Kamrun Nahar, Journalist, The Financial Express

Kamrun Nahar, Journalist, The Financial Express : Bangladesh has a poor healthcare system in terms of affordability, quality and in many cases accessibility. People in general have a low confidence on local doctors largely due to their businessman-like attitude rather than a life-saving service provider. Bangladeshi people prefer to receive treatment abroad increasingly due to the wrong diagnosis, thereby wrong treatment, mismanagement at the hospitals and exploitation at both public and private hospitals.
It is quite interesting to see that though the successive governments have been claiming success in the health sector, most of our frontline politicians are visiting foreign hospitals every now and then even for simple ailments. Even middle or low middle income people now tend to receive treatment abroad, especially in India,  Thailand, Singapore and Malaysia; that too by taking donations or lending from their relatives to save their lives.
History says Bangladesh once was much ahead of many of the countries where Bangladeshis are now thronging for education, holidaymaking and medical tourism. Thai or Malaysians used to come to Bangladesh to study engineering and pursue medical education. Ironically, these countries are much ahead of Bangladesh in the above-mentioned sectors. They could develop their service sectors in a planned way and became successful which Bangladesh has failed to do.
As far as health sector is concerned, the article 15 (Ka) of the constitution reads that the state is responsible for providing healthcare to its people. Here the state has two functions: it will ensure quality healthcare in the public healthcare centers and regulate the private healthcare centers. But to what extent the state is performing its constitutional obligation regarding healthcare has been a million dollar question.
There have been hundreds of thousands of hospitals, clinics, diagnostic centers throughout the country. But how many of them are registered? The pharmacies where majority of the people receive treatment also lack proper monitoring and registration process. But they are operating under the very nose of the administration. We see mobile court drives sometimes against some errant hospitals, but those are not enough. Powerful syndicates including government agencies are strongly linked to the establishment of the healthcare centers, mostly in question, putting people’s life at risk.
Duly, sometimes we see reports of horrifying incidents in these places. For example, it is alleged that a man having education up to eighth grade owns six hospitals in Dhaka. Those too are around the government hospitals at Agargaon area in the capital city. He has been operating as an orthopedic surgeon. We don’t know how many people became the victims until the last two cases when a man died and a child’s leg had infection after she was operated upon at a private hospital located opposite to NITOR. The accused owner of the hospital cum surgeon refuted all allegations, saying he never performs surgery. But there were several other non-physician surgeons doing the same job for him for many years.
So, most of the people are rushing towards foreign hospitals, out of frustration. A data of Indian directorate general of commercial intelligence and statistics on export of health services survey showed as many as 1,65,000 Bangladeshi patients out of the total 4,60000 foreigners visited Indian hospitals in 2015-16. The number must have increased over the years. The number of Bangladeshi patients visiting Thai hospitals was 63,000 over the same period.
A government data in 2012 showed Bangladeshi patients spend US$2.04 billion annually on healthcare abroad which is nearly 2.0 percent of our GDP. On the other hand, a major drawback of healthcare system in Bangladesh is huge out-of-pocket (OOP) expenditure. Bangladeshis spend $37 annually on healthcare against the World Health Organisation (WHO) recommended $108-112, of which 67% is borne by the individuals. The OOP is increasing here day by day while healthcare budget is decreasing. The patients spend 65% of the total treatment cost on medicine. These problems are accompanied by other irregularities like unnecessary medical investigation, medicine, wrong treatment and misbehavior of the doctors, nurses and other medical staffs.
Alarmingly, most of the private hospitals and clinics do not have any professor or specialist and nurse of their own. Doctors go there from government hospitals. Nurses are mostly without proper training as there is no process to develop the professional skills of doctors and nurses. The issues require serious action with regard to training on skills at the government facilities along with the government staffs. Otherwise, the life of common people will remain at risk.
The government needs to update the law for the private sector hospitals, clinics and diagnostic centers to streamline them and ensure quality service which is the core component of universal health coverage. Data shows, there are 2761 registered private clinics and 4094 diagnostic centers in the country, with the number of the unregistered ones being rather higher.
The government must bolster its monitoring mechanism to implement the law. In addition, it should be mentioned in the existing law and policies what standard of treatment to be followed and how much time the doctors will give to the patients. Only then we can stop outflow of our patients to other countries.