Bangladesh's healthcare system relies heavily on the government or the public sector to finance and set up overall policies and service delivery processes. Although the healthcare system faces many challenges, it seems to receive very little priority in allocating national resources.
Assessing the current challenges and opportunities for the healthcare system in Bangladesh, investigations prove that the healthcare system has faced multiple challenges such as lack of public health facilities, skilled manpower, adequate financial institution allocation and political stability. Bangladesh has made great strides in achieving the Millennium Development Goals (MDGs). Yet, the most important challenge is the absence of dynamic and practical stewardship that can formulate and implement policies to further strengthen and improve the overall healthcare system. Such strong leadership can lead to meaningful and effective healthcare system reforms which will work more efficiently to provide improved healthcare to the people of Bangladesh and be built on the values of justice and accountability.According to the WHO, the geographical distribution of human resource for health (HRH) is in a crisis. There are approximately 3.05 physicians per 10,000 population and 1.07 nurses per 10,000 population (estimates based on Ministry of Health and Family Welfare Human Resource Development, 2011). There is a serious gap between approved and filled healthcare positions: Approved healthcare care positions have 36 per cent vacancies and only 32 per cent of facilities have 755 per cent or more approved workers (World Bank, 2009). Alternative medicine (Ayurveda, Unani, and Homeopathy) accounted for 28 per cent of treatment in public healthcare services, but as of June 2011, the vacancy rate for alternative medicine providers (MHFW AMC 2011) was 50 per cent. Currently, healing programs include Integrated Management of Childhood Illness (IMCI), maternity and neonatal healthcare activities, demand-side financing programs with vouchers (DSF), emergency maternity care (Every Mother Counts), and in most cases if not all. The Department of Family Planning is also involved in sexual and reproductive healthcare care in addition to its role in family planning.
The government has started focusing not only on quantity but also on the quality of services. Free medicines are provided from the healthcare centers, which reduces financial stress of the patients. The position of the healthcare system of Bangladesh in preventing the global epidemic "Covid-19" is also commendable. There is no serious shortage of test kits in Bangladesh. But there are some issues that people are facing such as pregnant women’s proper treatment are sometimes hampered due to absence of doctors in the government medical care centres, corruption in the healthcare sector, lack of investment in healthcare services, etc. So, we can say these are problems existing in the healthcare system of Bangladesh. But as per the Article 15 of the Constitution of Bangladesh, the Government of Bangladesh is constantly striving to ensure the necessities of life (including medical care) for its citizens.
Like other countries affected by the Corona epidemic around the world, Bangladesh is dealing with Corona. The activities that have been decided so far to address the second wave are: ensuring an adequate supply of influenza vaccines and medicines, ensuring an adequate supply of medicines that are needed for corona treatment, increasing the number of tests and so on. To this end, the policy decision of antigen test has already been approved, to ensure testing on RT PCR machines in multiple laboratories in each district hospitals which were designated as Covid hospitals will be re-used as Covid hospitals if necessary, medical services through telemedicine and related medicines will be further strengthened. To ensure that people do not neglect testing and are motivated to come to the hospital before the situation worsens, public awareness campaigns to inspire people to adhere strictly to hygiene rules is needed.
According to the WHO, about three per cent of the GDP is spent on healthcare. However, government expenditure on healthcare is about 34 per cent of the total healthcare expenditure and the rest 66 per cent is out of pocket (OOP) expenditure. Inequality, therefore, is a serious problem affecting the healthcare system. Based on a review of secondary data, the paper found the country received some testing kits, PPEs, masks, and infrared thermometers from China to deal with the crisis; however, this covers only a small part of the real needs of the country. Meanwhile, using the quick point-to-point strategy, Ganashasthya Kendra (a local healthcare organisation) claims that it has developed a test kit that can detect COVID-19 in just a few minutes.
Bangladeshis work in many countries where the virus has spread and so they travel back and forth to these countries. China is not in the same position as before due to the pandemic. But they have brought a lot of control with their research. We are trying to imitate them in dealing with the situation. "The Institute of Epidemiology, Disease Control and Research (IEDCR) had launched an awareness campaign in Bangladesh even before the coronavirus was detected. In addition to installing thermal scanners at the airport, special units were set up at the hospitals.
Bangladesh is called the land of greenery. The average life expectancy of the people of this country is 72.6 years. The health of the people of the country can be ensured by ensuring healthcare services to people at all levels in the country. It requires the country's healthcare sector to work in a dedicated manner. In addition to the public sector in Bangladesh, the private sector, various NGOs and international organisations are also working for this purpose. In the public sector, the Ministry of Health and Family Welfare acts as the apex body for policy formulation, planning and decision making at the individual and collective levels. The four departments under the Ministry of Health are the Department of Health, the Department of Family Planning, the Directorate of Nursing Services, and the Department of Drug Administration providing healthcare services to the citizens. Bangladesh has been working to improve its internal healthcare system on a very small scale. Following in the footsteps of the Father of the Nation, from 1996 to 2001 and from 2009 to date, Bangabandhu's daughter Sheikh Hasina has taken groundbreaking steps in all fields of healthcare and medical education.The healthcare infrastructure of Bangladesh consists of the village to the union, union to the subdivision, subdivision to the district and district to division. The successful implementation of the National Pharmaceutical Policy of 1972 has resulted in tremendous progress in the pharmaceutical sector in Bangladesh. At the same time, as NGOs have a significant role to play in healthcare, nutrition, and family planning services in both rural and urban areas, a groundbreaking change has taken place in the family planning, maternal, and child healthcare sector in Bangladesh.
Improving the state of health, nutrition and reproductive health is a key goal of the Health, Nutrition and Population Sector (HNP) sector, especially for the economic emancipation of women, children and the elderly and for sustainable improvement in physical, social, mental and spiritual well-being. National Healthcare Policy, National Food, and Nutrition Policy, and National Population Policy are being implemented under the Ministry of Health and Family Welfare. While achieving the MDGs, some indicators have been achieved in the field of healthcare such as reduction of infant mortality rate, immunisation of infants and mothers, elimination of vitamin A deficiency, etc. So this is how Bangladesh is ensuring her improvement in the healthcare system compared to the world.
MD Toslim Bhuiyan Prantik, Student of Law
Department, North South University