Streamlining health services

The new health minister, also a ruling party stalwart, has been talking tough since his appointment against dereliction of duties and responsibilities on the part of doctors and other irregularities in the health sector. He seems particularly serious about ensuring the presence of the doctors in their respective workplaces, mainly in public rural healthcare facilities. Traditionally, health sector is a difficult area to administer for a host of factors, including inadequate budgetary allocations, poor doctor-population ratio and propensity among the majority of physicians and surgeons to work only in major urban centres, primarily in the capital Dhaka. Corruption and political interference are two other basic flaws in the administration of the country's public healthcare system.
The annual allocation in the budget for the health sector remains highly inadequate compared to the need. In the current fiscal (2013-14), the share of the health sector in the overall budget has, in fact, shrunk from that of the last fiscal -- from 4.9 per cent to 4.3 per cent. Such inadequate allocation has been forcing people to foot the medical bills from their own pockets -- citizens meet nearly 96 per cent of the medical expenses out of their own pockets. Moreover, the major part of the annual budgetary allocations is spent on salaries and allowances of public-sector healthcare officials. But the poor taxpayers do not get their money's worth from the public-sector healthcare facilities because of non-performance by health professionals and widespread graft.
Non-performance and corruption are two factors that have their presence in every sector. But, in most cases, they draw their strength from political patronage which is rather plentiful in this country. For instance, the abstention from duty by doctors employed for district and rural government-run healthcare facilities is an old problem. Even repeated warnings from the highest authority of the government could not force them to get their act together. It has been observed that the newly passed-out doctors at the first instance remain engaged in tracing the all-important political links to get jobs, at least, on ad-hoc basis and, at that time, they are found willing to work even in the remotest areas. But once appointed, they again try to use political links to get posting of their choice. These doctors are usually not serious enough about serving people in the rural areas because of the same reason.
Graft in the health sector is also linked to political influence that often tends to overshadow the normal recruitment and procurement processes. So, the pious desires of the new health minister would largely be fulfilled if the health administration enjoys a freehand in all matters and no outside forces are allowed to influence its decisions, involving appointment and transfer of doctors and other health officials and procurement of goods and services. There is no denying that the government does not have enough resources to ensure even the minimum medical assistance to a large population. But if physicians and other health professionals remain true to the Hippocratic Oath and the government can ensure the best use of the resources it allocates to the health sector every year, it would be possible to deliver relatively improved health services to the people.