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Access to quality health care

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03rd-May-2018       
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Dr. Samir Kumar Saha  :
World Health Day (WHD) is celebrated across the world, including in Bangladesh, every year on April 7 under the leadership of World Health Organization (WHO). The day marks the anniversary of WHO, which was founded in 1948. World Health Assembly was held first time in 1948 in Geneva by the WHO where it was decided to celebrate the WHD annually on April 7. It was first celebrated worldwide in 1950 as the WHD.
WHD is an annual event being celebrated for years to raise the common public awareness towards the health issues and concerns. The celebration focuses on increasing the life expectancy by adding good health to the lives of people and promoting healthier living habits.
The theme of the WHD this year is: Universal health coverage: everyone, everywhere.        
On the occasion of its 70th anniversary year, WHO is calling on world leaders to live up to the pledges they made when they agreed the Sustainable Development Goals in 2015, and commit to concrete steps to advance the health of all people. This means ensuring that everyone, everywhere can access essential quality health services without facing financial hardship.
Why health issue is important, because when people improve their health they enjoy fuller lives without the burden of health complications such as pain or disability, remain productive for longer and continue to contribute more to society.
According to WHO, countries that invest in Universal Health Coverage (UHC) make a sound investment in their human capital. In recent decades, the UHC has emerged as a key strategy to make progress towards other health-related and broader development goals. Access to essential quality care and financial protection not only enhances people's health and life expectancy, it also protects countries from epidemics, reduces poverty and the risk of hunger, creates jobs, drives economic growth and enhances gender equality.
Despite being a resource poor country, Bangladesh has achieved impressive health gains, which make it an example for other developing countries. Over the last decades, key health indicators like life expectancy and coverage of immunisation have improved significantly while infant mortality, maternal mortality and fertility rates have dropped considerably.
But most of these achievements are mainly quantitative while qualitative improvement is negligible. Poor access to services, low quality of care and poor status of child health still remain as challenges of the health sector.
The health system of Bangladesh relies heavily on  the government or the public sector for financing and setting overall policies  and service  delivery  mechanisms. Although our health system is faced  with many intractable challenges, it seems to  receive little  priority  in  terms of national  resource allocation. According to WHO 2010, only about 3% of the Gross Domestic Product (GDP) is spent on health services.
The government expenditure on health is only about 34% of the total health expenditure (THE), the rest (66%) being out-of-pocket (OOP) expenses. Inequity, therefore, is a serious problem affecting the health care system.  
The nutritional status of children and women in Bangladesh is very poor and needs special attention in order to improve the overall health status of the population. Despite various interventions designed under National Nutrition Project (NNP) low birth weight and malnutrition continue to be important causes of infant and under five mortality. A significant proportion of pregnant women is also iodine deficient and develops night blindness during pregnancy.
The health system faces multifaceted challenges  such as lack of public health facilities, scarcity  of skilled workforce, inadequate financial resource  allocation and political instability.
Although the country has a growing private sector primarily providing tertiary level health care  services, Bangladesh still does not have a  comprehensive health policy to strengthen the entire health system.  Clearly, the most crucial challenge is the absence of a dynamic and proactive stewardship able to design and enforce policies to further strengthen and enhance the overall health  system.  
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.
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.  
 (To be continued)
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.
Communicable diseases are a major cause of death and disability in Bangladesh. While the prevalence of tuberculosis (TB) has declined substantially, Bangladesh still ranks among the top ten countries in the world with the highest TB burden. The disease is found primarily among the poor and least educated populations. Pneumonia and water-borne diseases also are widely prevalent. Pneumonia and other infections are major causes of death among young children.
The toll of non-communicable diseases - chronic diseases, cancer, diabetes, cardiovascular diseases, and chronic respiratory diseases - is increasing in Bangladesh as the population becomes more urbanized. Cancer is the sixth leading cause of death in Bangladesh, accounting for more than 150,000 deaths annually.
Good governance is important in ensuring effective health care delivery, and that returns to investments in health are low, where governance issues are not addressed. Strengthening the health system through better management and organization and effective use of resources can improve health conditions and enhance the quality of health care delivery in Bangladesh. Furthermore, more research is needed on health system reforms.
Necessary steps should be taken to ensure the UHC by overcoming the challenges in the country's health sector.
To overcome the challenges in the health sector, a multi-sectoral holistic approach can be one of the important strategies. We have to take steps for utilizing traditional medicines such as Ayurveda and Unani for ensuring the UHC. Because, traditional medicines are cost-effective and easily available in our country.
Even western scientists are giving increasing attention to the traditional medicines. The ancient system has gained new dimension with standardized forms of formulations and adoption of modern manufacturing methods.   
As we have scarcity of manpower in the sector, we can use personnel from the traditional sector. It is time to recognize the natural system of medicine and utilize its workforce.
If necessary steps are taken for recognition and improvement of the traditional system of medicine, there would be development in our health sector. Sri Lanka, India and Child derived benefits by utilizing this system.
The WHD is a moment to think about the country's health issue. It is hoped that the day's spirit would motivate us to take necessary steps for ensuring the UHC by giving focus on the traditional system.
(The author is Executive Director of Public Health Foundation of Bangladesh)

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