The Covid-19 pandemic is first and foremost a health crisis. It has caused an unprecedented health emergency, threatening lives and livelihoods. Besides these, this pandemic has derailed the efforts to meet sustainable development goals (SDGs). Its most direct impact is on the SDG 3: Ensure healthy lives and promote well-being for all at all ages. The World Bank’s estimations show “one child is orphaned every 12 seconds due to a Covid-19-associated death, and the toll is growing.”
Before the pandemic, progress in many ‘health areas’ was moderate, whose acceleration was inevitable. Recent studies indicate, due to Covid-19 pandemic, healthcare disruptions could reverse decades of improvements. For instance, thousands of additional under-5 deaths may be expected in the future. The pandemic has interrupted childhood immunisation programmes in South Asia, including Bangladesh.
The Covid-19 outbreak turned the spotlight on the ‘extremely unpleasant’ condition of the health sector. The pandemic highlights how vulnerable we are to the Covid-19 crisis and how ill prepared the health sector is. In tandem, this pandemic calls for ‘determination of challenges’ of this sector and ‘revamping’ the public health system.
Experts have been increasingly advocating that this sector needs a radical change (i.e., transformation) to face the current and imminent challenges, including climate change. The transformative path calls for a proactive planning of rethinking development choices and breaking away from the poor access to essential health services - toward universal health coverage and sustainable financing for health.
Bangladesh makes “consistent progress” achieving good health and wellbeing (SDG 3). For example, the under-five mortality has declined from 36 per 1000 live births in 2015 to 29 in 2018. Over the past decade, Bangladesh makes “good progress” in reducing malnutrition. Stunting (height-for-age) of children is now below the WHO’s ‘critical’ threshold of 40%. Wasting also decreased from 14.3% to 8% over the last decade.
Notably, governments have aligned the 4th Health, Population and Nutrition Sector Programme (4th HPNSP) - with the SDGs. This programme is the first of the three successive phases in realising the SDGs and achieving Universal Health Coverage (UHC) by 2030.
However, governments are facing numerous difficulties in achieving the SDG 3 by 2030. This situation has been compounded by challenges associated with the Covid-19-related problems. The Ministry of Health and Family Welfare (MOHFW) indicates that the country is facing challenges for attaining several indicators of the SDG 3, including maternal mortality ratio (per 100,000 live births (Indicator 3.1.1) and proportion of births attended by skilled health personnel (Indicator 3.1.2).
Governments must show their political will, maintain a zero tolerance to petty corruption, and play pivotal roles in overseeing these salient features of governance of the health sector. The 4th HPNSP has three major components: (i) governance and stewardship of the sector; (ii) stronger health systems; and (iii) quality health services. However, proper implementations of these components are critical.
Second, the Ministry of Health and Family Welfare (MOHFW), Directorate General of Health Services (DGHS), other government and private hospitals and clinics must enhance their ‘capability’ to prevent, prepare, and protect. To prevent this, the health sector requires updated protocols for diagnosis and treatment, surveillance, epidemiological investigation, and others.
To prepare for future challenges, investments are needed in facilitating modern healthcare facilities across the country. In many cases, the DGHS and respective ministries do not have the capability to spend budget for the improvement of healthcare systems. Government’s specific attention to this matter is urgent.
To address future challenges, it is crucial to minimise disparities between rural and urban areas, poor and nonpoor populations as well as among different disadvantaged groups and geographic locations in accessing the health services; and across various educational levels and wealth quintiles. For protection, investments are indispensable to increasing the safety and enhancing the health of communities by educating, implementing appropriate policies, and conducting research (and outreach) for disease and injury prevention.
Third, implementing evidence-based healthcare policies and strategies is important in Bangladesh. A plethora of policy instruments has been formulated, a range of institutions and organisations are created, and a vibrant private sector in the health sector has been established. However, a lack of right implementation, coordination, accountability, transparency, and finance are defining features of these instruments.
Governments must address prevailing structural challenges. On a priority basis, the government should invest in improving healthcare facilities at the regional, district and Upazila levels. For instance, the MOHFW should strengthen the provision of quality health, nutrition and family planning services at the district (local) level.
Fourth, it is significant to shift from social safety net to social security programmes for the marginalised groups. In some cases, the government should provide unemployment benefits so that young poor or disadvantaged groups can have more access to safe, effective, quality and affordable medicines.
Special programmes for the poor people are essential in improving maternal health through medically trained care provider during childbirth and reducing out of pocket expenditure for medical services. Likewise, government’s investments are crucial for rising incidence of injuries including burn and acid injuries, a high incidence of child marriage, improving the doctor-patient ratio in rural areas, and ensuring urban primary health care service delivery especially for the poor.
And, five, government must invest in improving good public health because prevention is typically much cheaper than cure. A raft of research shows, “public health interventions (for example, tobacco control initiatives, immunisation, cardiovascular disease prevention, and workplace health promotion programmes) have been shown to save money, and some have cost-effectiveness ratios better than or equivalent to healthcare interventions.”
The Covid-19 pandemic, a public health emergency, elucidates “the need for greater public health preparedness has never been clearer.” This country has ample opportunities to address public health problems. Right investments are important for (a) developing evidence-based policies and improving institutional capacity for planning and management in public health, (b) strengthening the institutional scaffoldings for regulation and enforcement in public health, and (c) human resource development and training in public health.
Good health is fundamental to sustainable development and the 2030 Agenda. Attaining SDG 3 synergistically contributes to achieving other major SDGs, including no poverty (SDG 1) and zero hunger (SDG 2). To achieve SDG 3, the government must undertake a transformative path for reorienting the financial, economic and political systems, presenting their immense political will and proactive action by all stakeholders.
The writer is Professor,
Department of Agricultural
Extension and Information
Agricultural University, Dhaka.