Looking objectively at the health sector

Bangladesh has been one of the countries to pursue a policy of extending public health care at free or nominal costs to large sections of its population who badly need such medical or health care as they are too poor to buy medicare privately. Bangladesh is not seen lagging behind also in having an extensive network of public hospitals, health complexes in rural areas and publicly run hospitals and specialised treatment centres in the cities. These are also staffed by a large number of doctors, nurses, technicians and medical assistants.
A strong demand was voiced that more doctors and nurses should be appointed to improve the public health services. The present and previous governments acted on this proposal and additional doctors and nurses were appointed out of a hope that the same would lead to improved services. But anyone who has recently visited public hospitals and the health complexes across the country surely knows it from first hand experience how shockingly these bodies are lacking in taking proper care of the patients. Transparency International Bangladesh (TIB) that measures corruption, identified the heath sector as the second most corruption infested one in its latest annual report.
It is no overstatement to say that the public health care sector in Bangladesh is in a statethat leaves a lot desired. The same is the result of many factors : lack of supervision, poor motivation, corruption, psychology of those who man this sector, lack of investment in pressing areas of need, lack of training, lack of accountability, etc. In these circumstances, it would be the suggestion of anyone with ground level knowledge of the situation not to give so much attention to the quantity factor but to the quality factors involved in improving public health care. The move to increase the number of doctors and nurses for government service is fine. They may be useful to some extent in providing service where complaints are heard about insufficient number of doctors and nurses to cope with the demand .
But is it really the number that matters so much in the government hospitals and the health complexes ? Any impartial investigation should establish the correct picture which is that more than improving the ratio of number of doctors and nurses to patients , the main problem is the mentality of the doctors and their unrestrained unethical behaviour. Typically, a young doctor with a basic degree from the medical college, on being posted to an upazilla hospital, is found spending most of his or her time in Dhaka city and privately consulting patients for financial gain . He may visit the upazilla hospital like a migratory bird to spend some time there and to draw his salary against his government job which is to be considered not inadequate given his age and experience. But most of the time he or she remains on leave from the upazilla hospital. The picture is the same in all or nearly all the upazilla hospitals or health care complexes.
The scene is the same at public hospitals in the cities. Specialist doctors are at service in these hospitals. But they are found meeting the poor patients for only a part of their stipulated hours of duty. Frequently, in their hurry to see too many patients during a short session, none of the patients properly gets attention from the doctor ; hence diagnosis and prescriptions tend to be far from satisfactory. The doctors at public hospitals take their government salaries regularly and association with these hospitals add to their name and fame. But they are seen utilising this renown to open private chambers and draw patients to them spending the greater part of their time there, away from their hospital duties, to see patients privately for fat fees.
Deceit, exploitation of poor people and utter lack of care are presently the very transparent features of all publicly run medical care institutions in the country. The degrees may vary from institution to institution. But they exist, more or less, in all of them. The public hospitals are supposed to provide medicines free of cost or at much subsidised prices from their stores. The stores are also regularly and well supplied with medicines and various medical paraphernalia for the purpose. But the bitter reality is that patients admitted to public hospitals most of the time are required to buy their medicines or aiding items for surgery from outside the hospitals. They are routinely told that the hospitals’ stores have run out of these goods whereas what happens is that corrupt personnel manning the stores sell the goods — stocked there– to private medicine shops in full connivance with the hospitals’ administrations.
Food and laundry services for the hospitals depend on private contractors engaged by hospital administrations. But the contractors usually supply extremely poor food in terms of both quantity and quality and members of the hospital administrations say or do nothing in response as they get regular kickbacks from the contractors for their silence. The contractors cheat in respect of food supply to squeeze out more profits although ample funds are allocated in the hospitals’ budgets for the supply of proper food. Contractors engaged for the laundry services are also found doing the same to make money at the expense of the comfort and hygiene of the poor patients. Bed sheets and pillow covers come from the laundry as cleaned ones although the patients or their attendants may find them as anything but clean.
The premises of the public hospitals are to be kept germ free. For ensuring the antiseptic environment in them, huge sums are allocated in the budgets of the hospitals. Every government hospital or upazilla health complex on paper employs staff to work as cleaners round the clock to keep the premises clean. But allegedly, many of these cleaners are in the payrolls in paper only with no actual physical existence. The salaries of these ghost workers are regularly pocketed by certain potentates in the hospitals’ administrations. Even the few cleaners who actually work are too badly supervised and they get away with doing very little or nothing. Soaps and detergents for cleaning purposes –bought from funds of the hospitals– are also sold outside like the medicines and medical aids from the hospitals’ stores.
Valuable medical equipment have been lying in disuse at public hospitals. In some cases, the equipments have rusted away or turned unusable. The equipment could be an x-ray machine, dialysis machine, pathological testing instrument, etc.
There is hardly properaccountability to be noted at any tier of the public health care system. Deep and driving measures to be taken and sustained for the improvement of the public health care system, have been long overdue.