utilisation of the health budget by increasing allocation for government hospitals, health centres and healthcare professionals. However, increased allocation will not translate into enhanced facilities if corruption and some other irregularities in the health sector are not properly addressed. Absenteeism of doctors in government hospitals, particularly in rural areas has been an endemic problem. Many doctors exhaust their time and energy attending private clinics which leaves them with hardly any time for government hospitals where they are appointed to serve. It is the poor patients who mostly seek treatment at government hospitals and bear the brunt of these irregularities. Moreover, facilities in these hospitals like free medicines are scarce and those that exist do not come to the benefit of the poor due to mechanisms of vested quarters. So, to protect the poor from skyrocketing healthcare costs, public healthcare facilities must be better equipped with the necessary resources and logistics, and healthcare providers must be held accountable.

The country's high out-of-pocket healthcare expenses are not only pushing more people into the vicious cycle of poverty but also widening the gap between the rich and the poor. Globally, countries with robust government healthcare systems have achieved more equitable growth. For Bangladesh, allocating more resources to the health sector and implementing a strong strategy for enhancing financial protection for the poor and vulnerable will be crucial in ensuring access to basic healthcare for all. Otherwise, the vision of achieving universal health coverage will remain a mirage, not a reality.​

 

[Saif]

Hospitals need proper waste disposal

Medical waste problem at Rangpur Medical College Hospital is concerning.

www.thedailystar.net

Hospitals need proper waste disposal
Resolve the crisis at Rangpur Medical College Hospital

VISUAL: STAR

We are concerned about the medical waste problem at Rangpur Medical College Hospital where hazardous waste has been piling up inside the premises, posing health risks to both patients and visitors. According to a report by this daily, the planned construction of a waste management plant at the hospital has remained suspended for over five months due to protests from locals.

Locals are apparently worried that the plant's location, near the district's Bangladesh Medical Association building and adjacent residential areas, would cause odour pollution and pose health risks. They also allege that the plant does not have a location clearance certificate from the Department of Environment. Meanwhile, approximately 1.5 tonnes of waste, including 300 kilogrammes of hazardous waste generated daily by the hospital, are not being disposed of properly, which can have serious consequences.

Unfortunately, the situation at Rangpur Medical College Hospital is not an isolated one. Around 83 percent of hospitals in our country do not have a waste management system, according to a 2022 study by the Transparency International Bangladesh (TIB). The study also found that around 60 percent of hospitals do not have bins to store medical waste, let alone ensure basic segregation among reusable, recyclable, and non-recyclable waste—with hazardous medical waste being mixed with solid garbage in the bins that are available. In fact, at the Rangpur hospital, such waste is currently being dumped out in the open. Do the locals opposing the waste management plant not see the health risks of this uncontrolled dumping? A properly constructed waste management plant cannot pose more risks than the current situation.

Under these circumstances, hospital authorities must engage with locals, raise awareness with the help of experts if necessary, and ensure the plant's construction follows all due process. Meanwhile, all public hospitals in the country must take urgent action in line with the recommendations that came up in the TIB study. Simultaneously, the government must enforce the Medical Waste Management and Processing Rules 2008, penalising any non-compliance. The authorities also must ensure proper hygiene and cleanliness in public hospitals so that people do not fall sicker while undergoing treatment because of hospital-acquired infections.​

 

[Saif]

What would the healthcare sector of the future look like?

Healthcare around the world is going through unique and dynamic changes.

www.thedailystar.net

What would the healthcare sector of the future look like?

Photo: REUTERS

Healthcare around the world is going through unique and dynamic changes. Global megatrends like climate change, technological advancements, demographic shifts, and social changes are all impacting the stakeholders in healthcare—patients, practitioners and businesses—in significant ways. According to one estimate, the world population is likely to reach nine billion in another decade, with Bangladesh's population likely reaching 190 million. As a result, providing affordable healthcare services for such a large population will create both challenges and opportunities.

While there has been significant progress in reducing the incidence of malaria, tuberculosis (TB) and diarrhoeal diseases, ailments associated with the modern lifestyle, such as obesity, are rising exponentially. The risk of ailments caused due to environmental threats and natural disasters is also likely to rise in the coming years. At the same time, newer drug discoveries are making the cure of many diseases possible, and in certain instances, more affordable.

All these factors are forcing the healthcare delivery ecosystem to undergo a transformation that will be relevant for the future, while keeping patients and consumers at the centre. The entire care delivery ecosystem will be attributed by the capabilities of the ecosystem participants of being preventive, personalised, predictive, and by their points of healthcare delivery.

With the increasing focus on disease risk factors and self-directed healthier way of living, the need for curing many diseases associated with the lifestyle will decrease with time. A considerable number of businesses are likely to grow and lead this domain by delivering such services. On the one side, there will be providers of basic consultations on lifestyle, diet and physical exercise. On the other, there will be diagnostic service providers who would help in measuring the key health parameters to detect early indicators of life-threatening diseases or clinical incidents.

While such preventive care has significant impact in elevating the overall health of the population, it should be noted that the beneficiaries of such care are not sick individuals, but individuals who maintain a regular and good quality of life. Therefore, the patient experience—i.e. how such care gets delivered— would play a significant role in business success of the providers. Additionally, personalisation will be a key component in delivering unique patient experiences.

Personalisation of care also means bringing life sciences into the picture. Personalised medical examinations and clinical investigations result in better diagnosis of ailments and tailored prescriptions for cure. By deploying new generation biotechnology and genetic research findings, each patient's needs become unique and require unique treatment decisions. Some healthcare providers in the developed countries have already started offering such care to patients in areas like heart health, diabetic care, and metabolic activities.

In addition to biotechnology, other technological advancements, particularly in digital technologies and artificial intelligence (AI), are going to make a significant impact in the healthcare of the future. In fact, a prominent attribute is going to be predictive and proactive care for the patients. The vast amount of health data collected from a wide range of demographic populations is enabling the creation of tools that enable the prediction of many health accidents pre-emptively. Such predictive analysis can be used for the proactive treatment of the patients resulting in prevention of the same.

All of these suggestions can be implemented at a wide range of locations, including the homes of the patients. Technology has enabled care delivery points to become omnipresent with the use of telehealth services, community-based services, and remote interventions through robots. Access to healthcare has become easier with the advent of technology.

However, the inclusive access to healthcare will require a robust ecosystem of private-public partnerships to improve its reach and affordability. For private entrepreneurs, the business potential in highly populated countries like Bangladesh is enormous. At the same time, it's the collective responsibility of private-public partnerships to make such care delivery inclusive so that they are accessible to all levels of the economic pyramid.

Arijit Chakraborti is partner with PwC.​

 

[Saif]

Reimagining primary healthcare through the GP system

Despite progress in Bangladesh’s health sector, primary healthcare (PHC) remains inadequate, particularly in rural areas where access to qualified doctors is limited.

www.thedailystar.net

Reimagining primary healthcare through the GP system

FILE PHOTO: AMRAN HOSSAIN

The general practitioner (GP) system is the cornerstone of healthcare in many countries, providing individuals with their first point of contact for medical care. GPs are trained medical professionals who diagnose and treat various health conditions, from minor illnesses to chronic diseases, while emphasising preventive care through regular checkups, vaccinations, and health education. Acting as gatekeepers, GPs coordinate patient care, referring them to specialists when needed. Countries that have achieved universal health coverage—such as the UK, Australia, and Canada—rely heavily on GP systems to improve accessibility, ensure continuity of care, and enhance health outcomes.

Despite progress in Bangladesh's health sector, primary healthcare (PHC) remains inadequate, particularly in rural areas where access to qualified doctors is limited. Urban areas, on the other hand, lack a structured PHC delivery system, forcing citizens to rely on hospitals and informal healthcare providers. This leads to high out-of-pocket expenses.

UHC, which envisions accessible, affordable, and quality healthcare close to home, remains an elusive goal in Bangladesh. A well-structured GP system could take us one step ahead. It could revolutionise healthcare delivery by ensuring that every individual has access to a registered family doctor. A proposed GP model for Bangladesh would assign a medical team to every 5,000 people, led by a graduate doctor. Families would register with a GP team, with the flexibility to change providers every six months. GPs would be contractually appointed, with performance-based renewals tied to measurable outcomes like healthcare provision and patient satisfaction. Vulnerable populations would receive free or subsidised services, while emergency care, including ambulance services, would be universally free.

Under the system, the existing infrastructure, such as community clinics in rural areas, could minimise implementation costs. In urban areas, rented facilities could serve as GP centres. An integrated approach linking the GP system with the broader healthcare network would be essential for success. Public-private partnerships (PPPs) are essential for bridging gaps in the country's healthcare system. While current PPPs focus primarily on construction models, there is untapped potential in service-driven contracts, such as operation and maintenance, and greyfield upgrades.

However, the integration of the GP system into government structures requires a robust payment model. Salary-based systems may fail to motivate, whereas pay-for-performance or fee-for-service models incentivise quality. Bundled payments, capitation or global budgets offer flexibility, but payment models must prioritise comprehensive care, including promotion, prevention, treatment, and rehabilitation.

PPP agreements must include clear quality indicators. The private sector is adept at maximising profit; therefore, the government must skilfully set and enforce quality standards within contracts. Transparent performance reporting and strong monitoring frameworks are essential to maintaining accountability and ensuring that healthcare providers meet their obligations. The experience of integrating PPPs in other sectors offers valuable lessons for healthcare. By aligning community clinics, government structures, and private partnerships, Bangladesh can create a more equitable, efficient, and patient-centred healthcare system.

Even so, the financial viability of a GP system poses significant challenges. Bangladesh's low tax-to-GDP ratio, lack of social insurance frameworks, and predominantly informal workforce are major barriers. Global models, such as tax-based systems in the UK and Canada, performance-linked funding in Sweden and New Zealand, and mixed approaches like Singapore's, offer valuable lessons. Emerging economies like Rwanda and Thailand demonstrate the feasibility of community-based insurance and capitation-based funding for GP systems.

For Bangladesh, direct contributory mechanisms for the informal sector are impractical in the short term. Despite these challenges, several avenues could be explored, such as: i) redirecting unutilised funds within the health sector budget; ii) imposing targeted taxes on sugary beverages, luxury goods, and tobacco; iii) leveraging corporate social responsibility (CSR) funds; and iv) introducing minimal monthly charges or per-minute phone call fees. However, university students, formal workforce groups like garment workers, and other groups like bank account holders and microcredit beneficiaries, may be brought under compulsory health insurance schemes.

Bangladesh's COVID vaccination programme which successfully registered over 13 crore individuals using national identity cards (NIDs), highlights the potential for technology-driven healthcare solutions. A nationwide health card system could centralise patient data, enabling personalised, data-driven care. Additionally, artificial intelligence (AI) and the Internet of Things (IoT) could streamline healthcare processes by enabling real-time health data tracking, efficient referrals, and better care coordination.

The feasibility of these models has already been demonstrated through initiatives like UNICEF's Aalo Clinic programme in urban areas and Palli Karma-Sahayak Foundation's (PKSF) Samridhi programme in rural areas across Bangladesh. These examples highlight the scalability of the GP system in both rural and urban settings. By leveraging existing infrastructure, integrating advanced technology, and prioritising primary care, Bangladesh can build an equitable, efficient, and future-ready healthcare system.

Integrating the GP system into Bangladesh's broader healthcare infrastructure is a critical step toward achieving UHC. While it presents challenges, health experts generally agree that it is feasible with clear aspirations and a comprehensive, well-thought-out plan. Annual performance audits, based on defined quality metrics, will identify service gaps and areas for improvement, with public reporting enhancing transparency. A well-functioning complaint redress system will also be crucial for resolving patient grievances and maintaining satisfaction. It is important to avoid shortcuts and carefully consider the ground realities to prevent the common pitfalls that often arise during implementation.

The authors are members of UHC Forum and PPRC and experts in the health sector.​

 

[Saif]

Price ceiling should be priority health reform agenda

AS THE government discusses the reform strategy for the health sector, it should take into account findings of the Bureau of Statistics survey on public health services that reflect people’s demands and expectations. The survey report...

www.newagebd.net

Price ceiling should be priority health reform agenda
22 March, 2025, 00:00

AS THE government discusses the reform strategy for the health sector, it should take into account findings of the Bureau of Statistics survey on public health services that reflect people’s demands and expectations. The survey report published on March 20 says that more than 90 per cent of the people have urged the government to contain extremely high prices of health services, including medicine, physician’s visit costs and diagnostic charges. People have asked for fixed retail prices for all health services, medicines and medical accessories. The demands are more than justified when there is barely any stability in the drug market. The Directorate General of Drug Administration sets prices of 117 essential medicines while prices of all other drugs are determined based on proposals of manufacturers. A recent market analysis shows that prices of drugs greatly vary. The Bangladesh Association of Pharmaceutical Industries tries to justify the price difference, saying that the quality of drugs is different for different companies, yet substandard drugs flood the market, risking public health. The health reform should implement a price ceiling mechanism for drugs and also put in place an effective quality control mechanism for pharmaceutical industries.

The health services reform survey also reports a dependence on the private sector and talks about an effective decentralisation of health infrastructure. In Barishal, Chattogram and Dhaka, people are mostly dependent on private health facilities. Mismanagement, corruption and inadequate number of beds and physicians often compel people to seek health care from private facilities. There is approximately one hospital bed for every 990 patients. This translates to 0.96 beds per 1,000 people, which is significantly lower than the World Health Organisation’s recommendation. In district hospitals, many emergency facilities, especially dealing with non-communicable diseases, are absent. The treatment of the chronic diseases requires more resources than what is available with upazila health complexes. In the absence of such services, those who can afford seek services from private hospitals and people in poverty are left with no option but to suffer. At the moment, to establish private hospitals, clinics or diagnostic centres, it is not mandatory to obtain a licence. The price chart for medical services has not been recently revised. It is evident that the government has created a situation in which the private sector has more control over health services and the regulatory mechanism has failed the patients.

It is promising that the interim government has set up a commission to suggest reforms for the health sector. The commission, considering the findings of the survey, should prioritise a price ceiling and quality control mechanism for pharmaceutical industries as a reform agenda.​

 

[Saif]

HEALTH SECTOR REFORM: Commission for referral, back-referral system

The health sector reform commission is set to recommend ‘effective’ referral and back-referral systems, connecting tertiary and grassroots health facilities.

www.newagebd.net

HEALTH SECTOR REFORM: Commission for referral, back-referral system
Sadiqur Rahman 29 March, 2025, 23:48

The health sector reform commission is set to recommend ‘effective’ referral and back-referral systems, connecting tertiary and grassroots health facilities.

According to the commission members, these systems would not only facilitate the full recovery of critical patients at minimised expenses but also lessen the burden on public and private hospitals in cities including Dhaka.

If the referral system functions effectively, insolvent patients from rural and remote villages could avail themselves of specialised medical care at tertiary hospitals, they said.

‘In our recommendation, there will be a referred-back system so that a patient, after receiving treatment at a tertiary hospital, can receive rehabilitation services at the health centre where he or she was initially admitted,’ said Professor M Muzaherul Huq, a member of the Health Sector Reform Commission.

He added that the patients would be issued a health card for sequential use.

On March 20, the Bangladesh Bureau of Statistics published a public opinion survey on Health Sector Reform 2025, revealing that 92.6 per cent of respondents supported the introduction of health cards for patients.

The BBS conducted the survey on 8,256 households across the country.

Explaining the planned referral and back-referral systems, another commission member, Syed Md Akram Hussain, said that patients’ out-of-pocket healthcare expenses would reduce significantly if the referral and the back-referral systems work effectively.

‘We are planning to develop a network of general health practitioners or family care physicians who will be the initial responders to patients. Without their referral, no patient, except in an emergency, would be allowed to visit a specialist or a specialised hospital,’ Akram said.

Such a restriction, however, would prevent patients from making unnecessary hospital visits and incurring avoidable diagnostic and medical care expenses.

‘Moreover, the fee of a family care physician will certainly be less than that of a specialist,’ he added.

According to Akram, the commission would propose the availability of at least two MBBS doctors as family care physicians, or one family care physician per 15,000 people, at union-level health centres.

Such family health physicians would also be available at the ward level in urban areas.

‘We are planning to transform all district-level general hospitals into tertiary hospitals,’ Akram said.

The BBS public opinion survey on health sector reform 2025 also revealed that 91.3 per cent of respondents wanted primary health care to be recognised as a constitutional right.

‘The constitution does not legally bind the state to ensure citizens’ primary health care. It should,’ said Faizul Hakim, convener of the Janaswastha Sangram Parishad, a public health advocacy platform.

On January 15, the Constitution Reform Commission, in its full report, recommended that the right to health, which requires ‘significant resources’ and ‘time to implement,’ should be implemented based on the ‘availability of resources,’ with a commitment to ‘progressive realisation.’

The World Health Organisation defines primary healthcare as a system that enables health services to support a person’s health needs, from health promotion to disease prevention, treatment, rehabilitation, and palliative care throughout their lifespan.

However, the Health Sector Reform Commission will propose legally binding the government to ensure citizens’ primary health care.

‘Additionally, the commission will recommend “basic emergency care” free of cost. The government will be bound to bear this cost even if a patient receives the service at a private hospital,’ Akram said.

The commission would also recommend the establishment of a separate service commission for health professionals, the formation of regional health services, the creation of a private hospital management board, the allocation of 10 per cent of private hospital beds for insolvent patients, and the prevention of pharmaceutical company owners from owning hospitals, among other measures.

On November 18, the interim government formed five reform commissions on health, media, local government, labour, and women’s affairs.

These five reform commissions were initially expected to submit their reports by mid-February. However, on March 27, all commissions were granted an extended deadline until April 30.​

 

[Saif]

Well-meaning health-sector reforms that call for will

A SOUND referral and back-referral system in health care potentially has several merits. It can ensure equitable access to specialised health care. It can optimise the use of resources. It can improve patient outcomes. It can also enhance coordination between levels of health care. This is...

www.newagebd.net

Well-meaning health-sector reforms that call for will
03 April, 2025, 00:00

A SOUND referral and back-referral system in health care potentially has several merits. It can ensure equitable access to specialised health care. It can optimise the use of resources. It can improve patient outcomes. It can also enhance coordination between levels of health care. This is, therefore, a welcome move that the health-sector reforms commission is set to recommend ‘an effective referral and back-referral system’ to link tertiary to primary health services. The commission’s members say that it would not only facilitate the full recovery of critical patients at minimised costs but also unburden public and private hospitals in cities. In a society where out-of-the-pocket expenditure of patients is too high and quality medical treatment is too costly, the likely move certainly appears a glimmer of light at the end of the tunnel. If the referral system works effectively, insolvent patients from remote, rural areas would receive specialised medical care in tertiary hospitals, which the commission envisages to be upgraded from district general hospitals. In the back referral part of the system, patients could receive rehabilitation services in the initial health centres after they receive specialised treatment in tertiary hospitals.

A commission member says that there are plans to develop a network of general practitioners to initially respond to patients. No patient but in case of emergencies can visit a specialist or specialised hospitals without referral. The restriction would save patients unnecessary hospital visits and money on avoidable diagnostic tests and medical expenditure. The commission also envisages the availability of at least two people with MBBS degrees to work as family care physicians or one family care physicians per 15,000 people at union health centres in rural areas and at wards in urban areas. The Bureau of Statistics in a survey made public on March 20 shows that 91.3 per cent of respondents want primary health care to be recognised as a constitutional right. And, experts believe that the constitution should make citizens’ primary health care legally-binding for the government. The commission on constitutional reforms on January 15 recommended that the right to health should be implemented based on the ‘availability of resources’ with a commitment to ‘progressive realisation.’ The commission on health-sector reforms notes that it would propose that the government should be legally bound to ensure citizens’ primary health care. And, the basic emergency care should be free even if the patients receive the services in private hospitals.

Most of the propositions that have come to light appear well-meaning steps towards an effective reform of the health care system, but the government needs to show the will to carry out the reforms in the first place.​

 

[Saif]

Medical sector projected to reach $23b

Experts at a session on Thursday urged the investors to invest in Bangladesh’s medical sector as it is experiencing robust growth...

www.newagebd.net

Medical sector projected to reach $23b
Bangladesh Sangbad Sangstha . Dhaka 10 April, 2025, 22:23

Experts at a session on Thursday urged the investors to invest in Bangladesh’s medical sector as it is experiencing robust growth.

They also projected that the market volume will reach $23 billion by 2033, driven by increasing demand for medical consumables and advanced diagnostic tools.

They made the projection at a session on ‘Unlocking Healthcare Investment Potential in Bangladesh’ of the ‘Bangladesh Investment Summit 2025’ at a hotel in the city.

Md Saidur Rahman, secretary of the Health Services Division, was speaker of the session while Sylvana Quader Sinha, founder, chair and CEO of Praava Health delivered the keynote speech on ‘Unlocking Healthcare Investment Potential in Bangladesh’.

In his speech, Saidur Rahman described the remarkable growth of the country’s health sector and urged the investors to invest here.

‘It’s projected that the market volume of the country’s health sector will be $23 billion by 2033. It is clear that there are huge potentials for investors of the country’s health sector,’ he added.

Sylvana Quader Sinha said that the medical equipment and devices market was experiencing robust growth, driven by increasing demand for medical consumables and advanced diagnostic tools.

‘The sector is heavily reliant on imports, creating a significant opportunity for local manufacturing of medical devices, especially as the country works towards self-sufficiency in producing critical healthcare products. Investment potential exists in establishing manufacturing units for essential medical consumables, like in vitro diagnostic test kits, and low-risk health monitoring devices, and leveraging the B2C model to address the rising demand for consumables. As the health complexity increases, the demand for OT support and ICU equipment is also increasing, presenting the sector as a lucrative segment for investment with high returns,’ she added.

The founder of Praava Health said that healthcare had become one of the largest sectors of the Bangladeshi economy, in terms of revenue, it has been growing at a CAGR of 10.3 per cent since 2010, employing nearly 0.3 million people directly.

‘Several factors are driving the growth of the healthcare sector, including an aging population, a growing middle and affluent class, and the rising proportion of non-communicable diseases. The healthcare industry of Bangladesh comprises five prime subsectors: Healthcare Facilities, Pharmaceuticals, Medical Equipment and Devices, Digital Healthcare and Medical Biotechnology,’ she added.

Sylvana said that the country’s healthcare facilities are expanding with private hospitals, clinics, and diagnostic centres showing strong growth.

‘Public-private partnerships (PPP) and government incentives are encouraging investments. The sector benefits from policies like tax exemptions for private hospitals outside major cities, making it an attractive market for both local and foreign investors. The ongoing need for tertiary and specialized healthcare services in urban cities and the demand for primary healthcare in rural areas enhance the sector’s growth potential, positioning it as a key segment to invest in,’ she added.

She said that the pharmaceutical sector, recognised as a Pharmerging Market, is projected to reach $6 billion in 2025 at a 12 per cent compound annual growth rate (CAGR).

The industry is well known for branded generics-particularly in gastrointestinal, antibiotic and antipyretic therapies that quenches nearly all the domestic demand, she added.

Sylvana Quader said that digital transformation was further accelerating the growth in the healthcare sector. Since COVID-19, digital health has emerged as a key area of innovation, gaining momentum as the tech-savvy youth population increasingly turns to digital solutions for healthcare access.

The government’s Digital Healthcare Strategy 2023-2027 aims to integrate digital tools like cloud-based Electronic Health Records (EHRs) and telehealth platforms to enhance healthcare delivery and reduce costs, she continued.

She said that this transition presented investment opportunities in cloud-based services, interoperable health systems, and remote patient monitoring.

Additionally, partnerships with foreign tech companies for disease management solutions and healthcare technology innovations will be crucial in driving the sector’s growth, she added.​

 

[Saif]

Transforming Bangladesh into a healthcare hub

Bangladesh, one of South Asia’s fastest-growing economies, holds immense potential in the healthcare sector. However, the country’s health system currently faces several critical challenges — particularly the high cost of treatment, increasing patient outflow to foreign countries, the rising...

www.newagebd.net

Transforming Bangladesh into a healthcare hub
Syed Akram Hussain 11 April, 2025, 00:00

Bangladesh, one of South Asia’s fastest-growing economies, holds immense potential in the healthcare sector. However, the country’s health system currently faces several critical challenges — particularly the high cost of treatment, increasing patient outflow to foreign countries, the rising burden of cancer and chronic diseases, and heavy reliance on imported medical equipment and pharmaceuticals. According to the World Health Organization, government spending on health in Bangladesh was only 2.3 per cent of GDP in 2023, which is lower than the South Asian average of 3.4 per cent. On the other hand, an estimated $700 million in foreign currency is spent annually on treatment abroad. In this context, foreign and joint investments in Bangladesh’s healthcare sector are both timely and justified.

As a densely populated and rapidly growing country, Bangladesh offers significant potential for investment in healthcare. Each year, hundreds of thousands of patients seek treatment in countries such as India, Singapore, and Thailand, as well as the Middle East, Australia, and the United States. This leads to massive foreign currency outflow and places quality healthcare out of reach for many. Establishing world-class hospitals, cancer centres, transplant surgery facilities, and trauma rehabilitation centres in Bangladesh could drastically change this reality. The student and mass movement of August 2024, which resulted in numerous injuries, underscored the urgent need for dedicated trauma and injury rehabilitation facilities. This experience has made it clear — now is the time to invest in this critical sector.

Spotlight on visionary leadership

THE Investment SUMMIT 2025 was further elevated by the outstanding performance and strategic insights of Ashik Chowdhury, whose vision and coordination were instrumental in bringing together stakeholders across public and private sectors.

Special recognition also goes to Nobel Laureate Dr Muhammad Yunus, whose presence and commitment to social business innovation inspired all participants to reimagine healthcare as a human right and a scalable investment opportunity. Their contributions have set a high benchmark for future collaboration and innovation.

Priority areas for investment

Multi-super specialty hospitals: Establishment of international-standard facilities for complex care such as cancer, cardiology, neurology, and transplant surgery.

Cancer treatment centres: With approximately 150,000 new cancer cases diagnosed annually, each division in the country requires a modern, globally accredited cancer centre.

Transplant surgery centres: Kidney, liver, and bone marrow transplant facilities remain limited. Establishing full-scale transplant centres will reduce the need for overseas treatment.

Trauma and injury rehabilitation centres: Road accidents, political unrest, and natural disasters necessitate urgent and effective rehabilitation infrastructure.

Medical device manufacturing: Local production of technologically advanced equipment can reduce costs and create export potential.

Pharmaceutical research and export: Bangladeshi medicines are globally recognised. Increased investment in research and production will further boost exports.

Call for global collaboration

WE INVITE globally ranked medical universities, academic health centres, teaching hospitals, and pharmaceutical corporations to explore joint collaborations with local institutions in Bangladesh. This includes:

Establishing branch campuses or twinning programmes with Bangladeshi medical schools.

Setting up clinical research partnerships in oncology, non-communicable diseases, and advanced therapeutics.

Launching technology transfer hubs in diagnostics, AI in health, and precision medicine.

Co-investing in centres of excellence for cancer care, trauma rehabilitation, and transplant services.

Creating incubators for health startups in collaboration with local entrepreneurs and investors.

Such collaborations will not only provide high returns but also ensure meaningful social impact by building capacity and reducing global health inequity.

Attracting international patients

MILLIONS across the globe are seeking affordable, high-quality medical care. India and Thailand have already capitalised on this through strong medical tourism markets. Bangladesh, too, can tap into this opportunity by ensuring international standards of care, skilled professionals, clean environments, advanced technology, and digital referral systems. Expatriate Bangladeshis from the Middle East, USA, Canada, and Australia are especially likely to return for treatment. Simplifying medical visa processes, introducing airport-to-hospital shuttles, and creating package-based medical tourism offers will further attract foreign patients.

Medical devices and equipment production

ACCORDING to data from the Directorate General of Health Services and the Ministry of Commerce, Bangladesh imports an estimated $1.5 to 2 billion worth of medical devices, radiotherapy machines, and diagnostic tools annually. Producing these locally would not only save massive foreign currency but also open export markets. Currently, most critical medical equipment, including cancer therapy and surgical tools, are imported. With the right technology and public-private partnerships, Bangladesh can develop its own manufacturing capacity. Countries like India, China, and Malaysia have already captured a significant share of this global market. With relatively low labour and production costs, Bangladesh is well-positioned to become a medical device exporter. According to Allied Market Research, the global medical device market was valued at $570 billion in 2023 and is projected to reach $800 billion by 2028.

Opportunity for foreign investment in pharmaceuticals


BANGLADESH’S pharmaceutical industry is thriving, with exports to more than 150 countries. However, greater research and international investment are needed for developing innovative drugs—particularly for cancer, diabetes, heart disease, and rare diseases. Collaborations between domestic and international pharmaceutical companies could accelerate this growth. Such partnerships would generate employment, facilitate technology transfer, and ensure high-quality local production. This would also reduce drug prices and enhance competition in the domestic market. According to Business Monitor International, Bangladesh’s pharmaceutical export market reached $2.1 billion in 2023, growing at a rate of 8–10 per cent annually. With TRIPS waiver benefits extended until 2033, Bangladesh can manufacture patented medicines without restriction, making it a highly attractive destination for pharmaceutical investment.

Potential benefits

Saving billions in foreign currency annually.

Ensuring access to world-class healthcare domestically.

Generating millions of new jobs in the health, pharma, and equipment sectors.

Establishing Bangladesh as the healthcare hub of South Asia.

Improving international investor confidence and economic ratings.

Conclusion

INVESTING in healthcare in Bangladesh is a strategic decision — one that can significantly impact public health, the national economy, and the country’s global standing. With defined policies, structured partnerships, and a long-term roadmap, Bangladesh has the potential to emerge as South Asia’s premier medical hub. For development partners and investors, this is a high-impact opportunity where humanitarian value, profitability, and social responsibility intersect.

Professor Dr Syed Akram Hussain is a member of Health Sector Reform Commission.​

 

[Saif]

icddr,b launches advanced genome sequencing-based cancer diagnostics in Bangladesh

icddr,b has launched its Next-Generation Sequencing (NGS)-based cancer diagnostic service, making a major step forward in making precision cancer care more accessible and affordable in Bangladesh. Offered by the icddr,b Genome Centre, this is the most comprehensive molecular testing service of its

thefinancialexpress.com.bd

icddr,b launches advanced genome sequencing-based cancer diagnostics in Bangladesh
FE Online Report
Published :
Apr 23, 2025 16:48
Updated :
Apr 23, 2025 16:48

icddr,b has launched its Next-Generation Sequencing (NGS)-based cancer diagnostic service, making a major step forward in making precision cancer care more accessible and affordable in Bangladesh.

Offered by the icddr,b Genome Centre, this is the most comprehensive molecular testing service of its kind in the country, developed to support cancer specialists with faster, more accurate, and locally available diagnostics to guide personalised treatment plans.

The initiative addresses a longstanding call from Bangladesh’s cancer specialist community to reduce dependence on overseas laboratories, according to icddr,b.

Currently, many patients wait four to five weeks for results, often at high cost and with questionable report quality. In contrast, icddr,b will deliver reports in less than two weeks, backed by internationally trained experts, cutting-edge equipment, and globally benchmarked standards, it added.

“We are taking a transformative step toward accessible and precise cancer care in Bangladesh,” said Dr Md Mustafizur Rahman, Senior Scientist and Acting Senior Director, Infectious Diseases Division at icddr,b, adding that “We are ensuring the highest quality through globally trained professionals, rigorous validation, and world-class infrastructure. Our commitment is to provide cancer specialists and patients with timely, trusted insights that can make all the difference in cancer care.”

The service was developed under the leadership of Dr Tahmeed Ahmed, Executive Director of icddr,b, who envisioned the Genome Centre as a strategic initiative to strengthen national cancer care.

“This was a gap we could not ignore,” said Dr Tahmeed. “Our goal is to ensure no patient has to wait weeks or travel abroad for critical test results. We invite cancer specialists to work with us to bring this service to more people who need it most. This is not just a service—it’s a promise to deliver hope, trust, and better outcomes for all parties in cancer treatment and management in Bangladesh.”

This announcement builds on the momentum of a high-level visit to the icddr,b Genome Centre on 12 December 2024 by the Oncology Club of Bangladesh, and joined by members of the Lancet Oncology Editorial Board, and SAARC cancer specialists attending the Bangladesh International Cancer Congress.

The delegation praised icddr,b’s efforts to build world-class diagnostic capacity and advance cancer care in Bangladesh.

A 2025 nationwide study by BSMMU found that cancer affects over 100 in every 100,000 people in Bangladesh, with breast, oral, stomach, throat, and cervical cancers being the most common. Many patients facing delays in diagnosis, early and reliable testing is essential.

The icddr,b Genome Centre is well positioned to play a vital role in improving outcomes and reducing the national cancer burden. It offers testing for breast, lung, colon, ovarian, and blood cancers, enabling doctors to intervene when treatment is most effective.

To facilitate patient access, samples will be collected from any of the icddr,b Diagnostics Centres and booths in Mohakhali, Mirpur, Motijheel, Dhanmondi, Uttara, Niketon, Gulshan, and Baridhara.​

 

[Saif]

Health commission gets it right but execution matters

The recommendations, as reported primarily in the print media, made by the Health Sector Reform Commission look radical and ambitious. But the sector needs such a reconstructive surgery rather than a cosmetic one to cure the system. One of the basic human rights is right to health but this is gross

thefinancialexpress.com.bd

Health commission gets it right but execution matters
FE
Published :
May 07, 2025 23:44
Updated :
May 07, 2025 23:44

The recommendations, as reported primarily in the print media, made by the Health Sector Reform Commission look radical and ambitious. But the sector needs such a reconstructive surgery rather than a cosmetic one to cure the system. One of the basic human rights is right to health but this is grossly undermined almost everywhere, only more so in countries like Bangladesh, because of the outrageous social disparities. So the health reform commission has done the right thing by recommending legal coverage for every citizen's primary healthcare irrespective of his/her social standing. Incorporation of such a legal provision will guarantee that no one is denied medical attention. But this cannot be implemented automatically unless the medical infrastructure and other allied paraphernalia are attuned to the proposed healthcare act. Happily, the commission has focused on such details meticulously in order to make the medical marvel happen in the country through gradual implementation of its suggestions.

The first bold step would be higher health allocation initially at 15 per cent of the national budget. On the infrastructure side, the union level health and family planning centres have to be transformed into primary healthcare centres. What about upazila health complexes? In urban areas, their counterparts would be established at the ward level. Clearly, the emphasis is to take healthcare to the doorsteps of people at the grassroots level. If the programme can be made effective, it will be decentralisation of healthcare at its very best. The referral system suggested by the commission will then screen the patients with various acute or complicated ailments to district-level hospitals which will have specialised healthcare arrangements. Will the upazila health complexes serve as referral points? But how the medical facilities at the district level will improve their healthcare system is critical. Medical colleges and universities have to be restructured, according to the suggestion, to make them aligned to the World Federation for Medical Education (WFME). For overall supervision a permanent body to be named as the Bangladesh Health Commission will be assigned the job.

In fact, the whole gamut of medical system has been brought under the scanner. Medicines will have to be prescribed under the generic names, 25 per cent of which immediately and the rest within next five years in order to end the anarchy in the pharmaceutical sector. Alongside, the hawkish promotional activities by medical representatives, as prevailing now, will be banned. Additionally, establishment of a separate facility to be named a National Institute of Women's Health has also been recommended.

Clearly, a comprehensive analysis of the problems facing the health sector has been made. But still a few things need to be clarified. There is no guideline of taming the vested interest quarters including the big pharmaceutical sharks and commercial private practice. Although higher remuneration and special financial benefits have been suggested, those are unlikely to match the income from private practice by senior medical consultants. Similarly, streamlining the operation of pharmaceutical industries may not be any easy job unless a political government has the motivation and determination to do so. Finally, underlying the health reform commission's exercise is a highly appreciable intent to transform the healthcare system by revolutionising the process of accessing at least primary medical treatment on an equal basis. But the next level of healthcare will still remain unreachable to the poor and low-income people. Yet if the system offers medical treatment on a par with that offered abroad where $4.0-5.0 billion is spent annually by Bangladesh patients, the money thus saved can be reinvested for free treatment of at least a certain percentage of the poor and vulnerable.​

 

[Saif]

The alarming state of private healthcare

Licence renewal failures are undermining healthcare integrity

www.thedailystar.net

The alarming state of private healthcare
Licence renewal failures are undermining healthcare integrity

It is deeply concerning that thousands of private hospitals, clinics, and diagnostic centres across the country continue to operate without renewing their licences, largely due to inadequate monitoring by the Directorate General of Health Services (DGHS). Reportedly, out of 19,627 registered private hospitals and clinics, only 914, or just 4.66 percent, renewed their licences as of April 27. The previous year saw slightly better compliance, with 2,754 facilities renewing their licences. Likewise, only 1,790 of the 35,597 registered private diagnostic centres—around 5 percent—have completed their renewals this year, compared to 5,735 last fiscal year. This situation poses serious risks to patient well-being and safety, treatment quality and overall service standards, as well as hygiene in these facilities. A lack of oversight by the authorities could also lead to the use of substandard medical equipment or unsafe practices, as experts have warned.

According to the acting president of the Bangladesh Private Hospital, Clinic, and Diagnostic Owners Association, 90 percent of hospitals and diagnostic centres have applied for renewal this fiscal year. However, the process faces delays due to the limited inspection capacity of the DGHS. The requirement for environmental and narcotics clearance further slows down the renewal process. Previously, facilities could submit proof that they had applied for clearance, which was considered sufficient for licence renewal. However, a recent policy change now mandates the submission of an environmental clearance certificate, adding another obstacle to timely renewals.

The authorities' failure to conduct inspections efficiently has also allowed some healthcare providers to exploit the system, submitting renewal applications without necessary or up-to-date documents while continuing operations unchecked. This issue demands immediate attention. Over the past two decades, private healthcare facilities have proliferated across the country, mainly due to gaps in the public healthcare system. Unfortunately, many of these hospitals prioritise profits over patient care, treating healthcare as a secondary concern. Some even operate without the required credentials, a situation made worse by the inefficiency of the regulatory bodies. Without regular renewals, maintaining quality healthcare will become increasingly difficult.

A renewed licence ensures that a healthcare facility has the necessary manpower, equipment, and operational standards in place. Therefore, we urge the DGHS to expand its inspection team and improve resource allocation to ensure thorough evaluations of these institutions. While the renewal process should be simplified to avoid unnecessary hassles, private hospitals, clinics and diagnostic centres must still comply with standard procedures and submit proper up-to-date documents. Additionally, the DGHS must proactively scrutinise the thousands of private healthcare facilities that have mushroomed across the country over the years. And institutions failing to meet required standards should have their licences revoked to uphold healthcare integrity and protect patient welfare across the country.​

 

[Saif]

Health budget cut runs counter to reform ambition

The education and health sectors have historically been neglected in government budget allocations, resulting in excessive commercialisation and high out-of-pocket expenses for citizens. Many had high hopes that the interim government would break this trend by prioritising these two critical sector

thefinancialexpress.com.bd

Health budget cut runs counter to reform ambition
Atiqul Kabir Tuhin

Published :
May 22, 2025 00:05
Updated :
May 22, 2025 00:05

The education and health sectors have historically been neglected in government budget allocations, resulting in excessive commercialisation and high out-of-pocket expenses for citizens. Many had high hopes that the interim government would break this trend by prioritising these two critical sectors through increased funding and meaningful reforms. Unfortunately, that hope now appears to be fading as allocations for both education and health are set to decrease in the upcoming fiscal year. Compared to the current fiscal year's Annual Development Programme (ADP), funding for education will be reduced by approximately 30 billion taka, while the health sector will see a cut of around 25 billion taka.

The funding cut for the health sector comes at a time when the Health Sector Reform Commission is advocating for an increase in health spending to 15 per cent of the national budget and 5 per cent of GDP. This recommendation reflects the magnitude of systemic investment needed to revitalise the country's ailing health sector.

Yet, it is perplexing that the government is moving in the opposite direction. . Although the reform proposals have yet to be formally approved, the government could have at least signaled that, starting this year, health and education would be treated as priority sectors. If the current government ignores the reform commissions' recommendations, chances are high that all the well-meaning proposals, no matter how promising, will be shelved and forgotten under future political administrations.

The Health Sector Reform Commission, headed by National Professor Dr. AK Azad Khan submitted a fairly comprehensive report to Chief Advisor Dr Muhammad Yunus just two weeks back. The commission has put forward a bold and ambitious set of measures aimed at transforming the country's healthcare system into a more inclusive, accessible, and pro-people framework. At the heart of the Commission's recommendations is a call to recognise primary healthcare as a legally enforceable fundamental constitutional right, to be provided free of cost. It is unfortunate that, even after 54 years of independence, the state has failed to ensure basic rights such as healthcare for all citizens.

Although Article 15 of the Constitution enshrines food, clothing, shelter, education, and medical care as fundamental rights, there is no legal mandate to enforce it, rendering the basic rights largely ornamental. Recognising primary healthcare as a legal right, therefore, would mark a significant step forward, especially at a time when social disparities have been increasingly undermining equal access to these basic services. However, legal recognition alone is not enough. Such a shift demands concurrent investments in healthcare infrastructure, staffing, training, and logistics to become meaningful in practice.

To support this transformation, the Commission recommends making union-level health and family planning centres into fully functional primary healthcare centres, attended by at least two MBBS doctors and other necessary staff. In urban areas, equivalent facilities are to be established at the ward level. Once implemented, the people will receive free primary treatment at these facilities at ward or union levels. Facilities at this tier will function as referral points in the proposed system. According to the Commission's plan, a structured referral mechanism would direct patients with more chronic or acute conditions to Upazila or district-level hospitals.

The commission also proposes providing initial essential medicines ree of cost, then at subsidised prices from pharmacies at public healthcare facilities to be established under a National Pharmacy Network. Equally important is the proposed exemption of VAT on medicines for life-threatening and chronic conditions such as cancer, diabetes, hypertension, and essential antibiotics, which would significantly benefit low-income populations.

However, without sufficient budgetary support, even the most well-intentioned policies will remain nothing more than words on paper. Over the past decade, health sector budgetary allocations have remained stagnant at around five per cent of the national budget. Compounding the issue, the Ministry of Health has consistently failed to fully utilise its allocated funds. This lack of budget implementation capacity has often been cited as a reason for slashing allocation for health. Without enhancing the government's ability to plan, execute, and monitor spending effectively, increased allocations alone will not yield improved health outcomes. Deep-seated issues like corruption, administrative inefficiency and political interference must also be addressed for any reform measure to succeed. At the same time, good governance and oversight are essential to ensure that increased spending translates into improved outcomes for citizens.

Meanwhile, concerns about the feasibility of the Commission's proposals were raised during a recent webinar hosted by the South Asian Network on Economic Modeling (SANEM), titled "Health Reform Commission Report: Quick Fixes or Transformation?" Leading health economists pointed out that the report lacks a phased, time-bound roadmap. It offers limited guidance for policymakers on sequencing reforms, estimating costs, or identifying financing strategies. While the recommendation to increase health spending to 5 per cent of GDP is laudable, it would remain ambitious without a clear mechanism to fund such an expansion. They said the report does not address crucial options such as national health insurance, public-private partnerships (PPPs), or diaspora contributions-recourses that could help close the funding gap without unduly burdening taxpayers.

Bangladesh's healthcare sector stands at a pivotal crossroads. The country has made notable progress in several development indicators, yet the health sector continues to lag-not due to a lack of potential, but because of a lack of sustained priority. This trend must be reversed. A healthy population is not only a matter of social justice but also a cornerstone of economic productivity and national development. A universal healthcare system cannot be built on a fragile fiscal foundation. The government must take the Health Sector Reform Commission's recommendations seriously and act with urgency and commitment. Health is not a luxury-it is a fundamental necessity that must be enshrined and upheld in the national development agenda.

​

 

[Saif]

How young citizens of Bangladesh can transform the future of its healthcare

Students are uniquely positioned to act as catalysts for transformation.

www.thedailystar.net

How young citizens of Bangladesh can transform the future of its healthcare

Beyond the classroom, students would engage in hands-on, community-oriented activities designed to translate knowledge into action. Photo: FREEPIK

In Bangladesh, seeking healthcare services is marked by profound challenges that stem from a complex interplay of demand- and supply-side barriers. On the demand side, pervasive low health literacy severely limits individuals' ability to make informed decisions about their well-being. Sociocultural norms, often deeply entrenched, discourage proactive engagement with healthcare systems. At the same time, misconceptions about medical care, such as equating medicine with treatment, or assuming that costly interventions guarantee superior outcomes, further complicate the issue. Affordability remains a significant hurdle as many families struggle to access even basic services. Additionally, the readiness of public health facilities is often inadequate, undermining trust and discouraging utilisation. On the supply side, the healthcare system is a fragmented, pluralistic mix of providers, ranging from trained allopathic practitioners to unregulated traditional healers. This diversity, coupled with weak regulatory oversight, results in inconsistent care quality and frequent instances of inappropriate treatment.

For decades, efforts to address these issues have centred on behaviour change communication (BCC) campaigns, which aim to educate communities and shift attitudes towards healthier practices. While these initiatives have achieved some success in raising awareness, their impact is often fleeting. Top-down messaging struggles to resonate with our diverse population, failing to account for regional, cultural, or socioeconomic variations. Moreover, these campaigns rarely address deeper systemic issues, such as widespread mistrust in public health services or the absence of robust regulatory frameworks. As a result, the gains from such interventions tend to dissipate quickly, leaving communities vulnerable to the same barriers. To break this cycle, Bangladesh requires a transformative, community-driven solution, one that harnesses the potential of its youngest citizens to lead a paradigm shift in health literacy and behaviour.

Imagine a classroom in a rural Bangladeshi village where third-graders are not only learning foundational subjects like mathematics and language but also absorbing critical lessons about hygiene, the importance of vaccinations, and the value of clean water. Picture high school students stepping into leadership roles, organising health fairs to dispel myths about generic medicines or teaching their parents how to recognise early symptoms of common illnesses. This vision forms the core of an innovative proposal to train students from classes 3-12 as health ambassadors, equipping them with the knowledge, skills, and confidence to drive meaningful change in their families, peer groups, and broader communities.

Students are uniquely positioned to act as catalysts for transformation. As trusted members of their households, especially in rural areas, school-going children have a remarkable ability to share knowledge in ways that resonate deeply, often bypassing the resistance that external campaigns encounter. A young girl explaining the importance of antenatal care to her mother might inspire timely visits to a clinic, improving maternal and child health outcomes. A teenage boy challenging myths about traditional healers in his village could shift community perceptions, encouraging reliance on qualified providers. Through their peer networks, students can amplify these messages, normalising behaviours such as seeking care from licensed practitioners or prioritising preventive measures like regular check-ups. In communities where scepticism towards public health services runs high, students can serve as bridges, rebuilding trust by sharing evidence-based information about the benefits of government-run clinics and programmes.

The proposed approach is both practical and adaptable to the developmental stages of students. Children in classes 1-5 would focus on foundational health concepts, such as the importance of handwashing, safe drinking water, and balanced nutrition. These lessons would be integrated into their existing curriculum, making them accessible and engaging through interactive activities like storytelling or games. Older students, in classes 6-12, would tackle more complex topics, including maternal and child health, the management of non-communicable diseases like diabetes, and the dangers of self-medication or reliance on informal providers. To deliver this education, schools would establish well-being clubs—student-led groups supported by trained teachers. These clubs would serve as platforms for peer learning, fostering a sense of ownership and responsibility among participants.

Beyond the classroom, students would engage in hands-on, community-oriented activities designed to translate knowledge into action. Peer health clubs would encourage students to share what they have learnt with friends, creating a ripple effect of awareness. Community outreach initiatives, such as health fairs or door-to-door campaigns, would allow students to directly engage with neighbours, promoting local health services and addressing common misconceptions.

This strategy offers a sustainable, cost-effective alternative to traditional campaigns. By leveraging existing school infrastructure, the programme minimises the need for additional resources while maximising reach. Teachers, already embedded in the education system, can be trained to deliver health lessons, ensuring consistency and scalability. Local health workers can complement these efforts by providing technical support, such as guest lectures or materials for student-led campaigns. The ripple effect of this approach is profound: a single child educating their family can spark generational change, while peer-to-peer sharing builds a network of informed advocates. Over time, these efforts can reshape community norms, fostering a culture of accountability where citizens demand quality care and providers are incentivised to deliver it.

Evidence from similar initiatives underscores the potential for success. In India, school-based health education programmes have significantly improved hygiene practices, leading to measurable reductions in waterborne diseases. In sub-Saharan Africa, youth-led campaigns have increased awareness of HIV/AIDS, driving higher rates of testing and treatment adherence. These examples demonstrate that young people, when equipped with the right tools, can affect meaningful change. In Bangladesh, implementation would begin with the development of a tailored curriculum, designed in collaboration with health and education experts to align with national priorities. Teachers and students would undergo training to ensure effective delivery, while partnerships with local health offices would provide logistical support. Successful pilots could be scaled up through integration into national education policies, with backing from government agencies and development partners.

The challenges facing Bangladesh's healthcare system are formidable, but they are not insurmountable. By investing in students as health ambassadors, the country can cultivate a generation of informed, empowered leaders who redefine how communities engage with healthcare. This approach taps into the energy, creativity, and influence of young people, transforming them into agents of change. As students share knowledge, challenge misconceptions, and advocate for better care, they lay the foundation for a healthier, more equitable society. The voices of confident, knowledgeable young ambassadors could ignite a healthcare revolution, ensuring that every citizen has the tools to seek, demand, and access quality care. Through this innovative strategy, Bangladesh has the opportunity to not only address its immediate health challenges but also build a resilient, informed population capable of sustaining progress for generations to come.

Dr Syed Abdul Hamid is professor at the Institute of Health Economics of Dhaka University and convener at Alliance for Health Reforms Bangladesh (AHRB).​

 

[Saif]

Underfunding cripples public health sector

Health facilities are the places where the two most important events of life for a large number of humans - birth and death - take place. In today's world parents want their babies are born in a hospital, not at home, to avoid childbirth complications that might risk the life of baby or mother or b

thefinancialexpress.com.bd

Underfunding cripples public health sector

Shiabur Rahman
Published :
May 30, 2025 00:05
Updated :
May 30, 2025 00:05

Health facilities are the places where the two most important events of life for a large number of humans - birth and death - take place. In today's world parents want their babies are born in a hospital, not at home, to avoid childbirth complications that might risk the life of baby or mother or both. People prefer hospital care for themselves and their dear ones whenever they fall sick, particularly when they are terminally ill. Budgetary allocation and government's attitude to healthcare, however, do not reflect the priority the sector deserves.

There is no denying that the country's public healthcare system is grappling with chronic underfunding, misplaced priorities, inefficient management, and structural rigidity. Budgetary data in the last decade suggest that successive governments consistently allocated an average of just 5.0 per cent of the national budget for health. The allocation accounted for 2.0 per cent of the Gross Domestic Product (GDP). The figures are alarmingly low when compared with the recent Health Sector Reform Commission's recommendations, which suggest an allocation of at least 5.0 per cent of GDP and 15 per cent of the national budget to improve the country's healthcare system. More concerning is the fact that despite increasing public health demands the health ministry cannot fully utilise whatever allocation it receives. It is subjected to major cuts during mid-year revisions.

A critical yet often overlooked issue contributing to poor budget utilisation is the lack of administrative and financial skills among hospital managers. Most public health facilities in the country are headed by physicians. These doctors may be highly skilled in clinical care, but lack experience in financial management, project planning or administrative governance as most of them do not receive any formal training in these fields. Such skill mismatch leads to significant inefficiencies, resulting in a struggle for directors or chief executive officers with planning expenditures, preparing detailed project proposals, and executing development funds. As a result, significant portions of the development budget or Annual Development Programme for the ministry remain unused, prompting the finance ministry to downsize it towards the end of the fiscal year. Poor implementation performance affects infrastructural development, equipment procurement, and system upgrades, delays service delivery and deters international development partners from channelling aid through government systems.

Another administrative bottleneck lies in the highly centralised nature of health financing. Public health facilities are not allowed to retain or reinvest their earnings, no matter how significant they are. Government health facilities are legally bound to deposit almost all their revenues to the national exchequer within a limited time frame, leaving facility managers with no flexibility to address urgent local needs or improve service delivery. Such rigidity discourages initiative at the local level. A government hospital that earns revenue from different services cannot use that money to repair essential equipment, purchase emergency medicines or procure other emergency supplies.

The underfunding and low budget implementation in the health sector lead to overcrowded hospitals, overworked doctors, inadequate medical supplies and poor infrastructure. People often have to rely on out-of-pocket (OOP) expenditures for even basic health services, deepening inequalities. According to several surveys, Bangladesh consistently ranks among the countries with the highest OOP spending on health globally. In 2021, the World Bank reported that Bangladesh's OOP expenditure was 73 per cent while health economists estimate that the current real OOP expenditure has reached 83 per cent. Low government investment in health sector and a lack of health insurance result in so high OOP, causing financial burdens on families.

The Health Sector Reform Commission has put forward a roadmap to reverse the current state of public healthcare. It is now up to policymakers to demonstrate the will to follow through. Ensuring adequate funding, building administrative capacity of health facility managers, and decentralising financial authority are not merely technical reforms; they are essential steps towards securing the health and dignity of every Bangladesh citizen.​

 

[Saif]

We need an efficient healthcare system

Unimplemented health budget remains a major concern

www.thedailystar.net

We need an efficient healthcare system
Unimplemented health budget remains a major concern

At a time when healthcare experts are urging the government to increase the allocation for the health sector to 15 percent of the national budget or five percent of the GDP, it is deeply concerning that the two government divisions responsible for healthcare delivery have not even been able to utilise their Annual Development Programme (ADP) allocations. Reportedly, over the past 10 months, these two divisions—Medical Education and Family Welfare Division and Health Services Division—spent only a small portion of the funds allocated to them, making them the poorest performers in utilising their development budget. One of them spent only 2.34 percent of its Tk 2,283.16 crore budget by April this year—the lowest among all ministries and divisions—while the other used 14.9 percent of its Tk 5,673.51 crore budget, also nearing the bottom of the list. Unless the government addresses the factors behind such dismal performance and seriously considers the recommendations of the Health Sector Reform Commission, the much-needed change in our health sector will not come.

Reportedly, the factors identified by experts for poor ADP execution include the implementing agencies' lack of capacity, inexperienced project directors, dependence on the Public Works Department for construction, outdated budgeting methods, and leadership changes following the July uprising. In addition, government agencies often lack the necessary managerial and administrative capacity and experience to implement projects in the health sector. Many implementing agencies also lack financial autonomy, requiring them to seek the ministry's intervention, which is often a lengthy and bureaucratic process.

One crucial health project that has been delayed over the years is the one to establish fully fledged treatment centres at eight divisional headquarters for cancer, heart, and kidney patients. The project, approved in July 2019 and originally scheduled for completion by 2022, has undergone several revisions but still remains unfinished. Many other infrastructure development projects—for hospitals, medical colleges, universities, diagnostic facilities, and medical research centres—as well as the procurement of medical equipment are also facing similar delays. This means that the budget allocated for these projects remains unutilised.

While successive governments' neglect has completely crippled our health sector over the years, the situation has sadly remained the same during the interim government's tenure. We urge the government to address the issues hampering the health sector budget utilisation. The health budget must also address sector-specific needs, ensuring that adequate funds are allocated for the most-needed areas. The health sector must also have efficient leadership to ensure these projects are designed properly from the very beginning. The reform commission has put forward some pragmatic recommendations to overhaul our healthcare system, which should be implemented to make it efficient, pro-people, and accessible to all.​