According to the government’s Directorate of Health Services (DGHS), there are 654 government hospitals in Bangladesh with a total of 51,318 beds. There are 5,055 private hospitals with a total capacity of 90,587 beds. With various efforts, Bangladesh has achieved something in the health sector. This includes reducing maternal and child mortality. However, the health system in Bangladesh has always been issue-based. No overall plan was made.Sustainable Development Goal 3, regarding good health and well-being, is one of the 17 Sustainable Development Goals established by the United Nations in 2015. The official wording is: “To ensure healthy lives and promote well-being for all at all ages.”
After the COVID-19 pandemic in Bangladesh, many businessmen, senior government officials and politicians have been treated in government hospitals. In a normal situation, many of them would not even think about getting treated in Bangladesh. But in this time of the pandemic, government hospitals have become the only hope.
The country is already moving towards universal health care or universal health coverage by providing free medical care in community clinics and government hospitals across the country and free vaccinations through national immunisation programmes. Apart from this, universal health coverage activities are also being carried out directly through pilot health schemes in some areas.
There are also plans to launch it across the country in phases. However, there are still challenges to universal health care in the country. Still now marginalized and disadvantaged Dalits, day laborers, transgender people, hairdressers, sweepers, blacksmiths, sex workers, fishermen, cobblers, scavengers, ethnic minorities, persons with disabilities, despite their constitutional rights, face many difficulties in accessing health care. These communities are deprived of free healthcare in government hospitals due to lack of access.
However, the government is keeping an eye on the situation so that no one is deprived of medical treatment. But everyone’s constitutional rights must be ensured. However, no medical center was closed in the country even during the COVID-19 pandemic. Despite the lockdown of others, the medical or medical staff has provided services to the people even at the risk of their own lives.
Universal health coverage will be implemented in our country only when people do not have to spend money out of their pockets to get health care and when they can get any kind of medical service for free. We may have to go a long way for this. It is difficult to provide free healthcare to all the people in a country like ours.
We are in the era of SDGs. Earlier our expectation was health for all. Accessible and quality health is available to all. But we have to rearrange our expectations with the change of times. New diseases like COVID-19 are taking the shape of a pandemic. Now the epidemics are cancer, heart attack, and diabetes. These are the epidemics of the new era, the era of SDGs.
Now the cost of health has become much more expensive. According to government figures, 67 per cent of our health spending is out of pocket. But the global standard is about 34 percent. We are spending almost twice as much. Health costs are a big burden for us. We do not accept the cost of healthcare properly. Not only the poor but also many middle-class families have become destitute due to a lack of health care. The types of disease have changed. Many have to take medication for cancer or chronic illness. The government, of course, has some initiatives. There are large programmes to distribute essential medicines. We have to think about how to solve this problem. The issue of access to health care for marginalised, Dalit and disadvantaged people has come to the fore.
The various experiences of initiating Covid-19 from different perspectives remind us that the direct and indirect cooperation of all members of the community in ensuring health for all, coordination of all sectors, use of appropriate technology, and equitable delivery of health care were also mentioned. There are about 14,500 community clinics in the country that provide services to marginalised people. But it is not enough.
The local government can also play an important role in building a rights-based healthcare system. The 150-year-old institution, along with the local people, can create immense potential for solving many local problems in the event of a Covid-19 or similar catastrophic situation.
Health is predominant in any of our discussions – where there are no doctors, no medicines, no hospitals, no beds, poor hospital conditions, corruption, irregularities, low budget allocations, harassment of brokers, etc. Every aspect of it is medical. These issues also need to be discussed and resolved. But all this discussion is lost in the crowd – how can we reduce or prevent the disease.
The Constitution of Bangladesh recognises medicine as a basic need or requirement and identifies the development of public health as one of the primary duties of the state. But since the issue of health care is not mentioned as a fundamental right in the third part of the constitution, it cannot be claimed as a valid right. To ensure the health of the people of the country, health needs to be constitutionally recognized as a fundamental human right and the prevention of disease must be given priority.
The right of people to access healthcare is not a matter of kindness or compassion, it is also a matter of broad understanding of the common man and the creation of a culture of accountability for those who are in the role of service providers at the public-private level. Building a rights-based health infrastructure will make it easier to achieve these goals, achieve the SDGs and above all, better deal with the pandemic of Covid-19 or similar epidemics. At the same time, easy access to health care will be ensured for marginalized Dalit and disadvantaged people.
For all in the implementation of the SDGs, the intended SDG-3 has been used to ensure healthy living and reduce inequality in the SDG-10. The SDG-10 is the goal to reduce inequality. Thus, it can be said that no goal can be considered achieved until everyone’s needs are met. So ‘leave no one behind’ (LNOB) applies to all purposes. Not leaving anyone behind means reaching out to every single person and this has been considered one of the beautiful features of the 2030 Agenda.
In the context of Bangladesh, there may be landless people, homeless people, people living on chars, haors, hills and disaster-prone areas, widows, abandoned and distressed women, elderly people and single mothers, adolescents, persons with disabilities, affected people of coastal areas due to climate change. People living in high-risk areas, small farmers, ethnic minorities and fishermen who may be left behind can face HIV/AIDS, infectious diseases, mental illness, drug addiction, road accident injuries, school dropout and more. Women and students, domestic workers, and transgender people are at risk of being victims of violence. Marginalised people like cleaners, tea garden workers, gardeners, washerwomen, folk musicians, midwives, barbers, leather workers, cobblers, barbers, snake charmers, etc. may lag in SDGs.
Due to Covid-19, day laborers, rickshaw pullers, transport workers, people working in small and cottage industries, people in the informal sector and people of almost all professions except the government sector have lengthened the list. Therefore, we need meaningful access to healthcare for all, especially for these vulnerable people. All must have access to healthcare.
* Hiren Pandit is a columnist and researcher