The right to healthcare is enshrined in the Constitution of Bangladesh. However, despite considerable development in this sector over the last decade, the nation is still far from ensuring quality healthcare for all.

The towering and ever-increasing cost of healthcare is a constant headache for people in the country, making on-demand, quality healthcare virtually out of reach for most. The fact that almost 70 percent of all healthcare costs in Bangladesh are paid out of pocket, and that public spending on healthcare in this country as a percentage of GDP is the lowest in South Asia, only exacerbate this problem. In addition to low public spending, there are other factors contributing to the high cost of healthcare that need to be understood with their nuances.

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A significant portion of the healthcare budget fails to reach target citizens due to corruption, wrong priority setting, and sub-optimal implementation. The combined effect is an acute lack of accessibility to points of care. A large number of facilities (such as community clinics) are sitting idle due to lack of resources, whereas a few specialty centres (such as public medical colleges or district hospitals) are beset with overcrowding and poor service delivery. This forces people, especially lower-income groups who are more likely to flock to subsidised government facilities, towards private healthcare providers, creating a heavy burden on their finances.

Meanwhile, every year, an average of 700,000 people travel abroad for healthcare needs, spending a mammoth Tk 350 crore. Although patients going abroad spend around Tk 5.5 lakh on average, in many instances this cost can be substantially higher, especially for complicated and lengthy procedures. Besides, treatment expense in countries like Singapore can reach up to 10 to 15 times of what it costs in Bangladesh, while in India it can cost two to three times more. So, pursuing treatment abroad can severely dent people's finances, even for those with higher incomes.

Also, for conditions requiring lengthy treatments, like cancer, patients and their attendants often have to stay away from family and work for extended periods of time, thus negatively impacting their professional positions. This is an indirect cost of seeking treatment abroad, which again adds to the burden of already high healthcare costs. Plus, especially among middle- and lower-income individuals, discontinuation of treatment due to socioeconomic reasons or a lack of awareness is common. Incomplete treatment means the patient, in all likelihood, will fall ill again from the same or related cause(s), thus incurring a huge waste of resources.

Due to the absence of a comprehensive and consistent regulatory regime surrounding healthcare and a national accreditation system for health service providers, the pricing of health services becomes arbitrary.

Also, due to the lack of national health insurance, there is no large purchaser (either insurance companies or the government) that can bargain with health service providers to set rational pricing of services. Thus, health service market in the country is dominated by providers who put individual consumers under a heavy burden of differing prices.

As individuals, we have important roles to play in acquiring control over healthcare costs, such as keeping all our medical and health records in one place, putting aside at least three percent of one's monthly income for future health needs, having a doctor or a healthcare worker as a friend to get advice from for sudden healthcare needs, getting a health check-up every year and focus on prevention, maintaining a proper lifestyle to prevent and manage lifestyle diseases like asthma, diabetes and hypertension, and adhering to doctors' advice from the early stages of any disease.

However, to solve the healthcare problem at the national level, the government needs to undertake some initiatives.

Making public sector spending efficient

It is important to bring transparency to the process by ensuring accountability and the involvement of stakeholders, especially health professionals. Similarly, introducing a healthcare official for the job and streamlining the regulatory structure surrounding healthcare will make the sector more transparent and efficient. If done properly, an additional one to two crore people, especially from lower-income strata, can be brought under healthcare services.

Health insurance and universal health coverage

This could be a system to which everyone contributes according to their means, while the government gathers both public and private resources in a unified manner to ensure on-demand, essential health services for all.

Activating community clinics

Managing thousands of community clinics spread across Bangladesh properly, with community involvement and proper training, can be a real game-changer.

Building and maintaining trust in our own healthcare system

A nationwide healthcare accreditation system could be implemented to monitor quality as well as classify providers into service bands (A, B, C, etc). This will ensure that services are provided as per the respective charter and also allow the government to set prices for healthcare services in a comprehensive manner.

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Proper referrals and keeping electronic medical record (EMR)

Introducing a well-organised referral system backed by an NID-based, interoperable EMR will create a first line of health service providers in the form of community clinics and general physicians, who will be the primary custodians of individuals' health at the grassroots level. This will take care of the bulk of their healthcare needs at a minimal cost while only referring a small number of patients (who require specialised care) to the district- or national-level facilities.

Solving the healthcare puzzle for Bangladesh's 170 million citizens is not a one-day job. It will require clear-eyed national planning led by the government in conjunction with private and non-profit players—with national interest at its core—implemented in a sustained, transparent, and non-partisan manner over 5 to 10 years' time with the participation of individuals, who are our primary concern.

Dr AM Shamim is the founder of Labaid Group.

Views expressed in this article are the authors' own. 

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