Believe it or not, the physicians in Bangladesh spend only 48 seconds for each patient seeking primary healthcare. A prominent British Medical Journal (BMJ) has revealed recently this stunning truth.
A total of 179 studies were identified from 111 publications covering 28,570,712 consultations in 67 countries under this survey. The average consultation length varied across the world, ranging from 48 seconds in Bangladesh to 22.5 minutes in Sweden, the study found.
“We found that 18 countries representing about 50 per cent of the global population spend five minutes or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction,” said BMJ study.
The BMJ carried out the study to describe the average primary care physician-consultation length in economically developed and low-income and middle-income countries. It was also meant to examine the relationship between consultation length and organisational-level of health outcomes in the economically developed countries. The countries like the Australia, the UK and the USA have got sufficient data points to determine long-term trends. In Australia, the consultation length was relatively stable, in the USA it was increasing by 12 seconds a year, and in the UK it was going up by 4.2 seconds a year.
Out of 67 countries, 15 countries have reported consultation length at less than five minutes, 25 countries with five to nine minutes, 11 countries with 10 to14 minutes, 13 countries with 15 to 19 minutes and three countries with less than or equal to 20 minutes. The physicians in India spent 2.3 minutes and the physicians in Pakistan spent 1.3 minutes for each patient seeking primary healthcare. The BMJ study also revealed that 18 countries covering 50 per cent of the world’s population have a latest reported mean consultation length of five minutes or less. Unfortunately, the physicians in Bangladesh spend only 48 seconds for each patient seeking primary healthcare.
The common people of the country most earnestly expect that the public healthcare systems should serve them with efficient and transparent mechanism ensuring universal medical access. Unfortunately the public healthcare system in the country does not hold for this as it is beset with both neglect and corruption. The medical profession is one field where flawless and dedicated discharge of their duties by medical professionals is imperative, as it is involved with heath and lives of the people. But this ethical condition in the field of public healthcare continues to leave a lot expected by the people.
A daily sun report carried on April 27 said, of the 460,000 inbound patients to Indian hospitals more than 165,000 were from Bangladesh in 2015-16 making Bangladesh the largest foreign user of India’s health services. Over 58,000 medical visas were issued to Bangladeshi nationals in 2015-16. A large number of patients from Bangladesh go to India, Bangkok and Singapore for better treatment depending on their financial affordability. This tendency of the patients to go abroad for better medical treatment reflects the failure of overall healthcare in the country. Wrong treatment, negligence and malpractices by the doctors and lack of confidence in local diagnostic centres compel many patients to go abroad for treatment.
There is no denying that Bangladesh has made remarkable progress in the field of health services. There are various proliferations in health infrastructures, which include medical colleges, medical university, private medical colleges, private clinics, private hospitals, rural health complexes and community clinics.
But still there are many heartbreaking stories of lives ruined and cut short due to the unavailability of affordable and quality healthcare services. The healthcare system of Bangladesh is haunted by challenges of accessibility and affordability, particularly to the rural communities. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilisation, quality and equity of healthcare.
Around 6.4 million or four percent people of the country get poorer every year due to excessive costs of healthcare, said a study by the icddr,b. In this situation, the government should give special attention to ensure that the rural community clinics set under public, private entrepreneurship, do not become a business hub to sell healthcare services to the poor people. If the rural community clinics set under public, private entrepreneurship are run properly, it can usher a new era in healthcare services of the country.
We applaud the government’s move to introduce telemedicine and e-health schemes for rural healthcare centres to provide quality healthcare services to the rural people. The government has already started distribution of mini laptops containing ‘eToolkit’ and video materials on common diseases and their treatments to help the rural health workers to provide necessary healthcare supports to the rural communities. Surely this is an encouraging development towards taking the quality healthcare services to the door step of the rural people.
The healthcare services provided by the community clinics situated in the rural areas are not at all satisfactory. The evil practice of absenteeism among the physicians posted at the upazila level hospitals and health clinics often compels poor patients to visit the physicians at their private chambers paying prohibitive fees.
The incumbent government is promise-bound to take healthcare services to the door-step of the rural people. Bangladesh has achieved many of the Millennium Development Goals (MDGs), but a stronger commitment is needed to achieve the Universal Health Coverage (UHC). The goal of the UHC, as declared by the World Health Organisation, is to ensure that all people obtain the health services they need without suffering financial hardship when paying for those. The government should give special attention to ensuring quality healthcare for the poor who become the worst victims of weak governance in the health sector.
Catastrophic health expenditure in Bangladesh is nearly 16 per cent, while it is around 11 per cent in India and below 6 per cent in Indonesia, the Philippines, Sri Lanka, Hong Kong and Thailand. In Bangladesh, 64 per cent of the total health expenditure comes from people’s pockets, while 26 per cent comes from public fund and 10 per cent from external funding by NGOs and development partners, according to the icddr,b. Inadequate and inefficient public healthcare and profiteering in the private healthcare sector are two major factors behind such private spending, said the experts.
The people of Bangladesh are living longer, reflecting a significant progress in the country’s health and population status. Life expectancy rose to 69.4 years in 2012 from 66.8 years in 2008, an increase of 2.6 years in four years, according to a new survey of Bangladesh Bureau of Statistics (BBS). Experts attribute the progress to overall economic development, expansion of health services, better access to telecommunications and a rise in literacy rate.
But, the state of the public medical care system is not up to the expectation to the need of many medical care seekers living in rural areas. It is shot through with corruption, lack of proper care and accountability. The findings of the British Medical Journal that the physicians of Bangladesh spend only 48 seconds for a patient, is surely a national disgrace. It appears that the doctors in Bangladesh have forgotten the Hippocratic Oath once taken by them. Under these circumstances, the challenge for the government is two-folds: To improve services in the public healthcare system and also to engage in harder regulatory and supervisory activities to improve health service delivery systems.
The writer is a columnist