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Costly healthcare adds to poverty

6.4m people in Bangladesh get poorer every year due to excessive cost of medical treatment; public healthcare facilities remain inadequate

Staff Correspondent
The government should give special attention to ensuring quality healthcare for the poor who become the worst victims of weak governance in the health sector, a number of experts said yesterday.
Around 6.4 million or 4 percent people of the country get poorer every year due to excessive costs of healthcare, they said referring to a study by the icddr.b.
"About five crore people are poor. They cannot pay for healthcare available in the private sector, while public healthcare facilities are inadequate," said Mohammad Iqbal, deputy project coordinator of Universal Health Coverage at the icddr,b.
Hossain Zillur Rahman, executive director of Power and Participation Research Centre (PPRC), said, “With poor health, our workforce cannot contribute to a dynamic
economy. Health is crucial for our development."
The observations came at a discussion titled "Universal Health Coverage: Bangladesh Perspective" at The Daily Star Centre in the capital.
It was jointly organised by Brae, International Centre for Diarrhoeal Disease Research, Bangladesh (ieddr.b), the Centre of Excellence for Universal Health Coverage and The Daily Star.
Bangladesh has achieved many of the Millennium Development Coals (MDGs), but a stronger commitment is needed to achieve the Universal Health Coverage (UHC), Iqbal said.
The goal of the UHC, as declared by the World Health Organisation, is to ensure that all people obtain the health services they need without suffering financial hardship when paying for those.
Though Bangladesh has performed well in the health sector, achieving the UHC is still a far cry, the experts pointed out.
Life expectancy in Bangladesh is now nearly 70, which is 65 both in India and Pakistan.
Child death per 1,000 live births is 46 in Bangladesh, while it is 61 in India and 72 in Pakistan. And maternal death in Bangladesh is 194 per 100,000 live births against 200 in India and 260 in Pakistan.
However, catastrophic health expenditure in Bangladesh is nearly 16 percent, while it is around 11 percent in India and below 6 percent in Indonesia, the Philippines, Sri Lanka, Hong Kong and Thailand.
In Bangladesh, 64 percent of the total health expenditure comes from people's pockets, while 26 percent comes from public fund and 10 percent from external funding by NGOs and development partners, according to the icddr.b.
Inadequate and inefficient public healthcare and profiteering in the private healthcare sector are two major factors behind such private spending, said the experts.
Gonoshasthaya Kendra Coordinator Manzur Kadir said people in the remote areas and urban slums are heavily deprived of healthcare. Addressing this issue should be given top priority, he said.
Prof Rashid-e-Mahbub, president of the National Committee on Health Rights Movement, said upazila health complexes lack adequate facilities and fail to provide required services to patients.
Government officials and those in the corporate sector enjoy some sort of health coverage, while the poor segment of the population has very little access to healthcare, he said.
Some of the experts suggested introducing social health insurance, while others preferred making effective the existing public health facilities to achieve the UHC.
Bangladesh has done well in primary health coverage. But it might be difficult to attain similar success in the next phases, said Hossain Zillur.
Now more deaths are caused not by infectious diseases, but by non-communicable ones such as heart diseases and cancer, he added.
Achieving the UHC should be high on the government agenda, he said, suggesting that the issues of poor gov-
ernance and resource constraints must be addressed immediately.
Kawsar Afsana, director of Health, Nutrition and Population at Brae, said people are already spending a huge amount of money from their pockets for healthcare.
But they are still not getting quality healthcare, and millions of them are getting poorer.
“We are trying to devise a health financing model - a systematic way of paying money. The poor may not be able to pay, but will come under health coverage. This needs to be discussed," she said.
Jahangir Khan of the icddr,b said Sweden has social health insurance scheme based on tax money. Local governments there maintain a fund and have contracts with private hospitals that provide quality services.
The idea is that the rich pay more and the poor less, he said.
Such arrangements encourage competition among private healthcare providers and improve the quality of service, added Jahangir.
Kelvin Hui, principal adviser to GIZ Bangladesh, said the government is good at regulating, but not at running big hospitals.
Advocating social health insurance, he said a fundamental change is needed in healthcare management to improve the quality of services in Bangladesh.
Sukumar Sarker, senior technical and policy adviser to USAID, said since foreign aid is shrinking, there should be more focus on sustainable approach to healthcare based on domestic resources.
Putting stress on good governance, Liaquat Ali, vice chancellor of Bangladesh University of Health Sciences, said the state has to decide whether it would regard healthcare as a commodity or right.
Acting ieddr.b executive director Abbas Bhuiya said disparity in the health sector must be reduced, and vigorous efforts should be made to achieve the UHC.
Salehuddin Ahmed, managing editor ofThe Daily Star, moderated the discussion.
It was addressed by Brae Vice Chairman Mushtaque Chowdhury, exhealth secretary Humayun Kabir, and Prof Syed Masud Ali and ProfMalabika Sarker of James P Grant School of Public Health at Brae University.