Healthcare services need to be streamlined
Sunday, 17 January 2010
Shahiduzzaman Khan
IT is pathetic to look into the state of anarchy prevailing in the public healthcare services. Common people, especially the poor ones, are not getting minimum medical services at all. There are infrastructures at the upazila and union levels. Yet there are no medicines and services available. The physicians posted at the upazila level are seen absent from their places of work and most of them prefer to stay in the cities and towns. They are engaged in practice at private nursing homes and hospitals. Nurses are seldom seen at the upazila level hospitals. The country has, indeed, an acute shortage of professional nurses.
Many people perhaps know what is happening inside the public hospitals and institutions. Almost every week, large quantities of medicine and medical equipment supplies are sent to each and every hospital in the country. Excepting some low-priced drugs, most of such supplies vanish from the stores almost instantly. Where they go -- nobody knows. Vested coteries have surfaced in each and every hospital that include personnel from high-ups to the bottom level. If most of the employees are members of the syndicate, how can the medicines reach the doorsteps of the common men?
There is no proper accountability for supplies -- medicines, equipment, accessories and other items -- that are made from the public exchequer for such healthcare-provide units. Doctors in public hospitals or services are otherwise found to be busy with outside jobs in private hospitals and clinics. As far as the earlier move by the government to slap a ban on private practice by the public sector physician is concerned, there has been no progress yet to this effect. Admittedly, this is also a complex issue. Rational compensation packages are here relevant, besides the issues of a proper structure for doctors shunning private sector.
Intriguing though it may sound this is a hard reality with all public sector hospitals and medical institutions. Services are grossly meagre, nearly absent. The people have little faith in their treatment. There are a good number of doctors and nurses at the public hospitals. But the problem is: none seems to take proper care of the patients. They are busy with outside jobs in private hospitals and clinics. As the government failed to slap a ban on private practice by the public sector physicians, the door is wide open to those who want to engage themselves in private business. Most of the physicians are associated with the country’s sprawling nursing homes and hospital business; they are making money at the cost of the people’s sufferings. The plight of the poor patients -- needing treatment and medicines -- knows no bounds. Who cares?
The general people do really want to know why the public sector medical practitioners will be allowed to do private practice. In neighbouring India, private practice by the government physicians is strictly prohibited. If anybody (government physician) is found to do private practice, he or she will be immediately fired from his job. If the physicians say they are underpaid, the government may consider introducing a separate pay scale and extra incentives for them. Rewards for the talented but dedicated physicians should be there in order to encourage their professional activities.
Recently, the World Bank advised the government for contracting out the medical services to the non-government organisations (NGOs), private institutions of fame etc. It said Bangladesh government would benefit if it contracted out some of the medical services to the private sector ‘at certain levels.’ Such contracting-out should be based on win-win situation. The private sector organisations must be chosen from among the lists of transparent and accountable firms and organisations. At the initial stage, the government may go for contracting out union and upazila level medical services, which are all-important for ensuring bare minimum services to the needy ones at grassroots level. Then it may consider bigger public sector organisations in cities and towns to open up.
In this context, the government may even go one step ahead. It may consider transferring the management and operation of the large health sector entities to famous overseas medical services groups and firms. The large entities might include Suhrawardy Hospital, Hospital for the Handicapped and Disabled, National Heart Diseases Institute Hospital, Eye Hospital etc. In the wake of chronic mismanagement, negligence and widespread corruption in these organisations, it is necessary that there should be an effective mechanism to streamline the activities of such ailing organisations. For example, Singapore-based famous National Healthcare Group can be given responsibility of managing National Heart Diseases Institute Hospital. Similarly, some Thai healthcare groups may be given identical responsibility of running Suhrawardy Hospital, Hospital for the Handicapped and Disabled etc. The country will certainly benefit from such a move.
There are reports that some referral hospitals in the private sector are also doing illegal practice. They are reportedly bringing in hundreds of medical instruments allegedly by giving false declaration as duty-free imports of these equipment. The government allowed these referral hospitals to enjoy zero import duty facility along with non-profit charitable organisations. The condition was that they would render free services to the poor people or at reduced cost. But in reality, such referral hospitals, that got permission for duty-free import, do not give any facilities at discounted rates to poor patients.
Private hospital owners have otherwise been doing good business. They do not make payment of duties to the government on account of import of hundreds of medical equipment, but continue to charge very high for their medical services. It was expected that the people of modest and low income groups would get health services at lower costs and the poor would get some treatment free of cost from such hospitals. But that did not happen.
The wider public perception has been that charges for medical services in the country's private hospitals are too high. There are allegations that some of the hospitals were transferring funds abroad through over-invoicing of imported medical equipment. Due to this deplorable situation of the country's medicare services, local people spend a very handsome amount of money in foreign currencies, ranging, according to a rough reckoning on a conservative basis, between Tk 20 billion and about Tk 30 billion for taking medical services from abroad.
Such a situation witnessed some big budget hospitals coming up in the private sector. A few international hospital chains have set up their units in the country recently. There is no denying that this did have some good impact on availability of quality health services in the country. But the duty-free offer did not have any worthwhile effect on the costs of the services offered by the private hospitals. Such hospitals are yet to show any care about serving the poor.
szkhan@thefinancialexpress-bd.com
IT is pathetic to look into the state of anarchy prevailing in the public healthcare services. Common people, especially the poor ones, are not getting minimum medical services at all. There are infrastructures at the upazila and union levels. Yet there are no medicines and services available. The physicians posted at the upazila level are seen absent from their places of work and most of them prefer to stay in the cities and towns. They are engaged in practice at private nursing homes and hospitals. Nurses are seldom seen at the upazila level hospitals. The country has, indeed, an acute shortage of professional nurses.
Many people perhaps know what is happening inside the public hospitals and institutions. Almost every week, large quantities of medicine and medical equipment supplies are sent to each and every hospital in the country. Excepting some low-priced drugs, most of such supplies vanish from the stores almost instantly. Where they go -- nobody knows. Vested coteries have surfaced in each and every hospital that include personnel from high-ups to the bottom level. If most of the employees are members of the syndicate, how can the medicines reach the doorsteps of the common men?
There is no proper accountability for supplies -- medicines, equipment, accessories and other items -- that are made from the public exchequer for such healthcare-provide units. Doctors in public hospitals or services are otherwise found to be busy with outside jobs in private hospitals and clinics. As far as the earlier move by the government to slap a ban on private practice by the public sector physician is concerned, there has been no progress yet to this effect. Admittedly, this is also a complex issue. Rational compensation packages are here relevant, besides the issues of a proper structure for doctors shunning private sector.
Intriguing though it may sound this is a hard reality with all public sector hospitals and medical institutions. Services are grossly meagre, nearly absent. The people have little faith in their treatment. There are a good number of doctors and nurses at the public hospitals. But the problem is: none seems to take proper care of the patients. They are busy with outside jobs in private hospitals and clinics. As the government failed to slap a ban on private practice by the public sector physicians, the door is wide open to those who want to engage themselves in private business. Most of the physicians are associated with the country’s sprawling nursing homes and hospital business; they are making money at the cost of the people’s sufferings. The plight of the poor patients -- needing treatment and medicines -- knows no bounds. Who cares?
The general people do really want to know why the public sector medical practitioners will be allowed to do private practice. In neighbouring India, private practice by the government physicians is strictly prohibited. If anybody (government physician) is found to do private practice, he or she will be immediately fired from his job. If the physicians say they are underpaid, the government may consider introducing a separate pay scale and extra incentives for them. Rewards for the talented but dedicated physicians should be there in order to encourage their professional activities.
Recently, the World Bank advised the government for contracting out the medical services to the non-government organisations (NGOs), private institutions of fame etc. It said Bangladesh government would benefit if it contracted out some of the medical services to the private sector ‘at certain levels.’ Such contracting-out should be based on win-win situation. The private sector organisations must be chosen from among the lists of transparent and accountable firms and organisations. At the initial stage, the government may go for contracting out union and upazila level medical services, which are all-important for ensuring bare minimum services to the needy ones at grassroots level. Then it may consider bigger public sector organisations in cities and towns to open up.
In this context, the government may even go one step ahead. It may consider transferring the management and operation of the large health sector entities to famous overseas medical services groups and firms. The large entities might include Suhrawardy Hospital, Hospital for the Handicapped and Disabled, National Heart Diseases Institute Hospital, Eye Hospital etc. In the wake of chronic mismanagement, negligence and widespread corruption in these organisations, it is necessary that there should be an effective mechanism to streamline the activities of such ailing organisations. For example, Singapore-based famous National Healthcare Group can be given responsibility of managing National Heart Diseases Institute Hospital. Similarly, some Thai healthcare groups may be given identical responsibility of running Suhrawardy Hospital, Hospital for the Handicapped and Disabled etc. The country will certainly benefit from such a move.
There are reports that some referral hospitals in the private sector are also doing illegal practice. They are reportedly bringing in hundreds of medical instruments allegedly by giving false declaration as duty-free imports of these equipment. The government allowed these referral hospitals to enjoy zero import duty facility along with non-profit charitable organisations. The condition was that they would render free services to the poor people or at reduced cost. But in reality, such referral hospitals, that got permission for duty-free import, do not give any facilities at discounted rates to poor patients.
Private hospital owners have otherwise been doing good business. They do not make payment of duties to the government on account of import of hundreds of medical equipment, but continue to charge very high for their medical services. It was expected that the people of modest and low income groups would get health services at lower costs and the poor would get some treatment free of cost from such hospitals. But that did not happen.
The wider public perception has been that charges for medical services in the country's private hospitals are too high. There are allegations that some of the hospitals were transferring funds abroad through over-invoicing of imported medical equipment. Due to this deplorable situation of the country's medicare services, local people spend a very handsome amount of money in foreign currencies, ranging, according to a rough reckoning on a conservative basis, between Tk 20 billion and about Tk 30 billion for taking medical services from abroad.
Such a situation witnessed some big budget hospitals coming up in the private sector. A few international hospital chains have set up their units in the country recently. There is no denying that this did have some good impact on availability of quality health services in the country. But the duty-free offer did not have any worthwhile effect on the costs of the services offered by the private hospitals. Such hospitals are yet to show any care about serving the poor.
szkhan@thefinancialexpress-bd.com