Delivering healthcare on the doorstep

As high as 62 per cent of Bangladesh population lives in the countryside. Strangely, 75 per cent of its doctors and nurses serve the urban residents, who make up only 38 per cent of the population. Evidently, the statistics provided by Bangladesh 'Health Workforce Strategy 2024' of the Ministry of Health and Family Welfare do not present Bangladesh's overall healthcare service in the best light. When it is about the state of a nation's healthcare, one would expect that the incumbent elected government can change things for the better. Thankfully, to address particularly the poor primary healthcare delivery system, which is actually the foundation of a nation's entire healthcare regime, the incumbent government has reportedly undertaken a massive programme of recruiting 100,000 health workers and 25,000 midwives over the next three to four years.
This is to strengthen primary healthcare, expand grassroots services and thereby shift focus from the prevailing disease treatment, that is, a curative approach to one that stresses disease prevention. It could be further learnt that there is also a government initiative underway to establish primary healthcare units at the union and ward levels, upgrade upazila health complexes to 100-bed facilities and ensure an integrated service for mothers and newborns. Historically, the entire health sector in Bangladesh received a very small portion of the national budget, hovering between 5.0 per cent and 5.5 per cent over the last decade. Out of this low total, the share of the primary healthcare remained critically underfunded, generally making up less than half of the health budget. The good news is that the government has proposed a record amount of allocation for the health ministry, which accounts for roughly 7.4 per cent of the total budget. Even so, this is still far short of WHO's recommendation of allocating at least 15 per cent of the total national budget for the health sector to achieve universal health coverage (UHC). Against this backdrop, the government's plan, especially for recruiting healthcare workers and midwives towards improving country's overall healthcare system is clearly in line with the UN's SDG 3 targets of deploying midwives by 2030 to expand skilled birth attendance at the grassroots and union levels. Notably, the UN's SDG target is to reduce the present global maternal mortality ratio, which is 197 deaths per 100,000 live births.
That means the world, let alone Bangladesh, still remains off track to hit the UN's sustainable development goal (SDG) target of fewer than 70 maternal deaths by 2030. The incumbent government's aforesaid plan for recruiting so many midwives is definitely to meet the existing gap of health attendants which range between as low as 2,500 and 3,000 midwives. In that case, the government target of midwife deployment would be crucial to reach the SDG target on reducing maternal deaths during childbirth. However, rather than attaining some goals set from the top, whether by the administration at home or by the UN, the government should lay emphasis on taking a bottom-up approach. In fact, to deliver primary healthcare to the people's doorstep would require developing a database to reflect the exact picture of public health at the field level.
In this context, the government's plan of digital health which involves pilot-scale digital health cards and a referral system to reduce middlemen harassment with a view to improving service efficiency can be considered the right step forward. However, the suggested database, rather than being static, would be a dynamic one to reflect the ever-changing healthcare situation at the ground level. In sum, the government's policy of improving primary healthcare is undeniably well-intentioned. But the point is to commit the required human and financial capital as promised for the purpose, not to mention the political will. Let the government meet the expectations.