Hiren Pandit: A resolution on community-based health care was unanimously adopted at the United Nations recently. For the first time, a resolution on community-based health care was adopted unanimously at the United Nations. The historic resolution titled ‘Community-Based Primary Health Care: A Participatory and Inclusive Approach to Achieving Universal Health Services’ gave international recognition to Prime Minister Sheikh Hasina’s outstanding innovative leadership in establishing a community clinic-based model of primary health care in Bangladesh in a public-private partnership.
In the resolution proposed by Bangladesh, the member states of the United Nations widely recognized the successful innovative initiative of Prime Minister Sheikh Hasina in establishing community clinics, and this initiative was referred to as ‘The Sheikh Hasina Initiative’. This achievement reflects Bangladesh’s commitment to improving public healthcare and bringing equity to global healthcare. The resolution was presented to the General Assembly by Ambassador Mohammad Abdul Muhit, Permanent Representative of Bangladesh to the United Nations. The resolution was co-sponsored by 70 UN member states in strong support of community clinic-based health systems. The positive impact of this resolution in achieving universal health services in Bangladesh is highlighted. The adoption of the resolution by UN member states was cited as an unforgettable milestone in the global effort to achieve universal health care by 2030. Successful implementation of the resolution will play an important role in improving the health care of billions of people around the world by introducing community clinic-based health systems.
The resolution has far-reaching implications for promoting universal health services and international cooperation to achieve the United Nations Development Goals. Because it invites international financial institutions, multilateral and regional development banks and donors to provide appropriate technical and financial support for introducing and implementing this community clinic-based model health system in member countries, especially in developing countries. It should be noted that Prime Minister Sheikh Hasina launched this unique community clinic-based health system in Bangladesh in 1998 with the aim of bringing all the people of Bangladesh under primary health care, which has revolutionized the provision of primary health care benefits by the government at the doorsteps of people at the grassroots level across the country. This recognition will brighten the image of our country in the international arena in the indomitable development progress of Bangladesh under the leadership of Prime Minister Sheikh Hasina.
On behalf of the Bangladesh Permanent Mission to the United Nations, the resolution was negotiated with the member states by Deputy Permanent Representative Dr. Md. Manowar Hossain. The Mission has been playing an important role in health diplomacy for the past few years and in continuation of this resolution the Mission proposes for the consideration of the Member States earlier this year. After four months of intense discussions and negotiations with member states, the proposal was unanimously adopted on Tuesday. The government has established more than 18,000 community clinics across the country to ensure uninterrupted healthcare. This recognition will brighten our image in the international arena in the indomitable development progress of Bangladesh under the leadership of Prime Minister Sheikh Hasina.
The most important thing is that healthcare services have reached the doorsteps of everyone, and common people are coming there for treatment. As a result, many jobs have been created in the country, it has been reported by the government. Prime Minister Sheikh Hasina also said to share the experience of delivering health care to the doorstep of people through community clinics in other countries. Many countries are yet to bring healthcare to people’s doorsteps. If those countries want, Bangladesh will share our experience with them. The government started community clinics in 1998 but the health centers were closed in 2001. After Sheikh Hasina came to power for the second time in 2008, she established the community clinic by setting up a trust so that no one else could close it. Following the footsteps of Father of the Nation Bangabandhu Sheikh Mujibur Rahman, Sheikh Hasina has taken the initiative of a community clinic. Bangabandhu established a 10-bed hospital at the Union level to bring healthcare to the doorstep.
The claimants of this glory are the people of this country. Because they elected Awami League through voting and gave them the opportunity to serve them repeatedly. Sheikh Hasina is able to continue working for the welfare of the countrymen because she survived the bullet, bomb and grenade attacks. All those concerned with health feel that there has been significant progress in the country’s health sector in recent times. At present, there are 5 medical universities and 116 (public-private) medical colleges in the country. The number of beds in government hospitals has doubled in the last decade. A large number of super specialty hospitals have been established in the country in the private sector. The government has established around 18,000 community clinics and union healthcare centers across the country to bring healthcare to the doorsteps of the people. 30 different types of medicines are being given free to poor people.
Bangladesh has successfully tackled the Covid-19 pandemic and managed to save many lives. Considering the population density, many feared that the epidemic would result in large numbers of deaths. But concerted and timely efforts by the government and stakeholders can avert a potential disaster. 409 Junior Consultants, 2000 Doctors and 5000 Nurses have been specially appointed in Anesthesia on an emergency basis to deal with the situation during the Covid-19 pandemic.
In spite of various limitations, significant progress has been made in the health sector in the last 14 years. Healthcare is now much more accessible. It has reached the threshold of common people. We need to focus on preventive measures as well as the development of heart disease, diabetes, and stroke treatment services. Moreover, communicable and non-communicable diseases should be dealt with equally. Healthcare is now much more accessible. It has reached the threshold of common people. We have built and renovated more than 600 hospitals across the country to build a strong healthcare infrastructure. 11 postgraduate level super special hospitals, heart disease, thoracic disease, cancer and neuroscience infectious disease and leprosy hospital among other specialty hospitals have been established. About 18,000 community clinics and union healthcare centers have been set up to ensure primary healthcare for the rural population. Our medical care has improved considerably. The efficiency of doctors has also increased. Diseases that were previously treated abroad, are now being treated in the country and there are opportunities for treatment.
Heart disease is one of the leading causes of death in our country and all over the world. According to the World Health Organization, about 17.9 million people die of heart disease every year in the world. About 27 percent of the total deaths in Bangladesh are due to heart disease. Currently, 10 children per thousand are suffering from heart disease in the country. Also, 1 in 5 young people are at risk of heart disease. The number of heart disease patients is increasing in the country due to various reasons including diet, lack of physical work, smoking, and diabetes. The government has planned to build a medical college in every district.
However, much more work needs to be done in healthcare. The number of doctors produced in the country is not large in proportion to the population. There is one registered doctor for 1,581 people. Rural, remote and inaccessible areas have high rates of doctor vacancies. Although the equipment is available in many government hospitals, technician or technician posts are vacant. Both recruitment and retention in these positions are important. In addition to this, training and skill development of health workers is required. There are also many cases where health equipment is available but no one is available with proper knowledge to operate it. Besides doctors, there is a huge shortage of nurses, midwives and medical technologists. The demand to increase the budget in the healthcare sector in Bangladesh has been for a long time. A significant portion of the budget allocated is spent on physical infrastructure development, salaries and allowances. Hence the actual benefit to patients from the budget allocation is less. A common sector of the health budget is the procurement of equipment and the construction of infrastructure. The health ministry has been getting allocations close to 0.9% of GDP for the past year. The health infrastructure of Bangladesh is very rich in Southeast Asia. Weaknesses in management should be overcome. The infant mortality rate has decreased, the maternal mortality rate has decreased, the immunization program has accelerated etc. Affordable and quality health facilities for all. New diseases are becoming epidemics. Cancer, heart attack, and diabetes have increased at an abnormal rate. Corona has emerged as a new disease. These are the epidemics of the SDGs era. Like the overall economy of the country, healthcare services are expanding through the private sector. But the government should effectively regulate and monitor this sector to ensure its quality. The quality and cost of health care vary greatly through these unregulated private healthcare sectors. Transformed the health sector into a business rather than a service. There are systemic problems in the health sector. Those who will provide the service are not present in the hospital. Safe sanitation is in place but maintenance is weak. There is no good sewage system. The government is trying to eliminate these problems. The government is working through coordination. We also have more progress in the health system than before. More to come. There are infrastructural facilities of safe water and sanitation system in various healthcare institutions of the country including community clinics, and upazila health complex. Arrangements have been made for maintenance.
This year, 5,500 doctors will be appointed by the government and 15,000 nurses have been approved. 8 thousand more beds will be increased in hospitals. 20 thousand medical technologists will be appointed. Arrangements have been made to set up help desks in big institutes and hospitals for the help of people from outside Dhaka who are confused. Arrangements have been made to increase the number of public toilets in the hospital and make them separate. Water supply has been ensured in medical colleges, districts and upazila-level hospitals.
Many hospitals have been built at the union, upazila, and district levels and hundreds of governments and private medical colleges and hospitals are operational. Many specialty hospitals offer free medicine, surgery, gynecology, obstetrics, orthopedics, eye, ear, nose and throat, cardiac, neonatal and malnutrition services. Apart from 14 specialized hospitals for infectious diseases, leprosy and other diseases, all medical colleges, National Heart Institute and many district hospitals have medical facilities in ‘CCU’. Cancer treatment facilities are available in all medical college hospitals and National Cancer Institutes.
Many new institutes and hospitals have been built, Sheikh Hasina National Institute of Burn and Plastic Surgery, National Institute of Neuroscience, State-of-the-art Cancer and National Kidney Hospital, National Institute of Mental Health, National Heart Disease and Asthma Centre, Extension of Paralympic Hospital, National Institute of Ophthalmology, Bangladesh -Conversion of Kuwait Maitri Hospital into a government hospital, 500-bed hospital in Mughda, Sheikh Russell Gastroliver Institute, National Institute of ENT Hospital, National Institute of Nursing Higher Education and Research, Chest Disease and Kurmitola with 500 bed and Government Employees Hospital in Fulbaria, Dhaka, Abu Nasser in Khulna Specialized and Sheikh Fazilatunnessa Mujib Eye Hospital in Gopalganj and ‘Vision Center’ has been set up to launch online eye care services at this hospital.
Hiren Pandit is a columnist and a research fellow