Health services dipped for lack of proper policy

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Lack of proper policy and monitoring and non-implementation of existing regulations have led to severe deterioration in the country’s health services, medical experts and civil society members said at a roundtable yesterday.

As a result, patients have lost confidence in healthcare facilities and most of them go abroad for treatment, causing huge economic loss to the country, they said, suggesting bringing major reforms in the sector in order to stop malpractice and commercialisation of health services.

The Daily Star, Public Health Department of North South University (NSU) and Health 21, a platform of medical professionals and civil society members, jointly organised the roundtable styled “Rethinking healthcare services in Bangladesh” at The Daily Star office.

In his keynote presentation, Health 21 Executive Director Dr Rubaiul Murshed said patients are migrating from remote areas to big cities to foreign countries for treatment, spending some $145-350 million a year.

Quoting a study, he said the lack of patients’ confidence in radiology, imaging and laboratory tests and doctors’ efficiency and the lack of integrated healthcare facilities prompt them to go abroad for better treatment.

Dr Rubaiul, also chief consultant of healthcare services management of Apollo Hospitals, identified high error rates, lack of properly trained medical personnel, and unnecessary tests advised by doctors as the major impediments to health services.

“There are 42,573 registered doctors, 22,500 nurses and only 2,220 lab technicians in the country, while the reverse should have been the ratio,” he said. The shortage of competent teachers, teaching methods, poor accreditation system and lack of community-based practical training are the other setbacks in the medical sector, he added.

Prof Shah Monir Hossain, health adviser to Kumudini Hospital, said bureaucratic complexities and politicisation of the medical sector largely contributed to the mismanagement in the healthcare system.

“People at the management level are transferred so often that their ownership for an institution cannot be built,” he said, adding that the quality of medical professionals and allied staffs is also not satisfactory.

Bangladesh Medical and Dental Council, which is entrusted with monitoring the quality of medical professionals, is virtually dysfunctional, he said.

There should be a total career planning for the medical professionals based on the government’s capacity for employment, need for medical professionals and their skills, he said.

He alleged that many pharmaceutical companies are engaged in unethical practices like bribing physicians for prescribing their medicines.

NSU Pro Vice-Chancellor Prof SAM Khairul Bashar said healthcare has now become very commercialised, with diagnostic centres mushrooming and doctors advising unnecessary tests.

A lot of medical schools are growing but their standard is not up to the mark, he said, adding, “Adequate number of skilled medical professionals is not being produced just because of the lack of opportunities.”

Quoting a study, Dr Abu Jamil Faisel, country representative of EngenderHealth, said 30 percent of the health budget in the country generally goes wasted. He added that only 62 percent of the budget was spent in the last fiscal year.

Widespread advocacy and policy analysis are a must for the needed reforms in the sector, he said, urging the authorities to go for studies and policy reforms.

Tuberculosis specialist Dr Abdul Hamid Selim said although the country has good infrastructures, in many cases doctors are not found at the health and family welfare centres at union parishad levels. This leaves rural people deprived of health services.

Doctors often take fees from the patients at public hospitals and most of them have chambers for private practice, but they hardly provide the patients with due services, he said.

Maj Gen (retd) Dr M Shahjahan, adviser to School of Health Sciences at the State University of Bangladesh, said the public hospitals face a lot of limitations in getting financial allocation, while the doctors in rural areas are also not rewarded.

“The main problem [in the health sector] is the management, which should have been decentralised,” he said.

Valery Tailor of the Centre for Rehabilitation of the Paralysed (CRP) said it is not enough to translate books from English or other languages to Bangla, but it should be ensured that the learners, especially the nurses, understand those easily.

Health 21 Chief Coordinator Dr GU Ahsan said the lack of team spirit among the doctors, nurses and other staffs at the public hospitals is a major obstacle to a disciplined health service delivery system.

“The burden of disease is increasing here as we provide neither adequate preventive care nor quality curative care,” he said, suggesting integration of these two with special emphasis on public health.

About 90 percent drugs in the rural areas are prescribed by dispensers, he noted.

Jiban Roy Chowdhury, a researcher, suggested training medical graduates on communication skills, especially on how to deal with patients.

Michael C Hall of Apollo Hospitals said standards set by the private hospitals can prompt the public hospitals to upgrade standards in healthcare services.

“Nurses here still think they are not respected. This is where we need to improve,” he said.

The Daily Star Editor and Publisher Mahfuz Anam said public health must be ensured if Bangladesh is to move forward. He urged all to protest any injustice and irregularity democratically to bring about positive changes.

Dr Shahjahan N Samad, chairperson of Health 21, and Runa Khan, executive director of Friendship, an NGO, also spoke at the roundtable moderated by Dr Yasmin H Ahmed, managing director of Marie Stopes Clinic Society.

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