Sorry state of public healthcare service in Bangladesh

In the backdrop of population boom and increasing number of patients, healthcare facilities both in public and private sectors have quickly expanded in the country in recent years. But the quality of health service in general is yet to show signs of improvement. In public hospitals and health centres, it is common knowledge, powerful groups of employees with political connections extort patients in exchange of providing due facilities. They realise money from helpless patients either for providing a trolley or allotment of a seat. In some hospitals, it is alleged, 'Dalals' allure patients to go to clinics on the assurance of receiving better treatment. A section of doctors and hospital staff are also associated with those particular clinics. Let us cite an example of the country's premier government-run health facility- Dhaka Medical College Hospital (DMCH).On November 11 last, a private TV channel in its midnight telecast showed how a hospital staff alluring some patients to go for treatment at private clinics outside. Some members of the group were also found realising money from patients for the purpose. The video footage showed a woman in tears telling the TV reporter that she has already paid taka three thousand five hundred to a person at the hospital on the basis of his assurance that she would get better medical attention in an adjacent private clinic. The woman reported that she was a poor employee of a private company drawing a monthly salary of taka 3,000. After realising money at the outdoor the man disappeared. Therefore, the woman came to DMCH again. The TV channel narrated the condition of another person who has brought his patient to the DMCH and fallen prey to 'Dalals' and already spent taka 40,000 but to no effect. The TV reporter was found frantically trying to contact DMCH director for his version on cheating of the patients by 'Dalals'. But the director did not talk to the reporter. The TV reporter contacted the Director General of Health Services who admitted the problems relating to 'Dalals' in the hospital. The DG assured of taking necessary steps in this regard. This is not an isolated case, but similar incidents are frequently taking place in other government-run hospitals and health complexes.
Recently, another private television channel broadcast live an episode on how organised groups of employees at the Orthopaedic Hospital, popularly known as Pangu Hospital in the city, are engaged in pilfering medicines, gauge, bandages, disposable syringes, etc. from this government-run health facility. All these medicines and many other items are being sold to private clinics adjacent to the Orthopaedic Hospital at half of their prices. The TV crew entered the store room of one such private clinic where a large stock of medicines, pilfered from the Orthopaedic Hospital, was found. Labels on the bottles and packs of medicines clearly showed that those were government properties. The TV watchers were surprised to see that the store keeper of the private clinic was maintaining a register with entries showing names of employees of the Orthopaedic Hospital with their cell phone numbers who supplied medicines and other clinical materials regularly. The quantity of materials was clearly recorded in the register. One of the store keepers admitted to the TV reporter that the clinic was receiving regular supply of medicines and other materials from the Orthopaedic Hospital staff. A ward boy of the Orthopaedic Hospital whose name was found along with his cell phone number in the private clinic's register was hunted down by the TV journalist. The staff introduced himself as a ward boy of the Orthopaedic Hospital. When asked how his name with mobile phone number appeared in the private clinic register, he replied that as a hospital staff he often visits many private clinics and as such his name might have been recorded in the register. But the ward boy kept mum when asked about different medicines found against his name in the register. Another employee of private clinic's store was found swearing to TV journalist that he would not indulge in such practice in future. When asked, the Director of the Orthopaedic Hospital admitted about theft of medicines from the hospital to the TV reporter with an assurance that he would try to stop the malpractice. The Director General of Health Services who was also interviewed told the reporter that theft of medicines is also going on in other government hospitals. The DG informed that about 96% of the medicines needed by the patients are supplied to the hospitals by the government.
The TV crew went to another clinic which has registration. A general employee of the clinic frankly admitted that obtaining registration for a clinic is not a difficult task as this can be done easily on payment of money to the relevant health authorities. All types of patients are admitted to the clinic. The clinic staff confessed to the TV reporter that a patient is immediately transferred to a public hospital as soon as his/her condition deteriorates. In this clinic also the TV man found no qualified doctor or nurse. A young woman wearing a white apron was found there. When asked, the woman replied that she was not a qualified nurse but an Aya. How she performs the duties of a nurse without qualification, the Aya replied that she can do the job well on the basis of her experience gathered in the clinic. The TV reporter learnt that there are more than one hundred clinics and diagnostic centres operating in Ashulia and Savar and most of those have no registration.
The claim by the DG Health about the supply of medicines in government-run hospitals may be true but it does not help the large number of patients attending the government health facilities every day as unscrupulous hospital staff continues to take bulk of those away for sale.
Former health minister Professor AFM Ruhal Haque was never found wanting in telling people that there was no shortage of medicines in government hospitals across the country. He even announced on several occasions in the past that the patients at the government hospitals were no longer required to buy medicines at their own cost. Quoting civil surgeons, the minister had once said that whenever he wanted to send medicines in any government hospital they reported that there was enough stock of drugs at their disposal. The minister claimed that adequate supply of medicines to the hospitals was the result of pragmatic steps taken by the government in the country's health sector. The health minister mentioned that colour of the labels of medicines supplied to the hospitals have been changed to ensure free distribution to the patients. On one occasion, the government-run central medical store (CMS) which maintains supply of medicines to public hospitals had to take back non-essential drugs from twenty districts. The civil surgeons of the 20 districts returned the medicines to CMS because those were not required in the hospitals there. Later on the health ministry and the director general of health had formed two separate committees to probe into the causes of refusal of civil surgeons to accept the medicines sent by CMS. The civil surgeons informed the health ministry and health directorate that they had contacted the CMS not to send non-essential drugs, but in vain.  
On the other hand many investors find it attractive to set up clinics and diagnostic centres even at upazila  level.
According to a dependable estimate, there are more than 10,000 private clinics and diagnostic centres in the country. But the mushrooming of clinics and diagnostic centres has failed to provide proper medical treatment to the growing number of patients. Out of 10,000 private clinics and diagnostic centres, about 4500 have registration and the rest are unregistered. The condition of some private clinics and  diagnostic centres in Ashulia and Savar on the outskirts of Dhaka city is really deplorable. In one such diagnostic centre, reports have it, a young man was found testing blood samples on glass slides. In reply to a question, the young man at the clinic explained the procedure of blood testing. The blood tester pulled out a computer print showing the pathological test result. When asked about his qualification, the young man replied that he was a computer operator of the clinic, not a pathologist. In reply to a question about how he could perform the blood test without being a pathologist, the computer operator informed that the test report would be signed by a registered pathologist associated with the clinic. In another room, a young man was found seated who introduced himself as a medical student doing part time job in the clinic. He said that he did not know the number of qualified doctors employed in the clinic. Another clinic staff who was present there said that when the condition of a patient turns critical the patient is quickly sent to a government-run hospital. It was also learnt that the clinic has no licence.
In another episode, the late night TV watchers were horrified to see surgical procedure being carried out on an infant at a rural health complex not far from Dhaka city. It was indeed a dreadful sight. The patient was screaming. A person in informal dress was found performing surgery on the baby. The 'surgeon' had no gloves, mask, nor apron. The open place where surgery was being performed appeared to be most unhygienic. The TV reporter, after the surgery, interviewed the 'surgeon' at the Keraniganj Upazila Health Complex across the river Buriganga. The private television channel which aired the event interviewed the 'surgeon'. The man in his late thirties introduced himself as a ward boy of the health complex. When the reporter asked him how he could do the operation without being a qualified doctor, the ward boy smilingly said that he had to do it in the absence of doctors. Other patients at the complex who were also interviewed complained about non-availability of medicines, acute shortage of doctors and a host of other problems. In fact, healthcare service in rural areas across the country faces those most common problems that include non-availability of essential drugs, equipment, acute shortage of doctors and other medical staffs.
The writer is consultant editor of the FE