eliminate Rohingya Crisis

(PDF) Health System in Bangladesh: Challenges and Opportunities

(PDF) Health System in Bangladesh: Challenges and Opportunities

372 Anwar Islam and Tuhin Biswas: Health System in Bangladesh: Challenges and Opportunities

In other words, political instability and violence paralyses the

health care system.

Moreover, political parties in Bangladesh seem to have

little commitment to shun violence or to honor their pre-

election “promises”. Every government has promised to

ensure health for all and enshrined it in the constitution.

Nevertheless, the promise remains unfulfilled even after forty

years of the independence of Bangladesh On the other hand,

intolerable corruption within and outside the health sector

seems to have further deprived the country of its resources

and denied it of decent human development. It is a country

where the rich and powerful (including political big shots)

routinely fly to Singapore, Thailand or India to avail health

care services. There is hardly any commitment to improve

the health system at home so that people at large could

benefit. Clearly the health system requires a strong and

efficient steward to come out of these drawbacks and deficits.

It is unfortunate that the health system in Bangladesh does

not seem to have an effective steward.

3.16. Weak Health Information System

Reliable and up-to-date health-related information is

essential for developing an efficient health system. Thus

WHO has emphasized on it as one of the building blocks of

any health system (WHO, 2008). Only collecting raw data is

not enough; those data must be managed, analyzed and

disseminated systematically to the appropriate authority to

facilitate decision-making and to take prompt actions. Over

the years, many nation-wide as well as smaller scale surveys,

surveillances and research studies have been conducted in the

health sector of Bangladesh; but it still do not follow a

standardized procedure to collect and manage health-related

data from all health facilities at a regular interval. By

following such unified and standardized health information

system, Bangladesh can improve the efficiency of all other

components of its health system.

4. Discussion

The challenges faced by the health system are multifarious

and varied. Bangladesh has a severe shortage of physicians,

nurses, midwives, and health technicians of various kinds. The

deficit will keep on rising as the population increases.

Inadequate number of appropriately trained human resources for

health in Bangladesh is a strong limiting factor for population

health [31]. In terms of health technicians of various kinds (from

laboratory technicians to physiotherapists) the deficit is almost

half a million. Midwives and community health workers are also

in short supply. The gap between what the government has

assessed (sanctioned) as requirement for providing healthcare

services and the positions vacant clearly shows that Bangladesh

has to make much greater efforts in ensuring accessibility to

essential health care services. Moreover, the human health

resources are heavily concentrated in urban centers, depriving

rural areas of much needed human resources for health.

According to Bangladesh Health Watch report (BNHA 2011)

62% of medical doctors in Bangladesh are working in the

private sector. In addition, the health workforce is skewed

towards doctors with a ratio of doctors to nurses of 1:0.4, and

that of doctors to technologists of 1:0.24, in stark contrast to the

WHO recommended ratio of 1:3.5.

Statistics on private sector appointment of medical staff

are not available. However, the physicians in public sector

often provide services in private hospitals. Moreover,

Bangladesh has only 0.4 hospital bed per 1,000 population

compared to that of 0.9 bed per 1,000 population in Ghana

(WHO, 2011). Likewise, although at a similar economic

level as Bangladesh, Kenya has 35 percent higher number of

hospital beds per 1,000 populations.

Another problem plaguing the health system is the sorry

state of infrastructural facilities. It should be noted that the

government has a policy of establishing 1 Community Clinic

for every 6,000 population covering rural Bangladesh.

However, it is yet to be fully implemented. In most cases,

community clinics consist of two rooms with drinking water

and lavatory facilities, and a covered waiting room.

Unfortunately it remote areas of Bangladesh community

clinics usually do not have even such meagre infrastructural

facilities.

So far as human resources for health is concerned, it is not

even clear if the sanctioned positions are sufficient to provide

healthcare services to all citizens covering their needs. It is

more important to look at the distribution of health care

expenditure of Bangladesh. In Bangladesh, the major sources

of healthcare funding include: households, government,

NGOs and development partners. Insurance makes up a

small share of the total source of health care financing in

Bangladesh (BNHA 2003). The continued absence of social

insurance and a minuscule private insurance market are

compelling the house-holds, particularly the rural poor, to

bear a large proportion of the national health expenditure

through direct or out of pocket (OOP) payments. Household

OOP expenditures constitute by far the largest component of

the Total Health Expenditure (THE) – its share was around

69% in 2001 (BNHA 2003). The share of out-of-pocket

expenditure in the total health expenditure increased from

57% in 1997 to 64% in 2007 .It should be noted here that

while basic health care service is supposed to be free in

public hospitals, patients end up bearing the costs of

medicine and laboratory tests, as well as some additional

unseen costs .Moreover, 5,122 registered diagnostic centres

are currently operating in Bangladesh (along with many

unregistered ones). Apart from these, there are a large

number of private clinics and hospitals in different districts

and cities that are not registered. Private for profit

clinics/hospitals, geared toward maximizing profit, usually

target middle- to high income segments of the society.

According to Health Bulletin 2013 there are 2,983 registered

private hospitals and clinics in the country with about 45,485

beds. Only a few among these have free beds for the poor.

The health system information technology (IT) is primarily

focused on family planning, safe motherhood, child health,

and immunization. Unfortunately the health information

system does not cover chronic non-communicable diseases


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