Assessing the fault-lines of the health sector: Implications for future policy response

In light of the ongoing Covid-19 pandemic, the Economics Study Center, University of Dhaka, launched its report titled "Assessing the Fault lines of the Health Sector: Implications for Future Policy Response" at the 3rd Bangladesh Economics Summit on the 19th of September 2020. A subsequent panel discussion was held to discuss the findings of the report, which was chaired by Dr Rumana Haque, Professor, Department of Economics, University of Dhaka and attended by the chief guest, Mr M.A. Mannan, MP, Honorable Minister, Ministry of Planning, Government of the People's Republic of Bangladesh.

Moreover, the esteemed panelists of this discussion session were Dr Taufique Joarder, Research Director, FHI 360 in Bangladesh, Dr Syed Abdul Hamid, Professor, Institute of Health Economics, University of Dhaka and Dr Muhammad Shahadat Hossain Siddiquee, Professor, Department of Economics, University of Dhaka.

Dr Rumana Haque initiated the session by mentioning the many successes of the Bangladeshi healthcare system throughout history such as in the areas of child vaccination, the widespread establishment of community clinics, reduction in child and maternal mortality, and how it all stood in contrast to the how the healthcare sector had struggled to handle to pandemic exposing its many flaws. She also highlighted many of the public healthcare sector's limitations such as limited budget allocation and high out-of-pocket expenditure of patients and emphasised on the need for addressing these issues.

Sheikh Rafi Ahmed, Secretary of Public Relations, ESC, then proceeded to present its report highlighting how even though the healthcare system of Bangladesh was plagued with problems like poor quality of service, high out-of-pocket expenditure, understaffing, administrative corruption, and mismanagement, the ongoing Covid-19 pandemic had exposed these fault lines and brought many other issues to light.

After conducting a qualitative study on this issue comprising 7 doctors and 4 patients as its case studies, Sheikh Rafi Ahmed highlighted the key findings of the study. The surveyed doctors talked about their struggles receiving medical education, improvising alternative medical solutions due to a lack of medical equipment, being overwhelmed by the influx of patients without proper PPE and facilities, dealing with an administration that lacked medical experiences, and often suffering from Covid-19 while handling patients. Similarly, the surveyed patients who had received treatment during the pandemic revealed that they struggled to find available beds at hospitals, faced poor treatment from medical support staff, had to pay for expensive medicine, and were often neglected from proper healthcare services if they lacked proper connections.

The honourable Planning Minister, Mr M.A. Mannan responded to the report by acknowledging the importance of addressing the issues plaguing the healthcare sector and emphasising on everyone doing their part to revamp the healthcare sector including himself. He also acknowledged that despite the strides made by the sector in the past, there are still many irregularities and deep-rooted problems related to corruption, embezzlement, misappropriation of limited resources, and the disparity between doctors and administrative officers that continue to hold the healthcare sector back. Finally, in response to a question regarding the government's initiative to achieve universal healthcare, Mr M.A Mannan responded that although the internal problems of the healthcare sector are a major obstacle to achieving this goal, the political landscape of the country plays a significant role as well.

Dr Taufique Joarder emphasised on the need for defined career tracks for public health officials so that the healthcare sector is better at taking preventive measures to future virus outbreaks and diseases. He elaborated that there are no defined career tracks for public health, those who are in charge of it tend to lack the administrative and planning skills necessary to handle such a massive crisis effectively as they often come from clinical backgrounds.

Dr Muhammad Shahadat Hossain Siddiquee disabout the healthcare sector's inefficient utilization of funds due to corruption and mismanagement highlighting the lack of proper governance and accountability of the public healthcare system. He also emphasised the need to fix regional inequalities in the quality of healthcare as well as the need to address non-communicable diseases such as diabetes, heart disease that a significant part of the population continues to suffer from.

Dr Syed Abdul Hamid focused on the need for proper short and long term planning concerning the healthcare sector so that impromptu or ad hoc solutions do not have to be devised when it is caught unprepared. He also talked about the need to establish separate career paths for healthcare professionals who want to teach, run clinics, join administration or public health and argued that we need to be able to make health-related decisions that aren't international donor-driven since we are less dependent on them to finance our healthcare. Finally, he concluded on the need to establish a permanent healthcare watchdog called the National Healthcare Commission (NHC) which can oversee the long term development of the healthcare sector.

Dr Rumana Haque, concluded the session saying that the pandemic reminded us of our limitations in the healthcare sector resulting in a renewed interest in ensuring accountability to prevent embezzlement and corruption, establishing separate career tracks for public health, establishing NHC to develop the health sector in a planned manner and decentralize power and responsibility on a regional level to promote healthcare equality.