The quality of health care services is a critical issue that needs to be improved remarkably to retain the reputation of achievements in the health sector. Strong resentment persists in Bangladesh about the deploring and declining standard of quality of health care services in spite of significant improvement achieved in health sector. The quality of health care services remains a matter of discord and great concern for government, health professionals and the public at large. Quality of care in health services must improve
Bangladesh
medical Association as learnt has extended their supports to these reformations undertaken by the Ministry of Health and Family Welfare to regulate unauthorized hospitals, identify fake doctors, restrict the function of below standard medical colleges and control the counterfeit medicine producing pharmaceutical companies
Dhiraj Kumar Nath
The quality of health care services is a critical issue that needs to be improved remarkably to retain the reputation of achievements in the health sector. Strong resentment persists in Bangladesh about the deploring and declining standard of quality of health care services in spite of significant improvement achieved in health sector. The quality of health care services remains a matter of discord and great concern for government, health professionals and the public at large.
What is quality of care?
Quality health care means doing the right thing, at the right time, in the right way, for the right personand having the best possible results in dispensation of services. The Institute of Medicine defines health care quality as the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.. A simple negligence in ensuring the quality of care might be fatal to make the life of a client unbearable leading to chronic ailments and bring premature death of a patient.
A handful of analytic frameworks for quality assessment have guided measure development initiatives in the public and private sectors. One of the most influential is the framework put forth by the Institute of Medicine (IOM) includes six aims for health care system like safety, effectiveness, patient centered responsiveness, timely services, efficiency and equitable services without any discrimination of gender, ethnicity, geographical location and socio-economic status of a client.
Reformation felt necessary
Considering the extent of its implication and realizing this alarming and deplorable situation, Government of Bangladesh has decided to adopt a few reformative measures in the health sector.
Bangladesh Medical Association as learnt has extended their supports to these reformations undertaken by the Ministry of Health and Family Welfare to regulate unauthorized hospitals, identify fake doctors, restrict the function of below standard medical colleges and control the counterfeit medicine producing pharmaceutical companies. All these initiatives are taken to improve the quality of health care services. Besides, there is a plan to recruit about 40 thousand hospital employees to strengthen quality of services. In the meantime, the license of 30 pharmaceutical companies has been cancelled as against the allegation of their production being sub-standard and counterfeit. All initiatives reflect commitments of the government to ensure quality of health care services and improve the image of governance of health sector in Bangladesh.
With the remarkable success of achieving the targets of millennium development goals and government commitments to attain the targets of sustainable development goals by 2030, there are efforts to improve the quality of services with the expansion of coverage of service delivery system. The sector wide approach of health population and nutrition sector development program for the 4th phase will be launched from July 2017 with the budget of more than US $10.00 billion that was about US $ 7.7 billion during 2011-2016 period of time. Unfortunately, quality of health care services could not yet gain peoples confidence although rate of investment and per capita expenditure for health care increased substantially.
Universal health care and challenges
The vision of health care services in Bangladesh is to ensure universal health coverage with pro-poor targeting and gender responsiveness.
Bangladesh, among 17 economies growing over 6 percent plus over the last decade is going to be recognized as middle income country by 2021. During the last 15 years about 2.5 crore of people graduated from poverty and different health indicators are very positive in comparison to countries in the South Asia. Many health indicators that Bangladesh attained are considered as illustrative and unprecedented.
Major challenge towards universal health coverage is to ensure quality of services and provide services to all irrespective of urban or rural and poor and rich.
In spite of large investment in building infrastructure, recruitment of huge numbers of staff and officials including nurses and service providers and procurement of huge medical and surgical equipment, there are wide scale allegations about poor quality of services. The common perception is that quality of services and efficiency of service providers and expertise of doctors and specialists must improve to gain the confidence of public at large.
Medical tourism for quality of care
Every year more than one thousand crores of taka are officially drained for treatment abroad and unofficially huge amount spent that one cannot even think of. Indian High Commission in Bangladesh opened a special medical visa centers to facilitate the patients to go to India. What an alarming and humiliating situation prevailing in spite of so much of money invested to ensure health care services in the country!!
Medical tourism is one of the fastest growing healthcare industries in some countries.. The world is in a healthcare crisis, given the ageing population, increasing costs and long waiting patients from developed as well as developing countries. Streams of people now quite often travel abroad with the objective of obtaining immediate health care. Outbound medical tourism to different countries from Bangladesh has been taking place due to inefficient human resources in health care management. Low quality or poor health care in the country is forcing patients to travel abroad. Thus the country is losing huge amount of foreign exchange.
Concern over the quality of health care services in Bangladesh has led to the loss of faith in public and private hospitals, low utilization of public health facilities and increasing the outflow of Bangladeshi patients to hospitals abroad. Under the circumstances, assessment of the countrys quality of health care service has become imperative, in which the patients voice must begin to play a greater role.
Health services facilities and causalities
According to DGHS, in the year 2011 about 11.25 crores of out-door patients received treatment from different hospitals and 43.24 lakhs were admitted to hospital of which 26,000 patients died. The death in hospitals was one lakh and 16 thousand in 2007. By any consideration, this is unacceptable. The available infrastructure to provide health care services is quite satisfactory and sufficient to address emergency care. From the grassroots to tertiary level, health care services facilities are available throughout the country. The community clinic for 6 thousands population gained momentum and 13 thousands 7 hundreds and 32 Community Clinics are functional at present There are health and family welfare centers in each union and in total 3 thousands and 8 hundreds and 81 are operative. There is more than 4 hundreds Upazilla health and family welfare complexes of which around 350 are upgraded as 50 beds and others are functioning as 31 beds hospitals. At the district level, there are about 64 district hospitals and 103 maternal and child welfare centers to provide health care services. Besides, there are government and private medical colleges and specialized hospitals providing services but perception of public about the health care services is yet a major issue to address. Hospital and clinic management has not developed as friendly and homely where patients and attendant suffer from tension and crisis of proper advices. There is no remedy if doctors and services providers misbehave with patients and earn money in the name of diagnostic examinations. The facilities for providing health care services are sufficient but causalities are also increasing that should not be excused by any consideration.
State of Urban Health care more critical
The quality of care in the health services of urban areas is more a critical issue where private sector services providers are dominating with profit motive without addressing quality issue. Urban population growth is more than 5 percent due to push and pull factors and it is estimated that 50 % of the total population will be urbanized by 2040. Urban disease profile is different from rural disease and dominated by food adulteration, noise, air pollution and traffic accident etc.
Unfortunately, Ministry of Health and Family Welfare has specialized hospitals and colleges but limited facilities to provide primary health care services for the slum and disadvantaged population. Urban health care is addressed by local government division with the support of non-government organizations as operators under the project urban primary health care services delivery project and health services delivery project of USAID, (smiling sun) and Marie stoppe clinics financed by DFID. More than 65% of the services are provided by non-government organizations in urban areas and urban local bodies are responsible to look after public health and primary health care under Local Government Act 2009. In reality, urban poor have little access to quality health care services paying at least 65% of expenditure from their out of pocket. Health Insurance is literary absent to support the public urban or rural.
Health Services Act
In order to properly address all these issues and critical areas to improve health services, public at large feel the need of Health Services Act to enforce discipline in the health sector The Law Commission is thinking to formulate a law regulating quality health care services to ensure rights to health care as per provision of Article-18(1) of our Constitution.:The idea is to establish a National Health Commission and start some Tribunals to mitigate contradictions and differences between doctors and patients, management and hospital authorities and create an environment of accountability and transparency in the health care delivery system.
The Ministry of Health and Family Welfare has introduced E-medical care and Shathaya Batayan (Health Information) with phone No. 16263 where anyone can get suggestion or complain etc but confidence of the people over the quality of health care services continued to be a far cry.
Equity in health care to be restored
The marginalized people of rural as well as slum dwellers of urban areas are treated in a highly discriminatory nature as regards their access to health care services. Even the lower middle class and the middle class do not get proper treatment facilities. On the other hand, the affluent sections of the people do not rely on health care personnel including doctors and nurses. Only in case of emergency when there is no other alternative, they take treatment in the country. Otherwise, the affluent people, even for minor sickness fly abroad to meet health care needs.
The Financial Express reported on June 10, 2012 that a section of unscrupulous hospital staff realizes money from helpless patients either for providing them a trolley or allotment of a hospital seat. In some hospitals, it is alleged that middlemen allure patients to go to private clinics promising them better treatment. A section of doctors and hospital staff are also reportedly involved in such malpractices. Moreover, medicines supplied to the public hospitals find their way into the outside shops for sale. These have been continuing over the years unabated. Alleged wrong treatment and ill behavior from the doctors, nurses and other support staff have further added to the misery of the ordinary patients. Besides, the diagnostic centers have failed to earn confidence of the service seekers. The fees charged at the diagnostic centers are fabulously higher than they should have been.
Sustainable Development Goals and health care services
The Sustainable Development Goals 2030 envisages 17 goals and 169 associated targets with 226 indicators of which goal No. 3 is to ensure healthy lives and promote well -being of all at all ages. The goal No.3 has 9 targets of whic h maternal mortality is to be reduced to less than 70 per 100.000 live births by 2030 and bring an end to preventable death of new born and children of less than 5 years of age.
Besides, there is provision for elimination of HIV/AIDS, reduction of premature mortality from non-communicable diseases, reduce number of death from hazardous chemicals, air, water and soil pollution and contamination and above all, ensure universal access to sexual and reproductive health services including family planning.
To achieve these goals and targets of SDGs and create an environment of welfare in the health sector, there should be a regulatory framework for providing quality health care services to retain the image of the country gained so far.
The writer is a former secretary to the government
