Hiren Pandit: According to the data of the Directorate of the Health Services of the Government, there are 654 public hospitals in Bangladesh and the total number of beds in these hospitals is 51,316. There are 5,055 private hospitals, with a total bed capacity of 90,587. Bangladesh has some notable achievements in the health sector. This includes reducing maternal and child mortality. Bangladesh’s health system has always been issue-oriented. No planning at all. After the infection of the COVID-19 virus in Bangladesh, it has been seen that many businessmen, senior government officials, or politicians have been treated in government hospitals. In normal times, many people would not even think about getting treatment in Bangladesh. But in this time of calamity, the government hospital became the only hope. Much the same is seen in the field of dengue treatment.
The country is already moving towards universal health coverage, with free medical care at 14,500 community clinics and government hospitals across the country and free vaccinations through the National Immunization Program. Apart from this, universal health coverage activities are also going on directly through health schemes in pilot form in some areas. There are also plans to gradually launch it across the country. However, challenges still remain in the country’s universal health coverage program. Still Dalits, marginalized communities and underprivileged people especially day laborers, Hijra community, barbars, sex workers, fishermen, cobblers, scavengers, and ethnic minority communities, many have to face many ironies to get health care despite having their constitutional rights because of our mentality. These groups are deprived of free healthcare services in government hospitals due to their access constraints.
However, it is claimed that the government is keeping an eye on ensuring that no one is deprived of treatment. But the constitutional rights of all must be more strongly guaranteed. However, no medical center in the country has been shut down despite the Covid-19 pandemic. While others are under lockdown, it is certainly commendable that medical or medical workers have provided services for people at the risk of their own lives.
Universal health coverage programs will be implemented in our country when people do not have to spend pocket money to get health care, through specific plans and activities they can receive any type of medical care free of cost. It may take longer. However, it is difficult to provide free health care to all people in a country as populous as ours. Now we are in the SDGs era. Earlier our expectation was health for all. Now it is being said, accessible and quality health for all. The expectation we speak of as health for all has not yet been realized. But due to the change of day, we also have to adjust our expectations. New diseases like COVID-19 are becoming pandemic. Now epidemics are cancer, heart attack and diabetes. These are the epidemics of the new era, that is, the SDGs era.
Now health costs have become much more expensive. According to government statistics, 67 percent of our health expenditure is out of pocket. But the global standard is like 34 percent. We are spending almost twice that. Health costs are a big burden for us. We do not properly recognize the cost of healthcare. Not only the poor but also many middle-class families become destitute in meeting the health expenses. Because now the type of illness has also changed. Many need to take medication regularly due to cancer or chronic illness. However, the government has some initiatives. There are large programs to distribute essential medicines. You have to think about how to solve this problem. The issue of access to health care for marginalized, Dalit and underprivileged people has come to the fore.
The various experiences of taking initiatives on COVID-19 from different perspectives remind us of one thing over and over again, direct and indirect collaboration of all communities, coordination of all sectors, use of appropriate technology and equity-based health care delivery in ensuring health for all were also mentioned. Besides, the local government can contribute as an important institution to build a rights-based healthcare system. This 150-year-old institution can create immense potential in solving many local problems by bringing local people along with COVID-19 or such big disaster situations.
In any discussion we have about health, where there is no doctor, no medicine, no hospital, no seat, poor condition of the hospital, corruption, irregularity, low allocation in the budget, nuisance of brokers etc. are many issues. Every aspect of it is medically oriented. These issues also need to be discussed and resolved. But lost in all these discussions is how we can reduce or prevent disease.
The Constitution of Bangladesh has recognized medical care as a basic need or need and has identified the promotion of public health as one of the primary duties of the state. However, 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 an enforceable right. To ensure the good health of the people of the country, health needs to be constitutionally recognized as an enforceable fundamental human right and disease prevention should also be given priority.
Human rights to health care, not a matter of mercy or mercy, should also be widely understood by the general public and efforts should be made to create a culture of accountability for those who play the role of service providers at the public and private levels. Building a rights-based health infrastructure will make it easier to achieve these goals, achieve the SDGs, and above all, fight against COVID-19, dengue or similar pandemics more robustly. Besides, the issue of access to health care will be ensured for marginalized, Dalit and underprivileged people.
Universal health protection programs must be ensured if the World Health Organization’s Sustainable Development Goals (SDGs) are to be implemented. In order that no people in the country are deprived of medical services and the poor people do not become poorer or destitute while seeking treatment, it is necessary to implement health insurance to protect the health of all in Bangladesh. The purpose of health insurance is to cover the medical expenses of the individual.
Depending on the overall risk of health care and estimated health-related expenses, an insurer can take different types of health insurance. Such as monthly premiums or payroll taxes, which will cover the necessary medical expenses as per the insurance contract. This includes accident compensation, all medical expenses, disability or accidental death compensation etc.
The healthcare system in the United States relies heavily on private health insurance, which is the primary source of healthcare for most Americans. On the other hand, the United Kingdom’s National Health Service (NHS) is a government-run health care system, where everyone living in the United Kingdom naturally receives this health care. Our neighboring country India has already introduced several health insurances. The most popular of these is State Health Insurance. The project has won the trust of poor people due to the combination of state goodwill and modern technology. In other health insurance, the insured is supposed to pay the premium, but the government pays the premium in this insurance. Poor people can get many treatments free up to a certain amount of money in various public and private institutions. In exchange for 30 rupees, poor people can get the assurance of good treatment for their families. By carrying a smart card, five members of a family can get 30,000 rupees worth of treatment in a hospital in a year. Launched on April 1, 2008, for people living below the poverty line, the scheme has covered 3.6 million families in six years.
According to the data of the Bangladesh National Health Account, 6.4 million people are getting poorer than the poor every year while seeking health care. Of these, 15 percent are in extreme distress. Because 67 percent of the health expenses of the people of Bangladesh have to be spent from their own pockets. As a result, people are becoming poorer day by day while meeting health expenses. Private expenditure will continue to rise if the health sector is not covered by insurance soon.
According to the Health Finance Unit, less than 1 percent of the country’s population is covered by health insurance. That means more than 99 percent of people are still out of health insurance. Some private institutions, corporate houses, and universities are running health insurance for their employees, but they are not able to provide all kinds of health protection in these insurances. It can be seen in the reality of our country, that it will not be possible to bring all people under insurance so easily, especially in the case of the lower middle class or lower class, the matter is more difficult. In this situation, we should first cover the middle class from the upper class gradually. Insurance premiums can be determined in proportion to income and according to the number of family members. The poor population should also be covered under insurance, but it should be at a very low cost or if possible free of charge. That is, the poor population will be covered by insurance, but its premium may be paid by the government. Here one more thing needs to be ensured so that there is no delay in getting services like conventional insurance. Something like the way the National Pension Scheme has been introduced and can be taken forward.
Hiren Pandit is a columnist and researcher