Medical expenses and poverty

One of the stark realities of life is that the health-related expenditure does contribute to the pauperisation process, perhaps beyond the perception of most people of the country. This is corroborated by an updated report, prepared jointly by the World Health Organisation (WHO) and the World Bank (WB). Its findings thus show that 4.5 per cent or 6.3 million people of Bangladesh were pushed below the poverty line in 2011 while meeting their medical expenses. The rate was the highest in the world, followed by neighbouring India.

Such findings belie the health sector honchos' oft-repeated tall claims about the country making substantial progress in meeting basic health needs of the people. The per capita out-of-pocket expenses, now estimated at over 60 per cent, have been on the rise in recent years, contradicting concerned functionaries' lofty claims. The main reason for the continuous increase in such expenditure at the individual or family level has been the highly inadequate public health facilities. This has in turn led to expansion of expensive private healthcare -- that too, questionable on qualitative counts in many cases -- even up to small urban centres.

There is no denying that the government has created new healthcare facilities across the country. This has been done with a particular focus on, what the authorities concerned say, meeting the medical needs of the rural population. But the allocations meant for meeting actual medical needs of the poor and low-income people remain far too inadequate. Unfortunately, the people even do not get the due benefit of such inadequate allocations because of widespread mismanagement, corruption and lack of devotion to duty on the part of the physicians. The patients at almost all public hospitals and health centres are required to buy most medicines and surgical goods from outside. There are allegations galore that the bulk of government supplies are sold to private parties through the backdoor by an unscrupulous section of the medical staff.

If not others, the poor and low-income people are forced to pay a price for all the ills dominating the health sector. When public health facilities fail to offer the minimum services, those particular sections of people are forced to go to relatively expensive private ones. That is how the process of pauperisation starts. If the illness of someone is of serious nature, the concerned family has to meet the medical expenses either by selling their valuables such as land or taking recourse to borrowing from friends or relatives or money-lenders.

The per capita public sector health spending in Bangladesh is one of the lowest in the world. Though the size of its national budget has been growing every year, the health sector allocations have however remained almost stagnant. The physical infrastructures in the health sector have improved notably in recent years. But there has not been a matching improvement in services offered by public-sector healthcare facilities. The government should pay due attention to this particular area. Like many other areas under government control, the health sector management does surely deserve a major shakeup. This is particularly so in view of lack of transparency and accountability that has gripped it. It is distressing to see that some people are thrown into the poverty cycle just for meeting their medical expenses. The situation needs to be reversed at any cost. The health ministry should work out a realistic programme to achieve this.