Nation’s healthcare in a shambles

"Healthcare is a human right" as articulated in the World Health Organisation (WHO) constitution and Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR). The WHO preamble defines 'health as a state of complete physical, mental and social well-being, not merely the absence of disease'. Admittedly, it is highly challenging to attain this standard of human health anywhere, only more so in poorer countries like Bangladesh. On this count, this country has only exacerbated its healthcare system for multifarious reasons, chief among those being the policy failures and the endemic corruption and inaction of the regulatory health service authority. The country has developed moderately extensive healthcare infrastructure even up to the bottom tier of rural areas. But the conditions of the majority of those including some upazila health complexes are unfortunately deplorable. Had those been run by trained and required staff and integrated into a well-coordinated national healthcare system, patients barring critical ones would not need to rush to cities, face hassles and incur unnecessary expenditures.

The systemic weakness thus reportedly forces patients to bear as high as 74 per cent out of pocket (OOP) expenses of medical costs on an average, reportedly highest in the world. This was slightly lower in 2022 and 2023 ranging between 67 and 69 per cent, according to different studies. Notably, different countries use different metrics to measure the expenditure. But one study concludes that OOP ranges from 20 per cent to 60 per cent in lower middle-income countries while in developed countries it is estimated to be between 15 per cent and 25 per cent. Cuba, not a rich country, presents a unique and refreshing picture of healthcare management. In 2021, its OOP was 8.39 per cent--- showing a declining trend, with the country spending 14 per cent of its GDP, highest in the region, on public health. Evidently, it is the political will to give priority to public health that determines the state of a nation's healthcare system.

Bangladesh's political system is not like that of Cuba but even under the current arrangement, the people can receive timely and better medical treatment. True, this is an overpopulous country and the challenge is even greater to provide for quality medical services. The government hospitals are under stress because of the crowding of patients far beyond their capacities. This excessive pressure could be lessened quite significantly if the community hospitals in villages and health complexes were developed not only to deliver initial medical care through proper diagnosis but those also arranged camps in order to make villagers aware of the preventive aspects of health and hygiene. Even the related textbooks do not have lessons on how students can maintain personal health and environmental hygiene.

Last but not least, private health facilities have been commercialised far too much. Unless the public-private cooperation is achieved at a reasonable level and the management of private hospitals, clinics and diagnostic centres are made convinced of the need for reining in their outrageous profit motive, healthcare cannot be available, accessible and acceptable to the general public. In a way, the majority of physicians have also sold their souls to a new breed of hospital managements who could not care less for humanitarian services. The yawning mistrust compels patients who can afford to seek medical treatment abroad but the poor are left in the lurch.