Covid-19 exposes fault lines of Bangladesh's healthcare sector

The ongoing Covid-19 pandemic is making policymakers around the world rethink the healthcare systems of their respective countries. There have been growing concerns over how to make the healthcare systems better adapt to crisis like this. Developing nations like Bangladesh have suffered tremendously, which makes way for a discourse on how things can be better in terms of healthcare.
In this context, Economics Study Center (ESC) conducted a study aimed to do a review of the existing healthcare system in Bangladesh. To go deeper into identifying the crisis, the authors conducted two phenomenological studies. The first one was conducted to describe the lived experiences of doctors working in the healthcare sector of Bangladesh. The second phenomenological study was conducted to describe the essential structure of the lived experiences of patients availing treatment in the healthcare system of Bangladesh.

In the context of the Covid-19 crisis, the authors focused on the fundamental challenges and how the country's healthcare system can deal with them better. After an extensive literature review, the authors have identified some key issues in Bangladesh's healthcare system, such as inequality in the healthcare sector and the effect of poverty on healthcare services, lack of mental healthcare facilities, exorbitant costs, absence of health insurance, ineffective administration, shortage of staff and equipment, lack of oversight in the pharmaceutical industry, corruption and information gap.
EXISTING FAULT LINES IN THE HEALTHCARE SECTOR: From the extensive literature review, inequality is a great concern when it comes to ensuring healthcare for all. Inequality in the healthcare system exists based on a lot of factors other than the socio-economic position or income status of an individual including location, age groups, etc. Gender-based inequality is also quite prevalent in this sector. These factors not only affect the possibility of availing healthcare services but also affect medical help-seeking behaviour. For example, households in the upper 20 per cent are three times more likely to seek medical advice when a child is suffering from diarrhoea, fever, or acute respiratory infections than households in the bottom 20 per cent. Only 37 per cent of the sick children get treatment from a trained provider, with the girls and the poor having lower rates. Exorbitant healthcare costs fuel the problem of inequality even further. Around two-thirds of the medical spending is done by the citizens at the time of service, with the low-income citizens getting affected the most as a large portion of their income is being utilised in this case. While the inability to afford healthcare results in deteriorating health, attempting to do so causes the inevitable reduction in the earning capacity of the poor. Moreover, health insurance as a financial scheme is not very popular in this country due to the shortage of proper health services, lack of trust, and the absence of proper infrastructure.
The Health Information Service (HIS) is still at the growing stage in Bangladesh. This translates into people not knowing adequate health measures, preventive care, leading to a catastrophic unawareness among the people regarding the current ongoing pandemic. The pharmaceutical industry severely lacks oversight where the market is extremely concentrated with the top 10 firms catering to about 70 per cent of the market. The shortage of proper medical staff and equipment has reached an alarming level. The Bangladesh Health Facility Survey 2009 reported that on average more than 30 per cent of basic equipment is missing from health facilities. There are only 0.300 physicians, 0.280 nurses or midwives, and 0.020 dentists for every 1,000 people.
The lack of mental healthcare support is highly alarming if you consider the statistics of the population with mental health issues. The stigma around mental health is so widespread that there are only 0.49 mental health specialists per 100,000 people in a country where 16 per cent of the adult population suffers from some kind of psychiatric disorder. Inadequate hospitals, lack of awareness, and unavailability of follow-up treatment are a few of the major problems in this sector.
The healthcare system of the country is overall severely inefficient. Administrative and regulatory issues don't allow the Secretariat sufficient time for policy formulation and planning. The officers in the Secretariat also lack specific knowledge or training in the health sector. There is no formal coordination mechanism to ensure that the roles of each agency are respected, adhered to, and coordinated. Corruption is in the veins of the healthcare system. Purchasing public positions, drug mishandling and leakage of public funds for this sector are some very prominent issues in this regard, which are needed to be addressed.
A PHENOMENOLOGICAL STUDY OF THE LIVED EXPERIENCES OF DOCTORS WORKING IN THE HEALTHCARE SECTOR OF BANGLADESH: The first phenomenological study is a randomly selected sample of seven doctors, all of whom are currently employed in the healthcare sector of Bangladesh and had to treat patients throughout the coronavirus pandemic. Firstly, 68 significant statements were extracted and clustered into sixteen 16 essential themes. The findings reveal that the doctors had a pleasant learning experience in medical school despite certain deficiencies. However, they were unhappy with mismanagement in the health administration, scarcity of resources, lack of manpower, and overload of patients both during the pandemic and before it. They were disgruntled by the lack of financial opportunities during the initial years and the sheer lack of protection. They faced corruption in the health administration and often suffered from such unethical practices. The doctors were disappointed with the quality of PPEs, the testing facilities, and the sheer dearth of ICUs during the Covid-19 pandemic. They also faced difficulty to manage patients amid widespread misinformation. All of these issues have made their professional experience quite miserable and these should be addressed immediately.
For the completion of the second phenomenological study, the authors conducted the phenomenological interview of four respondents. First, 76 significant statements were extracted. Then these statements were clustered into 12 essential themes. The patients experienced that the hospitals treating coronavirus patients often suffered from a lot of deficiencies in terms of the number of available caregivers, seats, and management of these resources which meant that they were often neglected by the caregivers. The patients found that the private hospitals were costly but the quality of service was often better than the public hospitals. The patients also faced great difficulties while getting tested for Covid-19, finding seats in the hospital and the ICU. The respondents also revealed that it is necessary to have connections to get seats in the ICU. The patients faced some grave issues while availing Covid-19 treatment which should be addressed immediately.
The authors hope that this report will be an important document capturing the fault lines of the healthcare sector at its most vulnerable time and signify the necessity of bringing much-needed changes in the healthcare sector.
Sheikh Rafi Ahmed is the PR and Communications Secretary of Economics Study Center (ESC). [email protected]
Tanjim-Ul-Islam is the President of ESC. [email protected]
Nahaly Nafisa Khan is the Vice President of Economics Study Center
[email protected]

[The article is based on the report titled "Assessing the Fault Lines of Bangladesh's Healthcare Sector: Implications for Future Policy Response" which was launched by Economics Study Center (ESC) on 19 September 2020. ESC is a pioneer student chapter of the Department of Economics, University of Dhaka.]