Public healthcare services in a mess
Sunday, 8 January 2012
Shahiduzzaman Khan
It is just horrible to look into the state of affairs prevailing in the public healthcare services. Common people, especially the poor ones, are not even the getting minimum services. There are infrastructures at the upazila and union levels. Yet there are no medicines and no 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 the country's each and every hospital. Excepting some low-prices medicines, most such supplies vanish from the stores almost instantly. Where they go -- nobody knows. Vested coteries are there in each and every hospital. If most of the employees are members of the syndicate, how can the medicines reach the doorsteps of the common people?
What really happens to the public hospitals and institutions, whether in cities or in the countryside, is known to everybody. There is no proper accountability for supplies -- medicines, equipment, accessories and other items -- at the expense of 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 properly incentivised salary structure for doctors shunning private sector.
Intriguing it may sound though, 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 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 for them and also give them some extra incentives. Rewards for the talented but dedicated physicians should be there in order to encourage their professional activities.
Recently, the World Bank had advised the government for contracting out the medical services to the non-government organisations (NGOs), private institutions of fame etc. It said the government of Bangladesh would be benefited if it contracts out some of the medical services to the private sector 'at certain levels.' Such contracting-out should be based on a 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 further. It may consider transferring the management and operation of the large health sector entities to some renowned 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 doing an illegal practice. They are reportedly bringing in hundreds of medical instruments allegedly by giving false declaration as duty-free imports of such equipment. The government permitted these referral hospitals to enjoy zero-duty import facility, along with non-profit charitable organisations. The condition was that they would render services to the poor people at a reduced or free of cost. But in reality, such referral hospitals, that got permission for duty-free import, do not give any facilities at discounted or reduced 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. Some such hospitals do also allegedly sell equipment, imported duty-free, out to other clinics for profit. The concerned revenue officials do also have allegations about some of the hospitals transferring funds abroad through over-invoicing of imported medical equipment. The government made medical equipment import duty-free with a view to promoting quality health services in the private sector and putting a check on overall medical expenses, in foreign currency, by those who can otherwise foot the bill thereof.
The facility saw some big budget hospitals coming up in the private sector. It also attracted a few international hospital chains into the country over the years. 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 positive care about serving the poor. There are no free beds, even in a limited number, for the disadvantaged patients.
szkhan@dhaka.net
It is just horrible to look into the state of affairs prevailing in the public healthcare services. Common people, especially the poor ones, are not even the getting minimum services. There are infrastructures at the upazila and union levels. Yet there are no medicines and no 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 the country's each and every hospital. Excepting some low-prices medicines, most such supplies vanish from the stores almost instantly. Where they go -- nobody knows. Vested coteries are there in each and every hospital. If most of the employees are members of the syndicate, how can the medicines reach the doorsteps of the common people?
What really happens to the public hospitals and institutions, whether in cities or in the countryside, is known to everybody. There is no proper accountability for supplies -- medicines, equipment, accessories and other items -- at the expense of 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 properly incentivised salary structure for doctors shunning private sector.
Intriguing it may sound though, 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 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 for them and also give them some extra incentives. Rewards for the talented but dedicated physicians should be there in order to encourage their professional activities.
Recently, the World Bank had advised the government for contracting out the medical services to the non-government organisations (NGOs), private institutions of fame etc. It said the government of Bangladesh would be benefited if it contracts out some of the medical services to the private sector 'at certain levels.' Such contracting-out should be based on a 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 further. It may consider transferring the management and operation of the large health sector entities to some renowned 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 doing an illegal practice. They are reportedly bringing in hundreds of medical instruments allegedly by giving false declaration as duty-free imports of such equipment. The government permitted these referral hospitals to enjoy zero-duty import facility, along with non-profit charitable organisations. The condition was that they would render services to the poor people at a reduced or free of cost. But in reality, such referral hospitals, that got permission for duty-free import, do not give any facilities at discounted or reduced 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. Some such hospitals do also allegedly sell equipment, imported duty-free, out to other clinics for profit. The concerned revenue officials do also have allegations about some of the hospitals transferring funds abroad through over-invoicing of imported medical equipment. The government made medical equipment import duty-free with a view to promoting quality health services in the private sector and putting a check on overall medical expenses, in foreign currency, by those who can otherwise foot the bill thereof.
The facility saw some big budget hospitals coming up in the private sector. It also attracted a few international hospital chains into the country over the years. 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 positive care about serving the poor. There are no free beds, even in a limited number, for the disadvantaged patients.
szkhan@dhaka.net