Issues in public health care

Some 18,000 community clinics, according to an earlier announcement by the functionaries of the government, are to be established at the ward level. A good number of such clinics have already been established and there are plans to set up more. But what is disconcerting to note is that these clinics are found to be far from delivering satisfactory health services. A serious dearth of doctors, nurses, technicians and medical equipment are noted . Thus, the challenge remains to provision these clinics adequately and run them efficiently. The issue of absentee doctors must be addressed as well through a proper accountability procedure. Such doctors do need to appreciate the fact that they are obligated to discharge their duties with due sincerity at their places of posting. The government had earlier introduced the so-called user fees in the publicly-run medical and health care facilities. Under 23 categories, user fees were introduced for 470 types of services in the public hospitals. The public medical care institutions were obliged, at least in theory, to extend free medical services or at nominal costs until the introduction of this fee. But in the backdrop of such free and nominal payments leading to poor or even no treatment of patients, it was decided that user' fees would be applied to bring about positive changes through users bearing a part of the real costs of treatment. But the real experience after introduction of the users' fees has been that patients' treatment costs, on average, have climbed up to a great extent, disproportionate to such fees. Which the poor are finding it difficult to pay. They are not even getting the services that they have been expecting, particularly on the quality aspects. Thus, it requires a re-think whether the user fee system should be given up with restoration of the previous system of free treatment or treatment at nominal costs only. If it is decided to go back to the older system, then it must be ensured that the free system or nominal payment system do not make the patients suffer like in the past due to corruption and neglect. A major health sector priority ought to be revamping the family planning programme by bringing all or nearly all fertile couples under it at the earliest. It is shocking that 45 per cent of potential couples from the standpoint of procreation abilities, remain unserved by the family planning programme. Aminur Rashid