Healthcare System in Bangladesh || Challenges and Opportunities

Table of Content: Healthcare System in Bangladesh || Challenges and Opportunities

Introduction
The present state of healthcare in Bangladesh
Medical facilities in Bangladesh
Major problems in our health sector
Achievements
Suggestions for further improvement
Conclusion

Introduction

Health is one of the most important sectors which generates intense emotional debate and ideological divisions. It is sometimes described as a fundamental human right. However, during the past few decades, il became clear that the right to healthcare is far from absolute in our country. Although the health chapter of the fourth five year plan (1990-95) began with the theme that access to health care is a fundamental right of a person. The fifth five year plan (1997-2002) states 'providing medical care is the constitutional obligation of the government.' Inadequate funding, inefficiency and corruption in our country restricted the access of the population to free medical care services. Thus, 'right to health services for all' has always remained neglected.

The present state of healthcare in Bangladesh

According to the constitution of Bangladesh, healthcare is a fundamental constitutional right of the people. But the actual picture of our health sector is gloomy and people are being deprived of their fundamental right of health sevices. A World Bank report says 'Bangladesh is at the top of the list with regard to malnutrition, maternal and infant mortality. In Bangladesh-

70 percent mothers and children suffer from malnutrition;
Everyday 700 children die due to malnutrition;
Every year 28000 mother die due to pregnancy related diseases and complications.
Every year more than 3330000 children are born out of which one third are born with lesser than normal birth weight.
Among children under five years of age two third suffer from malnutrition.
Children between age 6 to 7 months do not have proper growth.
During Child births 5 expecting mothers die out of 1000 births.
Almost 95% deliveries take place at home. One third of these deliveries suffer from pregnancy related post delivery diseases.
It is reported that due to various diseases, mortality rate of under five children is between 7-8.2%.
One out of nine children die before the age 5. Among the hardcore severe poor, the rate is one out of six.
Number of below five children is 20 million in the country. Out of this twenty million 3,80,000 die every year. 1,20,000 die due to pneumonia, 95000 due to diarrhoea, 19000 due to measles related tetanus and 15000 due to measles.

Medical facilities in Bangladesh

Medical college and Hospitals-18
Specialized Hospitals and centers-60
National Institutes-05
Medical University-01
Post graduate institute and Hospitals-05
Infectious disease Hopitals-05
TB Hospitals-04
TB clinics-44
Leprosy Hospitals-03
Mental Hospitals-01
Paramedic Institutes-01
Dental College Hospitals-01
Functioning Thana Health Complex (THC) ... 402 (31-bed)
Population to doctor ratio 1: 2773 (Economic Review 2010)

Major problems in our health sector

Our health sector is riddled with numerous problems. Among these, major problems in providing adequate and quality health care to the people involve the following:

1. Inadequate number of physicians: In Bangladesh, there are only 30000 registered doctors for more than 160 million people. Here, the population to doctor ratio remains at 1: 3137. Thus, people are being deprived of proper treatment. Particularly, the rural people are being maltreated by village doctors who have no certificate at all.

2. Wrong treatment: Every year thousands of people in our country are dying due to wrong treatment by doctors. The reasons behind such pathetic occurrences are inadequate technological facilities for diagnosis, lack of experienced manpower and after all, ignorance of doctors.

3. Private practice: In public hospitals, most of the time the doctors remain absent and a little portion of the day they spend in office. Almost all the doctors have private clinics where they spend most of their times and lethe a lot of money. Even their contract with the patients is so negligible that a twinkling of eye towards the patients is enough to diagnose him. Sometimes, they use office bearers, peons, guards to convince the patient that he may consult him in his private clinic.

4. Lack of accommodation facilities: Almost all of the government Hospitals lack adequate accommodation facilities. Number of beds in these hospitals are too little to accommodate a large number of patients. Ambulance service and proper referral service are almost nonexistent. The internal environment of the hospitals, specially government hospitals is so haphazard and polluted that it sometimes worsens the condition of patients.

5. Unwillingness to stay at rural areas: The registered doctors, specially specialists and experts do not want to stay at local rural areas. For this, it is serious problem of our health sector to transfer doctors to rural areas and provide proper healthicare facilities to rural people.

6. Inadequate management: Although government Hospitals, Health complexes and centers lack adequate equipments, even the equipments available also are not in order due to inadequate management and maintenance.

After all, what is most important to note is that our patients suffer from confidence on our total healthcare delivery system, in doctors, in reliability for medical test and in overall management.

Achievements

The major successes in our health sector during last decades may be mentioned as under:

Small pox, cholera and malaria have been eradicated or are no longer major killers.
Life expectecny at birth reached at 66.8 in 2010 which was only 45 in 1970.
Total fertility rate was reduced from 6.3 in 1975 to 1.32 in 2010.
The crude death rate droped from 12.0 in 1990 to 6.3 in 2010 and is declining further.
EPI coverage had been over 66 per cent which is around 95 per cent at present.
Infant mortality rate declined to around 41 per thousand live births in 2010. Similarly, the age under 5 mortality droped from over 210 in the mid 1970s to 133 per thousands live births in 1995.

Suggestions for further improvement

For providing better health care to the people and ensuring health care for all, the following suggested measures deemed to be considered:

1. Primary and secondary healthcare facilities should be given under supervision and management of the local government authority.

2. A strict and workable referral system should be instituted from bottom up and patients referred from lower tiers should be given preference.

3. Blood transfusion units should be provided at thana level.

4. Ambulance service should be made adequate with a cost recovery strategy.

5. Medicines and examinations should be made free only for the poor. Those who are solvent should pay.

6. Poor, unemployed and destitutes should get full fledged healthcare service free of cost.

7. For middle income group of people healthcare service may be organized with the help of cooperative and insurance.

8. Patient counseling knowledge should be introduced in under and post graduate medical studies as a full fledged subject.

9. There should be independent council set up by the Govt. to monitor and regulate the standard of service in private clinics.

10. All the doctors, clinics and pathological laboratories should be brought under malpractice insurance scheme so that patients can get compensation through insurance company if any wrongdoing is committed to them.

11. Prohibiting private practice by professors of medical colleges who are teaching clinical subjects and attached with the college hospitals and by all other govt doctors. Their pay packages should be decent and should be allowed special stunts.

12. Arrangements made to ensure adequate supply of medicines and other paraphernalia constantly.

Conclusion

Above discussion shows that the key challenge in the health and family planning is to expand access to basic services and improving the quality of services both in the public and private sectors. The utilization of existing capacities and facilities, particularly rural health infrastructure can also be markedly improved. This will require prioritizing of public expenditure to ensure wider and more equitable access to basic services and improving the quality of services. The efficiency of public sector programs needs to be enhanced through appropriate organizational and management improvements.