Rajat Das Gupta
Antimicrobial resistance is not a new problem but one that is becoming more dangerous; urgent and consolidated efforts are needed to avoid regressing to the pre-antibiotic era.
For World Health Day 2011, WHO is introducing a six-point policy package to combat the spread of antimicrobial resistance.
The present elected government, since its assumption of office, has established a large number of community clinics across the country. But are the preponderant rural people of the country getting significantly any extra healthcare from their establishment? Marginally, perhaps, for the same remain understaffed. A large number of doctors stay away from their places of duties in such public healthcare facilities, in an uninterrupted sequence with the past, for promoting their careers in private hospitals or in private practice in cities. They are unconscientiously taking their salaries from the government. The government has not been able to stop this unacceptable practice. Under the present government, thus, infrastructural developments have outpaced the availability of the people who should run the system effectively.
In this backdrop, The World Health Day was observed in Bangladesh, as elsewhere abroad on Thursday amid different kinds of functions that were organized to mark the event and to reiterate commitment to making sustained efforts for accomplishing the long cherished national task of ensuring the availability of healthcare facilities to all citizens. But the same can do little to hide the fact that healthcare in the country remains in a state which is far from being described as even reasonably satisfactory. While speaking as the chief guest in a function to mark the World Health Day, the health adviser said regulatory reforms on health sector is needed very much as the country now does not need mainly investment in infrastructure, rather it needs skilled manpower. He was pointing perhaps to both not getting adequate services from the existing employed manpower in the publicly-run healthcare system as well as the dearth of trained manpower in it.
Bangladesh, as the report said, has a staggering shortage of over 60,000 doctors, nearly 0.3 million nurses and 0.5 million technologists. There are only about five physicians, two nurses and half technologist per 10000 people. So, a basic challenge to be overcome in the public healthcare system would be getting dedicated service from those already engaged in it and to recruit a large number to fill the vacant slots as well as ensuring that they are also obliged to discharge services sincerely.
There are also other aspects to be addressed and cured. Everyone in Bangladesh knows that most of the medical doctors in public hospitals either own or have a contractual relationship with private clinics. For these doctors, public service is a false identity. Their true identity is making money through their private practice or business. They appoint public hospital staff members as brokers to bring clients to private clinics, instead of properly treating them in public hospitals. Even if people are treated in a public hospital, they are forced to visit private clinics for a diagnosis so that doctors can earn "commissions."
In public hospitals, from the time patients arrive for treatment, the staff encourage them and their relatives to move to a private clinic to seek "better treatment." Simultaneously, doctors neither seriously listen to the patients nor explain their health problems and discuss possible treatments, including the diagnosis and medication. As a result, patients and their relatives always remain confused about the role of the doctors as well as the possibilities for treatment for alleviating their suffering. The greed on the part of a section of doctors is also reflected in their relationship with other healthcare professionals. They rarely delegate responsibilities to other medical specialists, such as physiotherapists, psychologists, counselors, nurses, speech therapists and so on, who are often looked down upon as lower class members of the health care profession in Bangladesh.
Moreover, medical equipment in public hospitals, as the reports in the media from the countryside from time to time do amply suggest, is intentionally kept "out of order" for years, in anticipation of increasing the business of private clinics and earning commissions. Patients in many cases cannot expect simple pathological or radiological tests in public hospitals. Ultimately, they are forced to go to private clinics and spend money far beyond their financial capacities. This culture has established a new group of millionaires in Bangladesh -- the owners of private clinics and diagnostic centres. In addition, many thousands of people who can afford to do so -- rich and middle-class patients -- go to hospitals abroad, to avoid even the undeveloped locally available privately offered health services, while a lack of governmental monitoring helps sustain such systems at home.
Antimicrobial resistance is not a new problem but one that is becoming more dangerous; urgent and consolidated efforts are needed to avoid regressing to the pre-antibiotic era.
For World Health Day 2011, WHO is introducing a six-point policy package to combat the spread of antimicrobial resistance.
Challenges facing the health sector in Bangladesh
In this backdrop, The World Health Day was observed in Bangladesh, as elsewhere abroad on Thursday amid different kinds of functions that were organized to mark the event and to reiterate commitment to making sustained efforts for accomplishing the long cherished national task of ensuring the availability of healthcare facilities to all citizens. But the same can do little to hide the fact that healthcare in the country remains in a state which is far from being described as even reasonably satisfactory. While speaking as the chief guest in a function to mark the World Health Day, the health adviser said regulatory reforms on health sector is needed very much as the country now does not need mainly investment in infrastructure, rather it needs skilled manpower. He was pointing perhaps to both not getting adequate services from the existing employed manpower in the publicly-run healthcare system as well as the dearth of trained manpower in it.
Bangladesh, as the report said, has a staggering shortage of over 60,000 doctors, nearly 0.3 million nurses and 0.5 million technologists. There are only about five physicians, two nurses and half technologist per 10000 people. So, a basic challenge to be overcome in the public healthcare system would be getting dedicated service from those already engaged in it and to recruit a large number to fill the vacant slots as well as ensuring that they are also obliged to discharge services sincerely.
There are also other aspects to be addressed and cured. Everyone in Bangladesh knows that most of the medical doctors in public hospitals either own or have a contractual relationship with private clinics. For these doctors, public service is a false identity. Their true identity is making money through their private practice or business. They appoint public hospital staff members as brokers to bring clients to private clinics, instead of properly treating them in public hospitals. Even if people are treated in a public hospital, they are forced to visit private clinics for a diagnosis so that doctors can earn "commissions."
In public hospitals, from the time patients arrive for treatment, the staff encourage them and their relatives to move to a private clinic to seek "better treatment." Simultaneously, doctors neither seriously listen to the patients nor explain their health problems and discuss possible treatments, including the diagnosis and medication. As a result, patients and their relatives always remain confused about the role of the doctors as well as the possibilities for treatment for alleviating their suffering. The greed on the part of a section of doctors is also reflected in their relationship with other healthcare professionals. They rarely delegate responsibilities to other medical specialists, such as physiotherapists, psychologists, counselors, nurses, speech therapists and so on, who are often looked down upon as lower class members of the health care profession in Bangladesh.
Moreover, medical equipment in public hospitals, as the reports in the media from the countryside from time to time do amply suggest, is intentionally kept "out of order" for years, in anticipation of increasing the business of private clinics and earning commissions. Patients in many cases cannot expect simple pathological or radiological tests in public hospitals. Ultimately, they are forced to go to private clinics and spend money far beyond their financial capacities. This culture has established a new group of millionaires in Bangladesh -- the owners of private clinics and diagnostic centres. In addition, many thousands of people who can afford to do so -- rich and middle-class patients -- go to hospitals abroad, to avoid even the undeveloped locally available privately offered health services, while a lack of governmental monitoring helps sustain such systems at home.
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