[🇧🇩] Healthcare Industry in Bangladesh

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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.​

 

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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.​

 

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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.​