[🇧🇩] Healthcare Industry in Bangladesh

[Saif]

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.​