Bangladeshis’ woes deepen amid lack of health coverage

By SM Najmus Sakib

DHAKA, Bangladesh (AA) - Despite having one of the world’s fastest growing economies, Bangladesh is lagging far behind in providing standard health care services to its over 166 million people, which is deepening their woes amid the coronavirus pandemic.

Experts have suggested universal health coverage to ensure that all people can have access to quality health services without financial hardship as the existing costly health care system forces over 5 million people into poverty each year, according to the World Health Organization (WHO).

Health and Family Welfare Minister Zahid Maleque admitted Thursday at an event in Dhaka that Bangladesh did not give due importance to the health sector.

“Our budget for the health sector is only 0.9% of GDP,” he said, adding the government is working to make it 9%-10% for its development.

- People woes deepening

Saif Uddin, 36, an employee at a private company in the capital Dhaka, had admitted his father to Dhaka Medical College Hospital recently after he began having difficulties breathing. Later, his father tested positive for COVID-19 and required oxygen and intensive care unit (ICU) support.

“I had to shift my father, 74, to a private caregiver in Dhaka as we failed to obtain necessary services from the public hospital. Now, my father is being given treatment in an ordinary room at a private hospital after he was being provided uninterrupted intensive care unit support for eight days,” he said.

“We had to pay at least 500,000 takas [approximately $6,000], which forced us to draw bank savings to meet the treatment cost,” he told Anadolu Agency.

Saif is among thousands of Bangladeshis who are forced to cover the lion’s share of their health care treatment costs mainly due to the absence of national health coverage or insurance programs from the government’s end.

People in the country are falling into poverty to meet their health care expenditures, which have increased manifold amid the coronavirus pandemic as they have to depend mostly on private caregivers, Prof. Muzaherul Huq, former regional director of the WHO (South East Asia region), told Anadolu Agency.

“People are rather interested in keeping money in banks instead of spending on private health insurance programs as the companies in the country are yet to gain the trust of people,” he said, adding “people mostly are not aware of health insurance.”

Private companies cannot be a solution to health coverage until the government introduces health insurance programs and hospitals incorporate those accordingly, Huq suggested.

He said the WHO is currently working on a public health pilot project.

- Monolithic health care, medicine market behind poor health care

Dr. Zafrullah Chowdhury, founder of Gonoshasthaya Kendra, the first health center or hospital in independent Bangladesh, shared his concerns over the costly and uncontrolled medicine market in the country.

In 1982, the military government had taken responsibility for determining the price of medicines, Chowdhury said, and blamed the elected governments for permitting private pharmaceutical companies to once again "control the market without regard for people's welfare."

“Patients have to bear most of the treatment costs,” he lamented, blaming “pharmaceutical companies for determining drug prices,” which are often too high.

In addition, the country faces a slew of issues, including a critical shortage of health care personnel, as most doctors choose to work in major cities, while 70% of the population lives in rural areas, he added.

He proposed the government take intern doctors to the union level in order to provide treatment in rural areas for at least two years, which will benefit both.

“Private insurance programs are not effective initiatives for such a big population, and only a small portion could go for private insurance as the biggest portion could not bear the premium of private insurances,” he said.

Introducing national health insurance programs to provide standard and inexpensive treatment is not a big deal, but a political will is needed to this effect, he continued.

- More health budget, health commission policies need to be adopted

Syed Abdul Hamid, a professor at the Institute of Health Economics at Dhaka University, said the government provides only 17% out of the total health care expenditure of citizens in the country while 7% comes from donor agencies and people have to bear 74% from their own savings.

He proposed that the government increase the budget allocation to reduce the people's burden by half but added pessimistically that it would be difficult in the current circumstances.

However, he believes that the government will boost services if it strengthens health care management capability and makes proper use of the existing health care budget.

Hamid suggested forming a ‘National Health Commission’ and a task force consisting of health experts and stakeholders to address the need of introducing national health coverage programs and mandatory health insurance.

“Before that, we need a national ‘Health Security Act’ to have precise guidance and policies,” he added.

Existing private insurance companies are unable to gain the confidence of the public, and a lack of oversight by the government's regulatory authorities exacerbated the problem, as people's lack of confidence has stymied the growth of the private insurance industry, which could further boost the health sector, he claimed.

“Health insurance for common people across the globe has been introduced by the government as private insurance companies cannot indulge people mandatorily in any health coverage package. And public and government hospitals will have the mechanism to incorporate the services as they will provide the service to people,” said Hamid.

- Government account

Syed Mojibul Huq, additional secretary of the Public Health Division at the Health and Family Welfare Ministry, told Anadolu Agency that the government is working closely to address the need of introducing health coverage for its citizens and employees.

“In the last pay commission, we introduced health coverage for 2.1 million government employees who draw a monthly salary from the government exchequer,” he said.

They held meetings with government agencies, private insurance companies and hospitals to work on the need for health coverage for people, who are getting interested in life and health insurance companies, he added.