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Decentralisation can improve our health system

Dr. Samir Kumar Saha
07 Jun 2023 00:00:00 | Update: 06 Jun 2023 22:54:36
Decentralisation can improve our health system

Every year, World Health Day is observed across the world in order to promote awareness among people towards the importance of good health. This year, the day focused on the theme ‘Health for All’. We hope that its message will be reflected in Bangladesh’s health sector.

Though our health sector improved a lot, people do not get desired results due to a number of factors in the sector. It has not been possible to give quality treatment to patients at medical college hospitals and specialized hospitals due to the pressure of a huge number of patients there. Because, patients are forced to come to those hospitals after being failed to get treatment at upazila level hospitals. Due to huge pressure of patients, medical college hospitals and specialized hospitals failed to give proper treatment to their patients.

Discrimination is a main factor in our health system. Our Health Information Service (HIS) is not fully improved. Hence, people have not knowledge about proper health services and preventive services. Hence, there was large scale unawareness seen among people during the Corona pandemic. There is massive lack of monitoring over medicine industry in the country where top 10 institutions supply 70 per cent of medicines.

If treatment system of hospital at district and upazila level can be improved, it would be possible to give quality treatment to at least 60 per cent-70 per cent patients at those hospitals.

There should be fundamental change in the quality of treatment at upazila and union level hospitals and community clinics. Though our health system improved much, our health service has failed to get people’s confidence due to lack of proper management. So, there is allegation made by people regarding the quality of health service.

We have not required manpower in our health sector at the moment, though the post has been created in our health management. There is only one registered physician for 1581 people in the country. The absence of physicians is more acute in rural, remote and inaccessible areas.

There is also scarcity of trained nurses. Many hospitals have medical equipment but the post of technologist is lying vacant there. If management of recruitment of manpower (doctors, nurses, paramedics, lab-technician) is not decentralized, there will be no solution to such mismanagement.

Merely appointing physicians will not be a solution, it is also equally important to take necessary steps for keeping them in respective work places. Only paying higher salary for physicians will not be sufficient to keep them at work places, steps need to be taken for ensuring their security. Especially it is needed to ensure security for women physicians at residences and workplaces.

Taking too much time in diagnosis of diseases often causes the death of patients. In a bid to solve this type of problem, necessary steps should be taken so that comparatively complex patients from upazila level can get treatment at district, divisional and specialized hospitals. Healthcare services for patients are hampered owing to management of purchase and repair of medical equipment of hospitals. After decentralizing experienced technician and engineers, steps should be taken for repairing the equipment within short time and this system should be brought under monitoring. For this, biomedical engineering division should be strengthened.

Bangladesh has made significant progress in health indicators in recent years. Life expectancy at birth for both males and females has gone up since the 1980s. Infant/child mortality and fertility rates have also declined considerably. The proximate causes behind these successes are interventions in preventive care that has been possible due to the commitment of the state supported by donors, focused policies and certain institutional innovations. Problems, however, remain with respect to curative care both in access and the quality of care for the poor.

According to national health policy of Bangladesh, the provision of primary healthcare services is a public responsibility and the government tries to fulfill this role through its own facilities that are geographically dispersed. A well-developed rural health infrastructure exists in Bangladesh compared to urban areas but they are inefficiently operated, and there is a trend of declining use of public facilities in recent years.

People rely increasingly for curative care on the private sector that includes different types of actors.

Available studies on the problems of the healthcare sector focus on proximate causes such as the absence of doctors, incompetence and indifference of health staff, and corruption related to medical supplies and unofficial fees charged from patients. The underlying causes of inefficiency are actually rooted in the system that lacks both incentives and accountability.

The current Awami League government has established community clinics as decentralized healthcare units at the village level to ensure smooth and equal access to family planning, preventive health services, and limited curative care for the local community.

If the government ensures skilled workforce, structural and technical support, local level planning, adequate funding, strategic coordination, and delegation of functions to address the challenges in providing health services to community clinics, then it is believed that these community-knit clinics would be considered as the lighthouse for providing primary healthcare for the disadvantaged rural sections of Bangladesh.

Decentralisation of the country’s healthcare system can ensure quality treatment for 60-70 per cent of patients at their doorsteps, according to a study. Though our healthcare system has improved, people are yet to find doctors, medicine and other facilities at upazila and district levels. People were still rushing to medical college hospitals and hospitals in the capital as a result. The centralized system caused indiscipline in the sector – many hospitals struggled to provide service while others saw very few patients.

The government should decentralize the healthcare system by boosting root-level medical facilities. It will ensure quality medication for 60-70 per cent patients.

The majority of posts at upazila hospitals remain vacant. It can be filled with local arrangements. Many countries have such systems. We must determine our ways to ensure sufficient manpower in the root-level health sector.

Titled “Bangladesh health sector: present challenges and future guidelines”, the study identified lack of cleanliness, mismanagement of resources, shortage of medicine, ineffective and insufficient equipment, carelessness in repairing those, and lack of medical teachers and trainers as key problems of medical facilities – from tertiary level to community clinics.

The Eminence Associates for Social Development organized a total of 11 policy dialogues with the participation of leading physicians, educationists, politicians, journalists and civil society people between March to July in 2021 to help conduct the study.

Bangladesh’s health sector is totally centralized, with which we will not be able to attain sustainable development goals. Decentralization of the sector was imperative. The study suggested the government address the issues as early as possible. Besides, the study also recommended an overhaul of medical education and an introduction of the much-talked-about digital referral system.

The writer is former Executive Director of Public Health Foundation, Bangladesh