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
Issues in the public health sector
The health sector of the country presents a mixed picture of significant progress, some unattained objectives and few cases of back sliding. The incumbent government had promised a great deal in its 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 that 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. This could be accepted as a 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 as well 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.
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. It was thought that introduction of users fees would free the government from paying huge subsidies while also 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.
A major public health sector priority also ought to be revamping the family planning programme by bringing all or nearly all fertile couples under it at the earliest.
