Making healthcare access universal

Dr Imtiaz Ahmed | Friday, 7 April 2023

World Health Day is celebrated on April 07 globally by World Health Organization (WHO). It officially identifies eight annual health campaigns worldwide, and this day is one of those. April 7 also marks the founding of WHO. Establishing World Health Day was one of the first things WHO did when it came into existence in 1948, and a day was declared for that purpose the next year. Interestingly, the first World Health Day was celebrated on July 22. Later, it was changed to the current date.
WHO recognises World Health Day as a platform to create awareness about major public health issues. The objective is to help people understand the concept of health and disease, generate awareness of important public health issues and achievements, and focus on ensuring worldwide access to essential health care. The goal is to promote a healthy lifestyle and better quality of life for everyone.
Since 1950, every World Health Day celebration has been centred on a theme. The Director-General decides upon the theme with member governments and staff support. This year's theme is 'Health for All.' The purpose is to demonstrate that health is a basic human right and everyone deserves the best health care.
The day offers a chance to reinforce WHO's commitment to partner with it and is also an opportunity to showcase the big achievements WHO has made over the years. One example includes the eradication of polio, thus protecting almost 20 million people from paralysis. Control of Tuberculosis is another, with approximately 66 million people cured since the dawn of the twenty-first century.
World Health Day is celebrated globally. Scientific discussions in the form of seminars, symposiums, panel discussions, focus groups, etc. are organised both at the international level by WHO and at the national level by governments. NGOs and Health Care Institutes also observe the day with various activities. In Bangladesh, rallies and seminars are organised. Many activities to celebrate the day extend beyond the date.
World Health Day is an important event for Bangladesh, like any other country. The day shines lights on our achievements and challenges and galvanises everyone to work together to improve the health of the population. In terms of challenges, Bangladesh is still suffering a double burden of disease, both infectious and chronic disease. Growing antibiotic resistance is a major public health issue for infectious diseases, with >70 per cent of bacteria resisting one or more common antibiotics.
A big issue in our public health sector is growing mortality from chronic diseases, e.g. diabetes, heart disease, cancer, etc. They account for more than half of all annual deaths and 41 per cent of all diseases afflicting people. It is estimated that by 2030, the chronic disease burden will be higher than any other disease.
Chronic diseases may not always kill, but they extract huge economic prices to ensure continuous care. The result is increased household, community, and society expenses. The high cost involved in managing this disease reduces the ability of the family to spend on other necessities, thus impeding access to many essential health services. Consequently, quality of life is significantly lowered.
Climate change is a global issue, and Bangladesh may be experiencing the worst. It has a serious negative impact on the health of our vulnerable population. Air pollution, which may or may not be linked to this change, is causing many negative health consequences. In 2019, it resulted in the death of almost 90,000 people here.
For three years until 2022, Dhaka acquired unwanted attention as the world's second most polluted city. A World Bank Report published in 2022 showed a high level of air pollution is still prevalent, and both urban and rural areas are affected. According to Wameq Azfar Raza, World Bank Health Specialist, climate change and air pollution are linked. Over time, climate change will exacerbate pollution, and people will suffer. Advance preparation is required to mitigate that risk.
Tackling public health issues is not only a government responsibility but we as individuals must also be involved. If we can tweak our lifestyle, e.g. regular exercise, a balanced and healthy diet, adequate sleep, etc., the risk of chronic illnesses could be reduced significantly. We must also take our health seriously and contact professionals when we sense something is wrong. Many of us try to wait out the problem until it becomes unbearable. At that stage, physicians may have limited scope to help us. So we need to be conscious of our health needs and seek the right care at the right time.
At the national level, the government is continuously working to improve the accessibility and affordability of health care. Strong public-private partnerships are being planned and launched. Health insurance is also being discussed, as this is one major impediments to making health care universal. 63 per cent of the health cost in Bangladesh is borne by the private sector, of which 97 per cent is out-of-pocket, which means the patients or their families are paying for it. In our country, 11 per cent of the household budget is earmarked for health services. Such a high out-of-pocket expense is directly associated with lower use of health services.
World Health Day is also a time to look back at our success. Bangladesh has quite an expansive health infrastructure and a big pool of health resources to draw from. There are many hospitals, health centres, and pharmacies across the country catering to the needs of many. Each district has a public hospital, while the unions and upazilas have their respective health centres. At the ward level, thousands of community clinics initiated by the government bear fruits.
In the last several decades, Bangladesh made rapid strides in the health sector. Regarding many health indices, we are ahead of our neighbouring countries. Our child mortality has dropped more than 75 per cent since 1980, and infant mortality, a major public health index, has halved since 1990. The life expectancy of Bangladeshi citizens, at 68.3 years, is more than that of India and Pakistan. Our health system creates a unique blend of private-public partnerships, allowing the government to work seamlessly with NGOs and the private sector.
We can also celebrate our success in controlling tuberculosis (TB). Once there was a saying, you are dead if you have TB. This is no longer true. With a massive deployment of health resources, our country increased the cure rate to 90 per cent, one of the highest in the world. Our family planning programme is another milestone, branded by WHO as a model for other countries. With proper planning and mobilisation of resources, we could curtail our fertility rate far better than many other Asian countries. We are also on track to achieve the sustainable development goals (SDGs) by 2040 and have already been recognised by the UN for our exemplary work.
A major recent achievement of our health sector was how we combat the Covid-19 pandemic. With direction from the top, Bangladesh was able to mitigate the impact of the pandemic and successfully implemented countermeasures. 629 institutes were immediately labeled as quarantine centres for isolation of the cases, while covid wards were established in hospitals nationwide for treatment.
A massive vaccination campaign was launched, with more than 70 per cent of the population receiving at least two doses of Covid vaccine. Dr ASM Alamgir, former chief scientific officer of Bangladesh's Institute of Epidemiology, Disease Control and Research (IEDCR), attributed this to the quick decision-making at the highest level of government and dedicated support from the officials.
World Health Day could also be a platform to tell the story of our many digital health initiatives. With an eye to building a digital Bangladesh, the government has already deployed the open-source District Health Information Software 2 (DHIS2), creating a data storehouse for the public health sector. DGHS has created many e-health resources for citizens and brought health sector partners under its umbrella. Teams are also working to develop a project called SHR (Shared Health Record). This is supposed to be a national database of electronic health records, which will significantly simplify treatment.
Telemedicine is another growing sector we could highlight during World Health Day activities. This is one of the lucrative investment areas and saw rapid growth during the pandemic. Almost one-third of our population used telemedicine services during Covid.
When we observe World Health Day, we celebrate our success and focus on the future. We identify where we need to improve, implement the plan, and reassess. Continuous improvement is imperative, as we are still far behind the goal of universal access to health care. Health is not a commodity; it is a basic right. WHO defines health in a holistic way, focusing on physical health, the health of our mind, and our well-being. Without it, we cannot survive. So we should all take the opportunity of World Health Day and redouble our efforts to be healthy.

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