Healthcare system under severe stress

The United Nations World Urbanisation Prospects 2025 report reveals that Dhaka City is the second largest megacity after Jakarta. Instead of celebrating this elevated status, both experts in urban development and ordinary citizens consider this sobriquet highly concerning. Not only has the capital city with 36.6 million population surpassed Tokyo and is all set to overtake Jakarta by 2050, according to the UN report. The elevated ranking unfolds a nightmarish picture if the Economist Intelligence Unit (EIU) 2025 Global Liveability Index (GLI) is taken into consideration. According to the EIU, Dhaka has already become the third least liveable city in the world. Civic services are woefully inadequate and its air quality is one of the worst in the world. If the city's population explosion follows the current trend with internal migration of people from villages and climate refugees mostly from coastal areas, its infrastructure and utility services already gasping from an outsize population will simply experience a breakdown.

How will the medical facilities, already overwhelmed, fare then? A report carried in the FE on Wednesday focuses on this particular area highlighting the mismatch between the demand for healthcare and the existing provisions. In a centralised system of administration, specialised medical services are also concentrated in the capital. Stressed far beyond their capacities, both public and private healthcare facilities struggle to serve a far higher number of patients than they can. When the rush of patients is heavy, it is natural that the overall environment for medical care is compromised to a large extent. Experts are of the opinion that establishing a few more large government hospitals in the city will not be an answer to the problem. The very idea of centralisation of all facilities in the capital will complicate the system even more. The need is to decentralise government institutions and organisations including hospitals.

Bangladesh has an advantage here, the potential of which can be cultivated. It is the upazila health complexes, union health centres and the village-based community health centres that could be reactivated by necessary investment and recruitment of medical staff. Right now, many of those are either operating in a moribund state or abandoned altogether. Had those been organised in an efficient manner, the majority of patients did not have to rush to Dhaka for better medical treatment. Hospitals in urban centres would not be crowded so much as those have to deal with now. Thus a referral system could be developed for better treatment of patients suffering from complicated diseases.

When education and healthcare should be given priority in budget allocation, the policymakers fail to take a long view of the benefits it can bring for the nation. Instead, they feel no qualms about slashing the allocation further in the revised annual development programme (RADP). The Directorate General of Health Services (DGHS) under the Ministry of Health and Family Welfare is also to blame for its failure to utilise the allocation well. This kind of casual outlook of the health services is unacceptable. There are reports of imported medical machines and equipment remaining packed for years or not in operation because of a lack of repair. Monitoring and supervision are conspicuous by their absence. Evidently, mentality rather than paucity of money is to blame for the healthcare system's problems.