Iftekharuzzaman
The country's health sector has been plagued by unprecedented corruption, irregularities, violation of ethics and rules, ultimately hampering quality service delivery to ailing people, the Transparency International Bangladesh (TIB) revealed Thursday.
A research, carried out by the TIB between November 2013 and August 2014, showed illegal money flows in almost every department under the Health Ministry including appointment of doctors, health officials, 3rd and 4th grade employees, ad-hoc doctors, promotion, transfer or stay at the same location.
The amount of bribes ranges between Tk 10,000 and Tk 1.0 million.
The allegations were made at a press briefing at Hotel Abakash in the city. The TIB carried out the research on the 'Challenges to Good Governance in the Health Sector and Ways to Improve' as part of its social movement against corruption.
TIB programme manager (research and policy) Taslima Akhter presented the research report at the press briefing.
The TIB conducted the qualitative research by interviewing doctors, employees, officials and staffs of various departments under the Health Directorate, representatives of the professional forums and media personnel.
The report said doctors pay Tk 0.3 million to Tk 0.5 million in bribe for recruitment on ad-hoc basis and Tk 0.1 million to Tk 0.2 million for transfer and posting to Dhaka from upazilas and Sadars, Tk 0.5 million to Tk 1.0 million to get transfer to Dhaka and nearby districts, Tk 10,000 and Tk 50,000 to get transfer from remote areas to an upazila sadar or from one upazila to another, Tk 50,000 to Tk 0.2 million for transfer of the fourth grade employees, Tk 0.25 million and above for remaining in the same suitable area.
Health officials pay from Tk 0.5 million to Tk 1.0 million in bribe for being transferred to Dhaka or adjoining areas, Tk 0.5 million to Tk 1.0 million for promotion, said Ms Taslima in her presentation.
The TIB also found irregularities and exchange of illegal money in purchasing machinery and medicines, repair and maintenance of hospital buildings and political influence in appointing medicine suppliers, she added.
The research also found that private sector healthcare service-providers have become errant, violating all kinds of rules and regulations due to lack of regular monitoring by the Health Directorate as the regulatory body suffers from inadequate manpower, ultimately creating scope for corruption and irregularity.
It was also found during the research that Bangladesh has one of the lowest manpower in the health sector against the World Health Organisation (WHO) standard to provide services.
More alarmingly, the successive governments have been decreasing the health budget, showing sheer negligence to the sector. This has created opportunities for corruption and lowered service quality drastically.
It highlighted the challenges of enforcing laws and rules in the health sector which could ensure better service delivery to people.
Referring to paragraph 14 of the National Heath Policy 2011, the report said everyone involved in the healthcare services is supposed to be made accountable by enacting laws and formulating rules. But there is no such an initiative so far.
As per the paragraph 16, measures should be taken to keep the costs of all kinds of diagnosis and treatment at a tolerable level, which is not followed.
TIB executive director Iftekharuzzaman said the health sector of Bangladesh has achieved a lot. But the situation could be much better if graft and irregularities are controlled.
He said there are certain issues of concern in the health sector. Bangladesh has the lowest share of GDP allocated for health or 0.84 per cent against 5.0 per cent according to global standard, Mr Iftekharuzzaman added.
"The miserliness in allocating funds for the health sector is unacceptable. Health sector infrastructure and manpower have been failing to deliver services as a result of low budgetary provision," he said.
Mr Iftekharuzzaman said the quality of healthcare services is comparatively low in public hospitals due to negligible budget allocation as increased development allocation can improve the services. "The private healthcare service-providers have established a commercialised profit-making system by neglecting all rules and regulations. This has been creating discrimination as the well-off are going abroad for receiving treatment," he said.
The TIB said private sector doctors have commission-based agreements with diagnostic centres, which get 30 to 50 per cent commission for referring the patients to a particular diagnostic centre. The brokers in the middle get 10-30 per cent commission.
Many diagnostic centres use names of pathologists to deliver a report despite having no staff pathologists of their own, the TIB said.
The TIB report said a large number of doctors, not recognised by the Bangladesh Medical and Dental Council, are practising across the country.
The graft watchdog identified limitations, absence and non-enforcement of laws, lack of accountability and transparency, monitoring, political influence, absence of long-term planning, weak infrastructure and low budgetary allocation as the reasons for widespread corruption in health sector.
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