Testing fee for whose benefit?

A little over two months ago, the chief of the country's health directorate in an interview with an Indian magazine narrated Bangladesh government's position on Covid-19 testing, saying the tests were free of costs.

"Our government policy is that anyone who gets infected with Covid-19 -- rich or poor -- is a government patient. We will take care of them, for free. Our priority is to test everyone," Prof Abul Kalam Azad, director general of the Directorate General of Health Services (DGHS), told The Caravan in late April.

"To make sure that happens, we have provided PCR tests to private laboratories for free on the condition that they would not charge the patients," he added.

But the government shifted from the stance as it has set fees -- Tk 200 and Tk 500 -- for Covid-19 testing at the public health facilities. For fixing the fees, the health ministry cited the reason as "to avoid unnecessary tests and ensure better management".

The move to levy the fees comes at a time when the country is witnessing a continuous surge in Covid-19 deaths and infections. A record 64 patients died and 3,682 new cases were reported in 24 hours till yesterday afternoon.

Talking on the issue, public health experts said none of the other South Asian countries charges any fee for the tests at their public healthcare facilities. Besides, imposing such a fee at government-run facilities is rare anywhere in the world.

They also said the government move would serve as a setback in efforts to contain the spread of the virus as many, especially those from the poor section of the society, might not be able to get tested at public hospitals and booths even if they show symptoms.

It will eventually increase the risk of further transmission of the virus, at a time when the country still lags behind in terms of aggressive testing of people as suggested by the World Health Organization and virologists, they said.

The fees will be an additional burden on people whose life and livelihoods have already been affected badly by the pandemic and the subsequent two-month-long shutdown that brought economic activities to a grinding halt, they added.

According to a health ministry circular, issued on Sunday, one has to pay Tk 500 for Covid-19 testing if samples are collected from home. The fee will be Tk 200 if samples are given to dedicated sample collection booths or public hospitals.

Private hospitals and health facilities charge each person Tk 3,500 for Covid-19 testing. The fee goes up to Tk 4,500 if samples are collected from an individual's home.

The circular said many, who did not show any symptoms, provided their samples for testing as it was free of cost. It also said the revenues from testing have to be deposited to the government treasury.

But experts rejected the government statement on "unnecessary testing", saying people throng hospitals and testing booths only after developing symptoms or out of fear.

"Test, test, and test -- this is the key to stopping the outbreak. But the government has taken an opposite move," said Prof Nazrul Islam, a member of the National Technical Advisory Committee (NTAC) on Covid-19 which advocates for expanding the testing coverage.  

"Due to the decision, we will be able to know the infection rate only among the affluent people. It's because the poor will prefer buying two kilograms of flour to spending the fees for testing," he told The Daily Star. 

He said the NTAC would inform its formal opinion on the matter soon.

Dr Mushtuq Hussain, consultant at the Institute of Epidemiology, Disease Control and Research (IEDCR), said, "We have no knowledge on any government [in the world] taking money for Covid-19 tests from its citizens. But this not the main issue here; the reality is that the decision will discourage the marginalised people from getting tested. "

As a result, he said, the virus would transmit further.

"If there was a mechanism for isolation based on symptoms, then this would have no impact. But ensuring isolation for each confirmed case through testing is not possible. So things would be worse without testing," he added.

Beginning the testing in late January, the country has so far tested 766,460 samples. The testing facilities were expanded over the time and now the tests are being done at 68 Polymerase Chain Reaction (PCR) labs at both public and private facilities.

Forty-three of them are government labs and those of armed forces, police hospitals and other autonomous bodies.

But the testing has been disrupted at some places due to a shortage of kits and a lack of bio-safety labs and skilled manpower.

A total of 18,426 were tested in 24 hours till 2:30pm yesterday. 

It is, however, still low compared to other countries.

The UAE is on top of the list in terms of conducting Covid-19 tests. It carried out 317,109 tests for each of its one million people, while the number is 98,469 for the US, according to Statista.com.

Bangladesh stands at the 28th position with 4,452 tests while India and Pakistan are in the 26th and the 27th positions with 6,086 and 5,715 tests.

WHO CHARGES WHAT?

In the United States, the tests are done free of cost, but the additional costs related to treatment could be as high as $30,000.

The National Health Service in the UK is testing suspected cases for free, but testing at the private facilities can cost as much as 375 Pounds.

In India, testing at the state-run hospitals is completely free, but some private labs were charging Indian Rupees 4,500 for each test. Later, the government instructed to cap the rate at private facilities.

Pakistan is testing Covid-19 samples free of cost at the government facilities across the country. But some private labs were testing individuals against a certain fee.

Even the government of Afghanistan is bearing the fees of tests in public facilities though people have to pay a certain fee for tests at private centres.

Nepal is not only bearing the cost of testing at its government facilities but has also announced that it would pay Nepal Rupees 5,500 for each test at private hospitals.