Ensuring tertiary-level treatment for the hardcore poor

People living below the poverty line are deprived of getting tertiary-level treatment from the country's public hospitals, although the government is committed to deliver free medical services at their doorsteps. According to the Bangladesh Bureau of Statistics (BBS) report, some 48 million people are still living on the breadline in the country, and are really vulnerable and helpless.
According to what the researchers say, poor hospital care poses a risk to the lives of many patients in the developing world. A study of 26 hospitals in eight countries in Asia and Africa found more than one death per day in every hospital was due to preventable accidents and poor treatment. Many deaths were due to poor staff training and supervision rather than a lack of resources. The study was published recently in The British Medical Journal.
Private hospitals, of late, have mushroomed in Bangladesh, mostly in the capital, and some of them do also render quality health services to the patients. But the cost of their services is so high that even people belonging to middle class families cannot afford to go to many of such hospitals for taking treatment. It is the government-run hospitals which are the ultimate destinations of the poor ailing people. As the budget allocation for the health sector has been shrinking while the country's population is increasing, public hospitals and healthcare centres of the country are failing to provide proper healthcare services to the poor people.
Although there is a provision to treat 10 per of the total patients, who are poor, at free of cost, hardly any private hospital follows this rule. Some private hospitals in the country have outdoor services that charge some fees from the patients. But now they have doubled the fees. Free services were available at the outdoor of the public hospitals earlier, but now some fees, though nominal ones, are being charged, adding to the woes of the poor patients. There are no free services wings in these hospitals.
It's more worrying that no private hospital receives patients facing police cases. On their part, most of the private hospitals refer serious accident-related patients to public hospitals to avoid hassles. There had hardly been any steps to address the situation. And that is why exclusive laws are essential to safeguard the common citizens' right. There should be a 'standard referral system' in order to determine whether the patients need to go to a professor directly or not. There is also a need to form a committee to define negligence, which would include physicians, experts and citizens.
Voice has been raised, time and again, in favour of multi-pronged measures -- legislative, legal and administrative -- to help streamline health services, especially in the private sector, where allegations of negligence or malpractices are levelled against individual doctors or institutions at regular intervals. Needless to say, such calls have been necessitated by many instances whereby patients have either died or their conditions aggravated allegedly because of negligence by physicians or hospitals concerned. A number of such instances resulted in violence and vandalism, involving the friends and family of the victims, while venting their anger and frustration over the state of affairs of public and private hospitals in question.
The fact remains that when patients go to their doctors, they do so with the faith that the latter will do their best to help and serve the former. Therefore, it is only natural that when a doctor wilfully breaches the patients' trust, through either negligence or malpractice, they should be held accountable and made to pay. Unfortunately, however, even though patients are constantly denied proper care, there have been no instance of doctors being held accountable due to the absence of well-defined laws and definitions of negligence. Such a lack of accountability, many do believe, is at the root of the dismal scenario now prevailing in the country's health sector.
Reluctance of many medical professionals to serve outside big cities has led to a wide disparity in the availability of healthcare services between the urban and the rural areas. There are many hospitals in the countryside where people do not get timely and proper treatment. A section of doctors is unwilling to work in rural areas allegedly because of less scope for private practice and lack of perks and privileges than that in the urban areas of the country.
But it is not acceptable that doctors will run only after their own fortune against their moral obligation to serve the ailing humanity. Worse still, corruption is rampant at the community clinics. Allegations are galore that medicines and equipment allocated for the clinics for the treatment of poor people are often misused and commercially used by a section of corrupt employees of the health centres.
When a big portion of the country's population is still poor, more emphasis should be given on public health sector to ensure healthcare services for them. While yearly budget allocation for the sector needs to be increased substantially to bring more people within the purview of its services, the government should also have a plan to upgrade its healthcare institutions so that people can rely on these while receiving medical services.
Health services in the private sector do also need to be streamlined. This is, however, not possible unless a proper mechanism is put in place. On its part, the government needs to initiate a move to create a legal framework so as to ensure quality treatment.  In fact, a holistic approach is required in order to provide full-scale free healthcare to the disadvantaged; otherwise, the concept 'Health for All' is not expected to materialise any time soon.                                  
szkhan@dhaka.net