Ensuring progress in health sector
The health sector of the country as it observed the World Health Day sometime ago, presents a mixed picture of significant progress, some unattained objectives and cases of back sliding. The incumbent government had promised a great deal in its previous election manifesto and must be credited for having worked considerably to keep its promises.
For example, it was stated in the election manifesto of the Awami League five years ago that in order to expand and strengthen health services at the grassroots level in the country, some 18,000 community clinics would be established at ward level under a new health policy. Some 10,000 of these community clinics have been set up throughout the country. Some more of these clinics at upazilla and union levels are being planned to be integrated under the community clinic framework.
This could be accepted as a very laudable achievement but for the fact that in most cases these clinics are not delivering amply health services consistent with their potentials. A dearth of doctors, nurses, technicians and medical equipment are noted in these clinics in many cases. Thus, the challenge remains to provision these clinics adequately and run them efficiently. The issue of absentee doctors must be addressed – specially– through a proper accountability procedure so that such doctors are only obligated to discharge their duties with due sincerity at their due places of posting.
Many doctors on the government’s health services in connivance with unscrupulous officials in the Health Ministry are usually able to avoid serving in the rural areas. Many of them remain in Dhaka month after month and draw their salaries and other benefits without doing adequate work at their properly designated places while the health services in the rural areas suffer very seriously from absence of doctors. Prime Minister (PM) Sheikh Hasina warned such absentee doctors for their dereliction of duty time and again.
However, like in all other cases of the taste of the pudding coming from eating it, the tough words from the PM will count for something only after the actual taking of the steps that would be required to ensure that the doctors do indeed feel obligated to serve in the rural areas. This is no easy task for on the one hand there are involved problems of psychology and character and, on the other, the doctors can point to the disincentives that keep them away from rural areas. The solution lies in psychologically curing the doctors of their inordinate fascination for working in urban areas as much as also providing them with further incentives, as far as would be truly justified, to have peace of mind to serve with dedication in the rural areas. But the greatest stress will have to be put on strict enforcement of rules and regulations to make it very difficult for them to go on so unconscientiously avoiding their duties in rural areas.
The nation makes much sacrifice to produce a doctor with highly subsidised medical education and then further pays not unreasonably for his or her upkeep with salaries and other facilities. In return, the nation should duly expect to get his or her sincere service. If the same is not honestly discharged, then the nation should have the right to apply coercion so that the same is discharged.
The problems complained by the doctors may not be ignored and steps may be taken to solve them . But the imperative is keeping up consistent pressure on them as per their service rules to do their bounden duties at their work stations.
From 2009, government introduced the so called user fees in the publicly run medical and health care system. Under 23 categories, user fees were introduced for 470 types of services in the public hospitals. The public medical care institutions were obliged, at least in theory, to extend free medical services or at nominal costs till the introduction of this fee.
But in the backdrop of such free and nominal payments leading to poor or even no treatment of patients, it was decided that users’ fees would be applied to bring about positive changes through users bearing a part of the real costs of treatment. This would free the government somewhat from paying huge subsidies ineffectively to the medical sector while enabling better treatment with patients bearing a part of their costs.
But the real experience after introduction of the users’ fees is that patients’ treatment costs, on average, have increased compared to the time when they were treated for free or at nominal costs. Thus, it requires a rethink whether the user fee system should be given up with restoration of the previous system of free treatment or treatment at nominal costs only.
If it is decided to go back to the older system, then it must be ensured that the free system or nominal payment system do not make the patients suffer like in the past due to corruption and neglect. The challenge would be to make the free or nominal payment system free from corruption and to make it work ridding inefficiencies. Then, it could prove to be a blessing.
A major health sector priority ought to be revamping the family planning programme by bringing all or nearly all fertile couples under it at the earliest. It is shocking that 45 per cent of potential couples from the standpoint of procreation abilities, remain unserved by the family planning programme. They are also bypassed by health and nutrition programmes. This neglect must be overcome with targeted policies. Time-bound targets must be pursued also in the areas of sanitation and helping people to avoid arsenic poisoning.
Meanwhile people, specially common people, are happy to see that the big general public hospitals in the cities such as the DhakaMedicalCollegeHospital, are running with some efficiency and a sense of a duty of care compared to the past. Let us hope that this trend would continue and be further improved.