From an economic perspective, a healthy nation is a productive nation indeed, a notion which strongly advocates the substantial allotment of resources to healthcare, something that Bangladesh’s last two budgets has failed to uphold, evidenced by the lowest allocation recorded in 24 years. One look at the doctor population ratio ( reported as 1:43660) gives us an overview of the extent of existing inadequacies, and a lion’s share of the blame itself goes to the absence of an approved and lucid health policy. Defined as "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’’, health is a quintessential dimension development, especially in a densely populated country like ours.Healthcare: How much are we entitled to?
According to an article published by the Business Insider, which delineated the expenditure patterns of different nationalities, the United States was identified as the biggest global investor on healthcare quite predictably, with the Healthcare Bill considered as a historic reform brought by the Obama cabinet.
Worldwide concerns about healthcare are increasingly on the rise, especially in developing nations, traditionally classified as lacking behind in terms of proper sanitation, hygiene and healthcare and also attributed as one of the reasons for lower life expectancies in Sub-Saharan African and South-East Asian nations. Over the decades however international development agencies have played a pivotal role in facilitating tremendous developments in the health sector, the forerunners being United Nations and its auxiliary bodies.
From an economic perspective, a healthy nation is a productive nation indeed, a notion which strongly advocates the substantial allotment of resources to healthcare, something that Bangladeshs last two budgets has failed to uphold, evidenced by the lowest allocation recorded in 24 years. One look at the doctor population ratio ( reported as 1:43660) gives us an overview of the extent of existing inadequacies, and a lions share of the blame itself goes to the absence of an approved and lucid health policy. Defined as A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, health is a quintessential dimension development, especially in a densely populated country like ours.
Poor health conditions in Bangladesh are attributed not by the lack of available public healthcare services however, but the inferior quality, juxtaposed to that provided by the private sector. The health care is a pluralistic system with four key actors: government, private sector, nongovernmental organizations (NGOs) and donor agencies.
The Government or public sector is the first key actor which is held as the single most vital provided of health care, as per the Constitution. Quality of services and facilities, however, is quite low due to insufficient allocation of resources, institutional constraints and Absenteeism. In order to fulfill the huge discrepancy created by the Governments limited capacity to provide basic health services, the private sector and NGOs have thrived in Bangladesh, and has consistently proved to be the more viable alternative. In response to the low quality of public services and their incapability to reach the entire population, international NGOs like Care Bangladesh or Danida have emerged as the Third Force, disseminating basic healthcare at the grass root level where state presence is almost intangible.
A parallel expansion in the demand for private healthcare has seen the radical proliferation in the number of nursing homes and private hospitals over the decade. One of the underlying causes of the intervention of the private sector could be blamed on the immense pressure on state-subsidized facilities provided by public hospitals like Dhaka Medical College. Given their affordable and feasible charges, they undoubtedly draw a huge proportion of the patients from low or middle income background.
Nevertheless the pressing problems faced by those seeking public healthcare however, is negligence and lack of maintenance, an issue that has maligned the reputation of public hospitals over the years. For the affluent class and those belonging to upper echelons of the society, private hospitals are the number one option, with their state of the art facilities and panels of highly qualified specialists. The huge divergence in service charges demanded by public and private hospitals simultaneously is an embodiment of the polarized quality of services provided by the two.
Mubasshir Morshed (not real name) , currently posted as a medical researcher in a reputed public hospitals of the country, delves into the various eclectic issues that entail the health sector of our country, a resonance of his arduous journey from a medical intern to a professional.
Like thousands of other medical students, I nurtured the intention to dedicate myself as a servant to humanity, to relieve their pain. Holding the circumstances of our country in perspective, however I soon received bitter dosed of reality over the span of internship. As a practitioner, I believe that the absence of a referral system is a concomitant brewer of frustration that we often see in young MBBS graduates in our country. A referral system is basically a structured form of hierarchy that exists all over the world, from general physicians at the very bottom, to specialist consultants at the top.
In our country a patient has direct access to the services of a specialist, so there is no scope for a young doctor to treat the patient at all, let alone refer the patient to a professional with greater experience and skills, in case he/she is unable to provide proper diagnosis. This practice of level jumping is responsible for prolonged periods of involuntary unemployment among fresh graduates, something which eventually pushes them towards malpractice.
When inquired about the extent to which political influence poses an obstruction to a laymans access to healthcare he ascribes, The problem isnt politics. Rather the root is embedded in the unjust immunity that political power gives these so called peoples representatives. If we observe closely, we can see that most of private hospitals and diagnostics at the district level are owned by political leaders or individuals who have some kind of affiliation with the ruling party.
He cites an example, Lets say an MRI costs TK 3000 in Mymensingh Medical College, which is state run whereas the same test will cost a patient TK 10,000, almost 4 times as much. What this politically backed philanthropist does is, he utilizes his muscle-power to make sure the MRI machine at the public hospital is malfunctioning or on the verge of becoming dysfunctional, so that the patient who would have otherwise visited the Medical College will be compelled to treat the malady at his clinic, thus establishing a foolproof way to retain profits.
But its not just the leaders who are corrupt, he laments, its the degradation of moral values and ethics amongst us that has led to such debacles.
A kidney transplant in India costs around 50 lakhs today whereas in Bangladesh the same operation could be afforded within 1.5 lakhs, but because of some unscrupulous traders involved in the heinous crime of selling kidneys, the state had to put a complete embargo on kidney transplant in Bangladesh. Now, there is no choice but to fly to our neighboring state and if God forbid the patient belongs to a vulnerable financial background, he might as well go bankrupt.
So as a physician and a stakeholder what kind of policy implementations are needed to improve the current scenario? ,he is asked.
Well, I would say the state needs to dismantle the very definition of health care currently advocated by our Constitution. Health isnt something that you can marginalize within the public good category. Neither is it non-excludable or non-rival, especially in the 21st century when medical science has made phenomenal progress with the help of technological advancement. Diagnosis and treatments are no longer as simple as it was fifty years back, and in an overpopulated country like ours, it is not possible for the state to bear the elephantine expenses of free health care, as opportunity costs are high. It is time we discarded the highly apocryphal free healthcare model of the British, and embrace the more pragmatic American system, based on health insurance. Tightening state regulations on private healthcare is a sine qua non if the government wants to uphold accountability and quell political foul play, he concludes.
A recent incident involving a grievously injured victim of road accident who was refused medical help (because apparently accidents are criminal cases and have to be dealt with by law enforcers a.k.a police), and succumbed to death subsequently has forced quite a few of us to rethink our rights as citizens and human beings. It is time the lawmakers addressed the inexcusable legal loopholes that atrophy our security. In a country where road accidents are rampant, legislations that protect the lives of victims must be promulgated, to impart justice.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm
-Excerpt from the Hippocratic Oath How much truth does this statement hold in todays world?
The question remains.
