The falling standard

Shamsul Huq Zahid | Published: November 02, 2016 00:00:00 | Updated: February 01, 2018 00:00:00

The observation that the current standard of medical education and health services is at its worst in the history of Bangladesh is likely to draw strong protests from most health sector administrators and physicians.
But what if such an observation comes from a fellow health professional, who is the Master Trainer on Ethics at the United Nations Educational, Scientific and Cultural Organisation (UNESCO)?
Physicians and others involved in health sector development, management and regulatory affairs are unlikely to contest the content of a long interview of the health professional in question, Dr. Mozaherul Haque, published in a Bengali contemporary a couple of days back.
Dr. Haque portrayed a dismal picture relating to medical education, ethical standard of most Bangladeshi physicians, regulatory control over doctors and medical education providers and use of public sector health allocations. Undoubtedly, he has spoken the mind of the vast majority of people who seek health services from various providers every day.Â Dr. Haque throughout the interview demonstrated his deep insight into the situation prevailing in the country's health sector.
He admitted that many patients go abroad for treatment out of an aggrieved feeling that local doctors were not adequately responsive to their (patients) needs. Moreover, patients do not find the behaviour and attitude of doctors friendly enough.
Dr. Haque also raised the issue concerning the ethical shortcomings on the part of doctors. The shortcomings, he referred to, included the taking of commission from the diagnostic centres and other benefits from the pharmaceutical companies in exchange for prescribing the medicines produced by the latter. He said a few doctors, at times, subject their patients to make extra expenditure on account of MRI and CT scan when a simple X-ray would serve the diagnostic purpose.
He has rightly suggested inclusion of subjects in medical education curricula that help the students learn about ethics, behavioural science and communication skill.Â A fresh medical graduate is required to take the Hippocratic Oath to uphold some specific ethical standards. But throughout his or her medical studies not a word is taught about ethics or encouraged to be kind and cooperative to their patients.Â Â Â
Dr. Haque squarely blamed the Bangladesh Medical and Dental Council (BMDC), and the ministry of health for the current deplorable situation in the health sector.
The BMDC is an independent entity and it is responsible for ensuring quality of medical education and standard of medical services provided by the physicians registered with it (BMDC).
Private medical colleges have mushroomed in recent years. When public sector medical colleges have been failing to provide necessary facilities as well as the required number of teachers, one can well imagine the state of affairs with the private medical colleges. So, doctors produced by most of these medical institutions are bound to be of low standard. Neither the BMDC nor any of the universities, to which the medical colleges are affiliated, apparently is interested to oversee the activities of the private medical colleges. In fact, there prevails a free-for-all situation in the arena of medical education.
Dr. Haque also raised questions about the quality of many private hospitals and clinics. It is the responsibility of the government to ensure the quality of services they offer to their patients. Unfortunately, the level of inspection and monitoring by the relevant agencies in this particular area has been traditionally very weak. Even strong criticism coming from various quarters has not been enough to invite genuine actions from the official agencies concerned.
Dr. Haque lamented that the quality of health services "continues to be very poor in Bangladesh" that has the world's best health infrastructures, right up to the union level. "We can afford the appointment of as many as 35-36 doctors at the Upazila level. But, unfortunately, we cannot ensure the regular stay of even five doctors at their workplace and serve the rural people", he said.
He also expressed his strong reservation about the quality and quantity of public sector health expenditures, saying that most part of the budgetary allocation for the health sector goes to meeting salaries and allowances, procurement and expenditure on infrastructure development. A tiny portion of the allocation is spent on areas that particularly benefit the poor patients.
But such a lopsided expenditure pattern does take a heavy toll on the common people. According to Dr. Haque, an estimated 6.4 million people fall into poverty trap annually while meeting their medical expenses. Though the figure tends to evoke surprise, it remains, as a matter of fact, a real one. The per capita out-of-pocket medical expenses in Bangladesh remains very high---Tk. 64 out of Tk.100.
Dr. Haque felt that health services delivery in Bangladesh would earn the confidence of the people only if the regulatory bodies and administrative agencies concerned tried their best to assert authority and mean business. At this point of time, banking on such a hope would hardly be realistic.
Â Â Â zahidmar10@gmail.com