Governance issues in health sector

Governance issues that are at the root of mismanagement in the health sector have largely been left unaddressed. This should not have been the case. This is particularly galling in a situation where around 6.4 million or 4.0 per cent of the country's population get poorer every year due to excessive costs of healthcare. This has been stated in the findings of a recent study by the ICDDR,B. Almost all of them cannot pay for healthcare available in the private sector, while public healthcare facilities, too, are inadequate. Meanwhile, the private sector has come up with some modern hospitals with some highly skilled physicians. A large amount of money has been invested in those. The initiatives of the entrepreneurs in the healthcare service sector are appreciated.

On the whole, there is no denying that healthcare facilities have otherwise expanded in the country with the passage of time. There are now more government and private hospitals with more and more beds added to serve the suffering millions. Add to these the thousands of union and upazila health centres. With the latest equipment and qualified specialists, some of the private hospitals in the capital and other cities having state-of-the-art facilities, have also helped reduce drainage of foreign currencies on account of overseas medical treatment. The government also allocates not-too-small an amount of public funds for health sector, though such allocations are considered by many not enough compared to the needs of the growing number of patients.

The government has furthermore quite rightly allowed duty-free imports of costly modern medical equipment and reagents by referral hospitals. This has been done for facilitating private hospitals in particular to treat a certain segment of patients who are otherwise unable to afford expensive treatment there. Almost all these 'referral hospitals', according to a report published in this paper last Saturday, have been flouting the rule since 2005 by refusing to treat poor patients as per quota set by the health authorities. This is unfortunate. But then it is also for the authorities alone to monitor strict enforcement of the rule, as the country loses a large amount of public revenues on account of the aforementioned duty-free imports. The defaulting hospitals should be taken to task.

What is really needed now is a compressive review of the entire health sector to find out why the overwhelming majority of the population have still no access to affordable and quality medical treatment at home. With the government hospitals failing to provide services, patients from the lower income bracket are becoming ultra poor due to high cost of hospital-based medicare. Despite suffering from acute shortage of resources, the government hospitals only utilise a little more than half of their annual budget, forcing patients to seek treatment in the private sector. The hospitals in rural areas reportedly receive funds against their budgetary allocations near the end of every fiscal year due to bureaucratic tangles. Thus they do not have much time to spend the money, a survey found. As a result, a significant portion of the health budget remains unused every year, while 64 per cent of the total healthcare cost comes from people's pockets. The government, donors and non-governmental organisations (NGOs) cover the rest.

Against this backdrop, the governance-related problems in the overall health sector should be fixed. This has to be done through a holistic approach. Health is crucial for economic development of the country. All inter-related issues in the sector must be addressed urgently. The sooner it is the better