Low-level health facilities have to be made functional for strengthening the primary health care services in a bid to attain Universal Health Coverage (UHC) in the country, health economists said.
The World Health Day 2019 will be observed today (April 7) in Bangladesh and elsewhere with the theme ‘Universal Health Coverage (UHC) for Primary Health Care (PHC) with a focus on equity and solidarity.’“If people get necessary health services in the low-level hospitals, the out-of-pocket (OOP) expenditure will remain under control. This will help us save at least 4,000 crore (40 billion) a year,” said Prof Dr Syed Abdul Hamid, director of Institute of Health Economics (IHE) of University of Dhaka.
“Insufficient budgetary allocations for the health sector accelerate the out-of-pocket expenditure. The OOP health expenditure in Bangladesh is around 67 per cent of the total health spending, which is much higher than that of the world average,” Prof Hamid said.
According to National Health Account reports, every year the OOP health expenditure pushes four to five million people into poverty, while many of the poor fail to afford minimum healthcare.
Health and Family Welfare Minister Zahid Maleque at a press conference on Thursday said the primary healthcare of Bangladesh is globally appreciated because of community clinics across the country.
“We spend only 0.92 per cent of the country’s GDP for health sector while India spends 2.5 per cent, Sri Lanka 5 per cent and Nepal 5 per cent,” he said.
Zahid Maleque said primary health service has been intensified through Community Health Care (CHC) system across the country and poor people are taking health services from the CHC set up in villages. “Around 50-100 people take health services in each Community Health Care every day.”He said the government is providing 30 types of medicines and family planning materials from the CHCs to the patients free of cost and there are also arrangements for normal delivery for mothers.
Mentioning that there are currently around 14,000 community clinics across the country, the health minister said the government has redesigned the community clinics. Now the community clinics will have two rooms, including a room with delivery facilities, two bathrooms, a restroom and a counselling room.
“We have a plan to set up a small corner at tertiary hospitals for primary health care,” he added.
Zahid Maleque said some health institutions have been set up to provide quality health services and the district and upazila level hospitals also have been modernised. “Now the number of beds in public hospitals stands at 50,000. More than 10 lakh people receive health services from public hospitals every day.”
Addressing the press conference, Ashadul Islam, secretary of Health Services division of health ministry,
said the ministry is implementing an essential health service pack of 250 types of treatment to citizens to ensure universal health coverage.
Sources at different upazila and rural-level hospitals said people are often deprived of necessary healthcare services at primary health care centres due to the absence of physicians and health workers and lack of necessary medical equipment.
Prof Dr Md. Amirul Hassan, director of Kuwait-Bangladesh Friendship Government Hospital, said, “Monitoring and evaluation will have to be strengthened and capacity will have to be increased to ensure quality health services in primary health care centres.”
He said necessary equipment will have to be provided for the lower level health centres and the health workers and other necessary staffs should be well trained to provide proper health services.
Prof Harun-Ur-Rashid, founder president of Kidney Foundation Hospital and Research Institute said, “The government should pay attention to low-level hospitals and clinics, including community health centres to strengthen those in a bid to ensure proper health service to people.”
“If people are aware of diseases in initial level through awareness raising initiatives, the government then easily can face the challenges of various communicable and non-communicable diseases,” he added. A study of the Institute of Health Economics (IHE) of University of Dhaka titled ‘Cross-cutting Issues of UHC in Bangladesh: The Way Forward’ carried out by its director Syed Abdul Hamid in 2018 has described the current scenario of primary health care services and made some suggestions to increase access to health care.
The report said 14.41 per cent of patients go to public health institutions while 9.74 per cent to private hospitals or clinics, 15.44 per cent visit the chambers of qualified physicians, 0.56 per cent go to healthcare facilities run by non government organisations (NGOs) and 59.87 per cent rely on the informal sector, including medicine stores and quacks.
The study said there are a total 137,024 beds in hospitals and clinics in the country, including 49,414 in public hospitals and clinics and 87,610 beds in private hospitals and clinics. “Some 36 per cent beds are in public hospitals and clinics and 64 per cent in private hospitals and clinics.”
“Public sector primary facilities are underutilized while secondary and tertiary facilities are over-utilized in the country’s health sector that leads to poor quality of services and affects equity in service. And the implications of the scenario is high out of pocket payments through consumption of private health care from home and abroad,” the study said in its major observations.
The study said growing preference for specialized physicians, increasing ability to pay, no restriction to choose any facility at the first contract and not having proper information where to get which services are reasons are the major reasons behind the underutilization of primary health care facilities.
Underutilization of primary health care facilities is also caused by non-availability medical care, including emergency care, lack of diagnostic and imaging services, lack of dedication and professionalism of the staff and lack of functional referral system, according to the report.
In its observations about the Upazila Health Complex (UHC), the study said those are poorly staffed, poorly equipped and there is a lack of adequate skill-mix and input-mix in the health complexes. “The district hospitals and medical college hospitals are better staffed and have better skill-mix and input-mix.”
Finance Minister AMA Muhith proposed Tk 23,383 crore for the health sector in the 2018-19 fiscal year. The proposed health budget was only 5 per cent of the total budget outlay, down from 5.2 per cent in FY 2017-18. Bangladesh’s health budget has always been much lower than the 15 per cent budgetary allocation recommended by the World Health Organisation (WHO), experts said.