Medical care in name only
Fahimda Akhter | Saturday, 12 July 2008
Bangladesh has been one of the countries, which pursue the policy of extending public health care for free, or, at nominal costs, to the people who can not afford it due to property. They are too poor to afford private medicare. Bangladesh does not lag behind in extensive network of public hospitals, health complexes in rural areas and government-run hospitals and specialised treatment centres in the cities. They are also staffed by a good number of doctors, nurses, technicians and medical assistants.
A strong demand was voiced for the appointment of more doctors and nurses to improve the public health service. Responding to this demand, previous governments appointed additional doctors and nurses out of an expectation that it would improve the service to the public. But anyone, who recently visited the public hospitals and health complexes across the country, knows it first hand, shock though, what care of the patients are taken there. Transparency International, Bangladesh (TIB), in its latest report, rated health as the second most corrupt sector. This indicates how rotten the state of affairs really are in the sector.
It is no overstatement to say that the public health care sector in Bangladesh is in a very bad state. This is the outcome of operations of many factors, which include, among others, lack of supervision, corruption, psychology of those who man the sector, their poor motivation, lack of investment in pressing areas, lack of training, lack of accountability, etc. And what is more distressing about the situation is the lack of incentives or rewards for those who are otherwise careful about their duties and try to put in their best for the well-being of the poor patients in the rural areas. This ultimately demotivates them and encourages them to join the ranks of those who tend to give a damn to their official responsibilities.
Under these circumstances, anyone in the know of ground level reality would suggest not to give so much attention to quantity but to the quality factors for improving public health care. The move to increase the number of doctors and nurses for government hospitals and health complexes is fine. They may be useful to some extent in coping with the demand.
What is really the problem? Is it really the inadequacy of doctors in the government hospitals and the health complexes ? Any impartial investigation would show that the main problem is the mentality of the doctors and their unrestrained unethical behaviour. Typically, a young doctor with the education from a medical college, on being posted to an upazilla hospital, spends most of his or her time in Dhaka city to earn out of private practice. They visit the upazilla hospitals like migratory birds to spend some time there and draw their salary. Many of them consider their pay to be inadequate compared to their experience. But most of the time they remain on leave from the upazilla hospitals. The picture is common in all or nearly all the upazilla hospitals or health care complexes.
Rural people without the means to go to cities for medical care in private clinics rush to these health complexes, but in vain. Most of the time they have to return home without treatment, check up or prescriptions because no doctor was available. Patients needing emergency operations or attention return in great disappointment.
The experience is no different at public hospitals in the cities. Specialist doctors give virtually no time to these hospitals. They are always in a hurry. The patients do not get the needed attention. The less said about diagnosis and prescriptions, the better. The doctors at public hospitals do not forget to take their salaries. Their association with these hospitals add to their name and fame, which they utilise for private practice or working with private clinics to earn more. Unlike in the other countries, no well-known doctor can be contacted by patients on the phone. It's a cut throat business.
Deceit, exploitation of the poor and utter lack of care characterise the publicly-run medical care institutions in the country. The difference is of degrees from institution to institution. But these problems ail all of them, more or less. The public hospitals are supposed to provide medicines free of cost, or, at much subsidised prices, from their stores. The stores are regularly replenished with medicines and other needed supplies. But the bitter reality is that patients admitted to the hospitals are required to buy their medicines or the needed supportive articles from outside. They are routinely told that the hospital stores have run out of supply. In reality, the personnel manning the stores sell everything stocked there to private medicine shops in connivance with the hospital administrations.
For food and laundry services, the hospitals depend on private contractors engaged by hospital administrations. But the contractors usually get full payments supplying less food of poor quality and the hospital administrations say or do nothing for the obvious kickbacks. The contractors squeeze out more profits by supplying less of poor quality, although ample funds are allocated by the government. Laundry contractors do the same at the expense of the comfort and hygiene of the patients. Bed-sheets and pillow-covers out of the laundry are anything but clean.
To keep the public hospitals and their premises germ free large sums are allocated by the government. Every government hospital or upazilla health complex, on paper, employs staff to work round the clock to keep the premises clean. But allegedly, many of these cleaners are in the payrolls on paper only. The salaries of these ghost workers are regularly pocketed by the potentates in the hospital administrations. Even the handful of cleaners, who actually work, get away doing nothing due to lack of supervision. Soaps and detergents bought for the hospitals -- are sold outside.
Valuable medical equipment have been lying out of use at public hospitals. In some cases, the equipment have rusted and can not be used. The equipment could be an x-ray machine, dialysis machine, pathological testing instrument, etc., and all these cost a lot.
There is hardly any accountability at any tier of the public health care system. Sustained measures are long overdue for the improvement of the public health care system.
A strong demand was voiced for the appointment of more doctors and nurses to improve the public health service. Responding to this demand, previous governments appointed additional doctors and nurses out of an expectation that it would improve the service to the public. But anyone, who recently visited the public hospitals and health complexes across the country, knows it first hand, shock though, what care of the patients are taken there. Transparency International, Bangladesh (TIB), in its latest report, rated health as the second most corrupt sector. This indicates how rotten the state of affairs really are in the sector.
It is no overstatement to say that the public health care sector in Bangladesh is in a very bad state. This is the outcome of operations of many factors, which include, among others, lack of supervision, corruption, psychology of those who man the sector, their poor motivation, lack of investment in pressing areas, lack of training, lack of accountability, etc. And what is more distressing about the situation is the lack of incentives or rewards for those who are otherwise careful about their duties and try to put in their best for the well-being of the poor patients in the rural areas. This ultimately demotivates them and encourages them to join the ranks of those who tend to give a damn to their official responsibilities.
Under these circumstances, anyone in the know of ground level reality would suggest not to give so much attention to quantity but to the quality factors for improving public health care. The move to increase the number of doctors and nurses for government hospitals and health complexes is fine. They may be useful to some extent in coping with the demand.
What is really the problem? Is it really the inadequacy of doctors in the government hospitals and the health complexes ? Any impartial investigation would show that the main problem is the mentality of the doctors and their unrestrained unethical behaviour. Typically, a young doctor with the education from a medical college, on being posted to an upazilla hospital, spends most of his or her time in Dhaka city to earn out of private practice. They visit the upazilla hospitals like migratory birds to spend some time there and draw their salary. Many of them consider their pay to be inadequate compared to their experience. But most of the time they remain on leave from the upazilla hospitals. The picture is common in all or nearly all the upazilla hospitals or health care complexes.
Rural people without the means to go to cities for medical care in private clinics rush to these health complexes, but in vain. Most of the time they have to return home without treatment, check up or prescriptions because no doctor was available. Patients needing emergency operations or attention return in great disappointment.
The experience is no different at public hospitals in the cities. Specialist doctors give virtually no time to these hospitals. They are always in a hurry. The patients do not get the needed attention. The less said about diagnosis and prescriptions, the better. The doctors at public hospitals do not forget to take their salaries. Their association with these hospitals add to their name and fame, which they utilise for private practice or working with private clinics to earn more. Unlike in the other countries, no well-known doctor can be contacted by patients on the phone. It's a cut throat business.
Deceit, exploitation of the poor and utter lack of care characterise the publicly-run medical care institutions in the country. The difference is of degrees from institution to institution. But these problems ail all of them, more or less. The public hospitals are supposed to provide medicines free of cost, or, at much subsidised prices, from their stores. The stores are regularly replenished with medicines and other needed supplies. But the bitter reality is that patients admitted to the hospitals are required to buy their medicines or the needed supportive articles from outside. They are routinely told that the hospital stores have run out of supply. In reality, the personnel manning the stores sell everything stocked there to private medicine shops in connivance with the hospital administrations.
For food and laundry services, the hospitals depend on private contractors engaged by hospital administrations. But the contractors usually get full payments supplying less food of poor quality and the hospital administrations say or do nothing for the obvious kickbacks. The contractors squeeze out more profits by supplying less of poor quality, although ample funds are allocated by the government. Laundry contractors do the same at the expense of the comfort and hygiene of the patients. Bed-sheets and pillow-covers out of the laundry are anything but clean.
To keep the public hospitals and their premises germ free large sums are allocated by the government. Every government hospital or upazilla health complex, on paper, employs staff to work round the clock to keep the premises clean. But allegedly, many of these cleaners are in the payrolls on paper only. The salaries of these ghost workers are regularly pocketed by the potentates in the hospital administrations. Even the handful of cleaners, who actually work, get away doing nothing due to lack of supervision. Soaps and detergents bought for the hospitals -- are sold outside.
Valuable medical equipment have been lying out of use at public hospitals. In some cases, the equipment have rusted and can not be used. The equipment could be an x-ray machine, dialysis machine, pathological testing instrument, etc., and all these cost a lot.
There is hardly any accountability at any tier of the public health care system. Sustained measures are long overdue for the improvement of the public health care system.