Page 74 - IBT Sept 2021 (1)

Health Sector
By Munira Fidai September 2021
Championing country has received around 16 international
awards and prizes, out of which, three were
United Nation awards for the incredible
development in the health sector. According to
the foreign secretary of Bangladesh, Masud Bin
Care Momen, a good way to describe the healthcare
system of Bangladesh is “good health at low
cost”.
Some particularly notable milestones in the
history of the health sector in Bangladesh are
its achievements in mass inoculation for
different, preventable diseases, reducing mother,
infant and below-5 mortality rates, family
planning, and, to some extent, child nutrition. the last decade. The stunting (impaired growth due to lack of
In keeping with article 15 of the constitution of
the People’s Republic of Bangladesh, where it
states that "It shall be a fundamental
responsibility of the State to attain, through
planned economic growth, a constant increase
of productive forces and a steady improvement
in the material and cultural standard of living of
the people, with a view to securing to its
citizens the provision of the basic necessities of
life, including food, clothing, shelter, education
and medical care.", the country undertook
family planning through fertility regulation
right after gaining independence in 1971.
According to the National Population Census of
1974, the total fertility rate (TFR) per female
stood at 6.9. By 1989, it saw a decline and
stood at 5.1 while by 1996 it was down to 3.3
births per female. After a 10-year hiatus in
fertility during the 1990s, the TFR further
declined to 2.3 births in 2011. The most recent
data shows that in 2019 the TFR in Bangladesh
was 2.0, at par with Sri Lanka and Nepal,
Photographs: Unsplash Pakistan at 3.3.
whereas the TFR in India was at 2.3, and in
The other success story associated with
Bangladesh’s health Bangladesh’s health sector is the one on mass
inoculation. In 1979, Bangladesh devised a
sector through the supremely effective national immunization
campaign called the Expanded Programme on
Immunisation (EPI). The program gathered
years made praiseworthy progress in the healthcare speed after 1985 when Bangladesh committed
sector, ever since the independence year, 1971. to immunize every child in the country by the
next 5 years, to the UN, thereby reaching
Given that the country is only 50 years old and universal child immunization. According to
was essentially a hard-hit nation when it gained research, by 2017, 89% of children between the
Economic strength and a wealth of health resources are its independence, Bangladesh has often been ages of 12–23 months were fully immunized
known to be crucial drivers to the success of healthcare called a “positive deviant” for exceeding against major vaccine-preventable diseases such
sectors worldwide. Most countries who boast of strong expectations despite widespread challenges. as tuberculosis, diphtheria, pneumonia, measles
healthcare systems often have these two propellants According to “The Lancet”, one of the most and others.
backing them up. However, one country that may have revered medical journals of England, One of the Millennium Development Goals that
proved this theory wrong is Bangladesh. Outperforming Bangladesh’s admirable success in this sector is Bangladesh had committed to, was reducing
many of its South Asian neighbours, Bangladesh has “one of the mysteries of global health.” The maternal and child mortality, and in it, the
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country has progressed in leaps and bounds, even receiving a
UN Award for the same, in 2010. As per data pertaining to
2019, the under-5 mortality rate was 28 per 1000 live births.
Infant and neonatal mortality rates stood at 21 and 15,
respectively. Where global life expectancy was 72 years,
Bangladesh, thanks to the above mortality rate reductions
stood at 73, above all but one South Asian country- Sri Lanka
which was topping the charts at 76 years.
Child nutrition is a problem that is being faced by most
developing countries in the world, with successes and failures
constantly warring against each other, hindering progress.
Bangladesh recognizes the dilemma, and it has taken steps to
mitigate malnutrition, demonstrating a steady improvement in
nutrition) rate among children under the age of five has
dropped down 10% from 41.3% in 2011 to 31%in 2018, and
wasting (low weight for height) has gone down from 15.6% to
8.4%. While the development has been consistent, it is still not
enough and more needs to be done for these figures to fall
lower.
Bangladesh boasts one of the best health networks in the
public sector. As per recent data, there are 47,678 domiciliary
workers with 13,907 community clinics at ward level, 4,646
union level facilities, 424 upazila health complexes, 59 district
hospitals, 18 medical college
hospitals and 12 specialized
institute hospitals, as well as
other facilities. Despite the
large set up, shortages of
human resources, shortages
of the specific skill sets, and
scarcity of equipment,
medicines and other supplies
hinder stakeholders from
maximizing the optimum
level of output from this set
with the public health sector of Bangladesh has been the lack
up.
A longstanding challenge
of public expenditure on this sector. This year, the country’s
allocation to the health sector is only 5.14% of the total budget
and less than 1% of GDP, despite Covid challenges. Public
expenditure on health in Bangladesh is one of the lowest, not
only in the world, but also compared to other lower
middle-income nations averaging 2.8% or even the South
Asian average of 2.1%. The country not only has a
concerningly low expenditure rate on the sector, the
expenditure is also not divided judiciously among all
geographical and residential divisions.
Taking advantage of this disparity, is the private health sector
of Bangladesh with healthcare facilities under the Directorate
General of Health Services (DGHS) being 2,258 registered
private hospitals and 5,321 clinics. Hospital beds amount to
54,660 under DGHS and 91,537 under private owned
hospitals. As privately owned medical establishments require
people to pay for their services out of their own pockets,
Bangladesh seems to be something of a “negative
outlier” among similar, low income (LIC) or low
middle-income (MLIC) countries. Statistics report
that the percentage of out-of-pocket (OOP)
spending on healthcare for this country stands at
a giant 72% compared to other LICs (39.6%) and
other MLICs (39.4%). This spells bad news for the
poor of the country as it implies that the country
is not beside its disadvantaged population in
financially supporting their basic healthcare
rights. Currently, OOP expenses make up roughly
67% of a household’s total expenses.
In its war against the mighty COVID-19,
Bangladesh has dedicated a number of beds and
ICU beds in all of its government run hospitals
and quite a lot of private hospitals as well. In
addition, when the cases peaked, the country country’s health sector. This backing from development
built some isolation centres and hospitals fully partners like the UN, World Bank and Asian Development
dedicated to patients of Covid-19. Tackling an Bank have been a pivotal source of funds generation for the
unprecedented crisis such as this is an arduous country’s health sector. For instance, WHO, as part of its
task for any government, and Bangladesh too, response efforts has helped to provide Bangladesh with 200
faced its challenges with testing, contact tracing, oxygen concentrators, 400 pulse oximeters, 100 venturi
isolating people and the expected challenges with masks, and 100 nasal cannulas to 17 district hospitals, as
doctor availability per patient. Inoculation well as 65 patient monitors to 10 Covid specialized health
campaigns are ongoing in Bangladesh and the facilities. Similarly, the World Bank and the ADB have agreed
government is working to get its hands on the to aid the country with $100 million each for emergency Covid
vaccines through agreements with producing response.
nations fast in order to immunize as many of its While Bangladesh has seen incredible success in its health
population as it can against the deadly sector in a very short time, the major challenge that remains
pandemic. to be conquered is its overall spending in this area. While
One of the few contingency measures that came optimists argue that Bangladesh’s outstanding achievements
out strongly from Bangladesh during the have come in spite of this low per capita GDP spending,
pandemic era is telemedicine. Online activities as experts do recognize inequities and vulnerabilities within the
a whole saw a rise in Bangladesh during the country, despite its progress. The government may argue that
months long lockdowns and in the interim, it has increased its healthcare spending in the face of the
mobile applications were launched, 29 solely for global pandemic, but in essence, the increase in the healthcare
only to foreign workers, 16 different portals and nominal increase of 13.7% increase. In fact, without the
sector has only increased from 257.3b to 292.5b, marking a
telemedicine, two online helplines were dedicated
support of non-governmental bodies, the year’s health
tools and seven chatbots were constructed for a allocation may have rested at 4.8% of the entire budget,
websites were created, 10 kinds of covid testing
instead of the 5.14% it now allotts.
variety of medical and other emergency purposes.
One of the more outstanding applications is the Covid-19 has come as a fresh perspective for Bangladesh and
its leaders, shining light on the glaring cracks and issues
one called COVID-19 DSS (Digital Surveillance
within its systems such as shortages in the areas of trained
System), where a user provides their information human resources, medical equipment, and supplies. Experts
to an AI system. The system can then create
awareness, help with digital screening, patient feel that even outside the pandemic, increased funds are
required to mitigate these crucial shortcomings. As
identification, identifying high risk COVID zones, Bangladesh strides towards attaining the Sustainable
and to integrate and analyze crucial data. The Development Goal (SDG 3) for Universal Health Coverage and
COVID BD tracker application is another risk becoming a middle-income nation, it may see a decline in
assessment software that specializes in financial support from its development partners which the
predicting probable rates of infection in a person. government would have to work to cover on its own. The
Bangladesh is said to have undertaken a country, known for its determination to survive the worst, may
“pluralistic” health system where resources from well come out shining in the years ahead, once it addresses
public funds were passed on to these challenges.
non-governmental organizations to work in the