Govt eyes WHO standard in health worker distribution by 2030

Even though Bangladeshi people's out-of-pocket payment for healthcare is the highest in South Asia, the government does not appear to be bothered about giving them some relief by increasing its share.

At present, individuals pay 67 percent of their health costs whereas the government bears only 23 percent.

They will have to spend the same amount from their income to get healthcare as they are doing now even if the Sustainable Development Goals (SDGs) are implemented in 2030.

The General Economic Division (GED) of the planning ministry has drafted a framework towards achieving the Sustainable Development Goals (SDGs).  The GED sent it to different ministries for review after an inter-ministerial meeting on March 22.

But the issue of reducing people's out-of-pocket expenditure for healthcare has not got attention in it. 

The framework mainly focuses on increasing the number of health workers and recruiting nurses and technicians in keeping with the number of doctors as recommended by the World Health Organisation (WHO).

Bangladesh ranks 57th in the WHO's list of countries with a health workforce shortage.  The picture of a severe manpower crisis has come to the fore during the coronavirus pandemic.

The government has recruited 2,000 doctors and 5,000 nurses on an emergency basis. The process of hiring 5,000 technicians is also underway. At present, there are 7.4 health workers per 10,000 people in Bangladesh. A target has been set to take the number of health workers to 31.5 in 2025 and 44.5 in 2030.

According to the WHO, there should be at least three nurses and five health workers for every doctor. The government has set a target to increase the number of health workers in keeping with this ratio by 2030.

Before that, the government wants to raise it to 1: 2.1: 3.4 in 2025 by recruiting nurses and health workers. At present, the existing ratio of doctors, nurses and staff in Bangladesh is 1: 0.5: 0.2.

Bangladesh's current position on various SDG indicators, including alleviation of poverty and hunger, job creation in industries, information on how much progress the government wants to make in 2025, and the targets for 2030 have been incorporated in the framework.

Economists said it will not be possible to achieve the SDGs within the timeframe because of the Covid-19 pandemic.

Zahid Hossain, former lead economist of the World Bank's Dhaka office, told The Business Standard that Bangladesh is already lagging far behind in implementing the SDGs owing to the coronavirus pandemic. If coronavirus is prolonged, the country will fall further behind. This is because poverty, food insecurity, inequality and unemployment are already on the rise under the impact of the pandemic.

In this situation, it is essential to formulate a specific action plan where the amount of investment and the source of money will be determined, he added.

The health sector's fragile condition has become evident in this time of coronavirus pandemic. The sector needs a lot of investment to achieve the SDGs, he added. 

It would be crucial to look into the number of doctors, nurses and emergency beds per hundred or thousand people and other essentials and to what extent these numbers shall be increased. Photo: Salahuddin Ahmed

Dr Shamsul Alam, senior secretary and member of the General Economic Division, told The Business Standard, "After reviewing the country's position in various indices for the implementation of SDGs by 2030, we have devised a draft plan and set targets for 2025 and 2030. The 8th Five Year Plan is also being chalked up keeping that in mind."

But the implementation of SDGs will not be possible as per the set targets due to the coronavirus situation, he added.

Growth is declining because of the ongoing crisis. And achieving the SDGs requires huge investment, which is not possible with the economy witnessing a slow growth, he said.

Now, if the allocation for the implementation of SDGs is increased, there could be a financial crisis in other important sectors. Moreover, the implementation of SDGs is not possible even if educational institutions remain closed. Because the quality and rate of education will see a decline, Dr Shamsul Alam pointed out.

"However, the government has put an emphasis on improving healthcare. I hope this will lead to a rapid improvement in various indicators of the health sector," he added.

He said when the country's economic situation returns to normal, they will increase allocation for SDGs, and the pace of implementation will go up too so that the targets can be achieved within the timeframe declared by the United Nations.

According to the "Multisectoral Action Plan for Prevention and Control of Non-communicable Diseases, 2018-2025" prepared by the health directorate, the out-of-pocket health expenditure paid by individuals is 67 percent while the government bears only 23 percent. The out-of-pocket expenditure in towns is 67 percent of the country's total health costs and it is 61 percent in villages. 

Even though ticket prices at health centres in upazila, district and higher levels are affordable, patients have to spend extra money on a diagnosis. Apart from medication, various tests cost them a lot of money which is very difficult for poor people to bear.

According to the Household Income and Expenditure Survey (HIES) of the Bangladesh Bureau of Statistics (BBS), 24.67 percent of households spend 10 percent of their total income on healthcare. 26.05 percent of rural households and 21 percent of urban households have to spend 10 percent of their total income on healthcare.

The same target has been set in the 2025-2030 draft plan for the implementation of SDGs.

Bangladesh's ability in the International Health Regulations (IHR) core capacity and health emergency preparedness index is 78 percent. The country aims to improve its capacity to 95 percent in 2025 and 100 percent in 2030 in the index.

Besides, in the SDGs implementation plan, a target has been set to reduce the maternal death rate from 181 per 1,000 to 85 in 2025 and 70 in 2030.

At present, 43.5 percent deliveries are done through skilled health workers. The target is to increase it to 72 percent in 2025 and to 80 percent in 2030.

The under-five child mortality rate will be brought down from the current 36 per 1,000 to 27 in 2025 and 25 in 2030.

The mortality rate from non-communicable diseases such as cancer and diabetes will be reduced from the existing 21.6 percent to 16.68 percent in 2025 and 14 percent in 2030.

According to the HIES, some 24.4 percent of the country's total population lives below the poverty line. However, many private research organisations said a large number of people living above the poverty line have moved below the poverty line amid the ongoing Covid-19 pandemic.

In spite of this, the General Economic Division plans to cut the poverty rate to 12.17 percent in 2025 and 7.02 percent in 2030.

According to the Food Agriculture Organisation's 2016 data, 32.3 percent of the country's population is facing food insecurity.

Experts say a section of middle-class and lower-middle-class families, who lost their jobs to the coronavirus epidemic, is also facing a new food crisis. Despite this situation, the GED has set a target of reducing food insecurity to 24.2 percent by 2025 and 12.6 percent by 2030.

The implementation of the SDGs aims to create twice the number of jobs by 2030 in the coronavirus-affected industries.

At this time of layoffs across the industries, the target has been set to increase the total employment in the manufacturing sector by 22 percent in 2025 and 25 percent in 2030.

According to the BBS Labour Force Survey, the manufacturing industry currently accounts for 14.4 percent of the total employment.