Dr. Samir Kumar Saha
Spent billions of Dollars for war purpose, but did not think properly about healthcare services to people and they did not take up any plan for investment in the health sector. Amid the Covid-19 crisis, the world has understood well how much it is important to invest in the health sector. Corona taught us that it is very tough for human beings to survive in the world without health protection.
The health sector in our country is not in satisfactory condition. Now it is the need of time to recast our health sector, including increasing investment in this sector.
The next national budget should be done to help sustain life and livelihood of people keeping in mind the issue of people’s health protection. I hope that the matter would get due priority in the next national budget.
According to a joint survey report (2019) of USAID and several organizations titled “Building awareness for universal health coverage: advancing the agenda in Bangladesh”, per head out of pocket health expenditure is 69.3% for taking health service, which is the highest in the South Asia.
According to the report, there are several reasons for the highest cost for treatment in the country. These are inadequate expenditure, lack of control in government expenditure, less allocation in budget, allocated money not properly distributed, excess pocket money, huge gap between government and pocket money, uncontrolled private health sector, lack of interest in health insurance, reduction of assistance by donors and less participation by private organizations.
There are several successes such as reduction of child mortality, improvement of nutrition condition and increased rate of vaccination in our health sector. But the private sector had no role in those matters. People’s personal health cost is rising due to uncontrolled private sector. Many people turned into poor while meeting their health expenditure. It is a big hindrance to achieving universal health coverage.
According to World Health Organization (WHO), about 52.50 lac people are falling to poverty every year while meeting their health expenditure in Bangladesh. About 2.25 core people are on the verge of big health risks. About 70 lac people from Bangladesh go abroad in the hope of getting better treatment facilities every year as they fail to get it in the country. In a bid to prevent it, those who are involved in the health sector should be aware of it and new technology be introduced in our health sector.
It is needed to further increase the involvement of private sector along with the government if we want to achieve the target of universal health coverage. It is required to take proper steps to provide necessary support to the private sector along with effective control over it.
Research findings said that, 60% of our people get health services from disorganized sector, 14% services are provided by the public sector and 26% provided by the private sector. No country in the world has been able to achieve the target of universal health coverage without the contribution by their private sector.
However, some countries such as Cuba and China are exception in this regard.
Cuba has a record of good health system and it is well-known in the world despite a long time international sanction, imposed by USA, on Cuba. After coming to power, Fidel Castro attached number one priority to health sector for national development. Many people believe that maximum health coverage given for people is the main reason of popularity for Fidel Castro.
In Cuba, efforts were made to build a health care system based on primary treatment. Under the system, family physicians were trained to coordinate public health programme and preventive education with treatment. Encouragement was given to alternative and traditional system of medicines.
A guideline on plant-based medicine was prepared under the initiative of Cuban Health Ministry. This list was hung at most of the hospitals and clinics and also indicating effectiveness of medicine for particular diseases. Encouragement to alternative/traditional medicine created a long term impact on Cuba’s health system. The traditional system, which also included acupuncture taken from outside the country, was also included in regular curriculum of all medical schools in Cuba.
But in our country, the scenery is totally different. Traditional system of medicine (which includes Ayurved and Unani) has been neglected for a long time and it has been kept away from the mainstream medical system. So, it is high time to properly evaluate the traditional system and keep adequate allocation in the national budget for its development as well as research.
Most of our health infrastructures are located in town areas while most of people live in rural areas. It can be termed as severe discrimination. Tendency to go to town by both doctors and patients will increase if health service system is not decentralized. Traffic jam will increase in towns where standard of health service will also deteriorate.
Ensuring participation of people, coordination among all departments, formulation of suitable strategy and ensuring quality healthcare is important if we want to ensure universal health coverage in the country.
Many countries in the world took steps for providing health services through virtual means for ensuring health for all. Treatment and suggestions aimed at facing public health risk are being given virtually.
Traditionally, our physicians get educated only centering hospitals. They only tend to treat patients. They do not get scope for training on social, psychological, cleanliness and epidemiologic side. Steps should be taken for addressing the matter.
We should keep in mind that our country was liberated through a nine month long armed struggle. It is the state’s holy duty to ensure healthcare for all the people. Hence, a suitable human resources policy should be formulated. Through this policy, a qualified manpower would be created for ensuring quality health service for all the people.
The outbreak of Corona pandemic exposed a dismal picture in our health system. We have built up hospital upto upazila level where basic facility of health service was not ensured. Riddled with corruption, incompetence and negligence for a long time, public health is now facing a grim reality. Present crisis in the health sector gave us an opportunity to recast it. We, taking the opportunity, can make our health sector modern and international standard by making adequate allocation in the national budget. Priority in the budget can be done in two categories-one is by facing corona and the other is by improving public health sector such as building infrastructure and renovation of current infrastructures. Hence, short, medium and long term road map should be chalked out. There should be increased budgetary allocation to implement those plans.
The writer is former executive director, Public Health Foundation, Bangladesh
