More needed for a pro-people health service
Tuesday, 29 June 2010
Pro-people health activists have reason to be disappointed with the 2010-11 proposed budget for the health sector ---- only six per cent, which is 0.6 per cent less than the previous year's allocation. Their demand, that a national health policy should be formulated to meet the needs of the population at large, has been ignored, and they suspect that much of the money would most likely go into recruiting doctors, nurses and other health workers on political considerations. Plans to build 13,500 community clinics across the country and increase the hospital beds at upazila and zila levels to 50 and 250 respectively, are all very well but can expenditure on infrastructure and recruitment alone guarantee essential health services to the neediest? This question arises because despite the existence of the physical infrastructure of clinics and hospitals, even at union levels, people rarely get served. The buildings simply become dens for local heavyweights or at best can be used as shelters against natural disasters.
The health problems generated by major disasters are considerable. Nine of the world's top ten countries for disaster-related deaths due to weather-based phenomena like floods and cyclones belong to Asia, and Bangladesh is one of the worst affected. In November 2007, Sidr alone killed some ten thousand people and injured thousands more. Government figures put the number of affected to as many as eight million and, it is estimated that about 71 per cent of the health facilities in the periphery of the storm were badly damaged. In this context expenditure on sturdier health infrastructure may benefit people in more ways than one.
For Bangladesh, with one of the world's highest maternal mortality rates, virtually everyday is an emergency of the silent kind, caused by day-to-day malnourishment, poor sanitation and poor management of scarce resources.
This silent emergency is not to be trivialized. So while it is important to invest in health infrastructure that can withstand hazards ---- not only to be able to safely serve people immediately but also to have systems in place to ensure continuity of care ---- the government must see to it that its primary purpose, to cater to the daily health needs of the community, is served. A health facility's actual value lies in its non-structural elements, as well as its mechanical, electrical and communications equipment, including storage and water-heating provisions. It is often damage to these that turns an otherwise good health infrastructure into a mere brick building. WHO information kits claim that only about one per cent of a hospital's budget is needed to have these non-structural elements in place, but this one per cent can protect 90 per cent of the hospital's value.
Unfortunately, a culture of poor management and maintenance in Bangladesh's government-run facilities can be the undoing of even the best health facilities available. This must, and can be overcome through continuous training of personnel in the use and upkeep of essential equipment. It is an imperative if existing facilities and newly established ones are to remain safe and operable whenever needed.
The health problems generated by major disasters are considerable. Nine of the world's top ten countries for disaster-related deaths due to weather-based phenomena like floods and cyclones belong to Asia, and Bangladesh is one of the worst affected. In November 2007, Sidr alone killed some ten thousand people and injured thousands more. Government figures put the number of affected to as many as eight million and, it is estimated that about 71 per cent of the health facilities in the periphery of the storm were badly damaged. In this context expenditure on sturdier health infrastructure may benefit people in more ways than one.
For Bangladesh, with one of the world's highest maternal mortality rates, virtually everyday is an emergency of the silent kind, caused by day-to-day malnourishment, poor sanitation and poor management of scarce resources.
This silent emergency is not to be trivialized. So while it is important to invest in health infrastructure that can withstand hazards ---- not only to be able to safely serve people immediately but also to have systems in place to ensure continuity of care ---- the government must see to it that its primary purpose, to cater to the daily health needs of the community, is served. A health facility's actual value lies in its non-structural elements, as well as its mechanical, electrical and communications equipment, including storage and water-heating provisions. It is often damage to these that turns an otherwise good health infrastructure into a mere brick building. WHO information kits claim that only about one per cent of a hospital's budget is needed to have these non-structural elements in place, but this one per cent can protect 90 per cent of the hospital's value.
Unfortunately, a culture of poor management and maintenance in Bangladesh's government-run facilities can be the undoing of even the best health facilities available. This must, and can be overcome through continuous training of personnel in the use and upkeep of essential equipment. It is an imperative if existing facilities and newly established ones are to remain safe and operable whenever needed.