The Bangladesh chapter of the international graft watchdog TIB (Transparency International Bangladesh) has, in a recent survey, found widespread corruption and irregularities in the country's health sector in the areas of appointment, promotion and deputation of the doctors.
Doctors, employees and different health professionals under the health ministry are reported to offer bribe ranging from Tk 0.5 million to 1.0 million to high officials of the ministry for lucrative posting, transfer and deputation.
The survey found that unemployed doctors pay Tk 0.3-0.5 million for being recruited on ad-hoc basis. More than 4,500 doctors were recruited during the immediate past tenure of the ruling Awami League government.
It was also found that the senior health officials pay from Tk 0.5 million to Tk 1.0 million as bribe for their transfer to Dhaka or adjoining areas while doctors pay Tk 0.25 million for staying in the same duty station for longer periods in a bid to earn extra cash from additional jobs at private hospitals.
Such corruption and irregularities take place through the involvement of the leaders of the employees' associations, ruling party appartchiks, and relevant officials.
The TIB said doctors have agreements with private diagnostic centres for which they get 30 to 50 per cent commission for referring patients to a particular diagnostic centre while the brokers in the middle get 10-30 per cent commission for bringing patients to private clinics and diagnostic centres.
Many diagnostic centres use names of pathologists to deliver a report despite having no staff pathologists of their own. A number of doctors, not even recognised by the Bangladesh Medical and Dental Council, are practising across the country and catering healthcare services to the public, the report claimed.
The graft watchdog recommended to the government to raise fund allocation for healthcare sector in coming budgets to tackle these issues. It suggested to update and enforce the laws related to the healthcare service.
However, the country's health sector has made some remarkable achievements as well. But graft has affected the standard of healthcare in the country. To ensure quality healthcare for a large segment of the country's people, private sector healthcare system needs to be standardised and a balanced healthcare budget needs to be implemented, TIB said.
However, the government has been able to reach the healthcare system to the doorsteps of the common people by setting up community clinics, ensuring availability of free medicine at state-owned hospitals with measures in place to avoid medicine theft, progress in maternal and child healthcare by taking some pragmatic measure and establishment of burn units in all the public medical college hospitals.
But what is worrying is that the cost of medical treatment is getting higher in the country day by day. There is a need to take a number of pragmatic steps by the government and the political parties to stop the whole-scale commercialisation of the healthcare sector.
It is really frustrating to note that political parties in the past hardly took any effective step against the widespread commercialisation of the healthcare services. With its increasing trend in the healthcare services, the access of ordinary people to healthcare has become more difficult. The weakening of the public health system has left the country very poorly equipped to handle public health emergencies.
The national health policy identifies two broad 'challenges' faced by the healthcare system. These challenges are in the areas of service delivery and that of demand for, and utilisation of, services. Poor management, limited resources and low quality of services are the challenges in the area of service delivery.
The dismal health and nutrition situation, implying a poor state of food and nutrition security in both rural and urban Bangladesh, needs to be addressed on a war footing. But there is hardly any sense of urgency on the part of a government that seems to be firmly anchored now in a neo-liberal mindset, to address Bangladesh's permanent state of nutritional emergency.
In fact, many private medical establishments hardly care for fair practices and playi with the lives of millions of poor people.
In a clear misuse of government subsidies in the health sector, the well-off people are enjoying disproportionately high benefits thereof, depriving the most poor who have the first right on such public resources.
According to a World Bank (WB) study, the richest 20 per cent take about 33 per cent of the subsidies meant for the country's poor while the 20 per cent of the poorest could use only 10 per cent of the services. The subsidies are primarily meant for the poor who can not afford healthcare services.
There is no denying that the healthcare services would continue to elude the poor unless the government implement the health policy in its totality. The poor should ideally be its ultimate beneficiaries. By eliminating corruption from the health sector, 'health for all' should be the basic motto.
szkhan@dhaka.net
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