Health reform commission to propose free primary healthcare for all
It will emphasise that 20% of insolvent patients get all treatment services free of cost at any hospital, and the authorities strictly monitor that 10% of beds at private hospitals are allocated for the poor
Highlights:
- Free primary healthcare and medicines for all, including hospitalisation coverage
- Unique patient ID and e-prescriptions to improve healthcare tracking
- 10% private hospital beds reserved for poor; 20% treated free
- Referral system introduced; GPs required for further treatment access
- Urban healthcare infrastructure expanded; rural services strengthened and decentralised
The Health Sector Reform Commission is set to make several major recommendations, including providing free primary health services and medicines, introducing a referral system, and monitoring prescriptions to check for unnecessary tests and medications.
It will emphasise that 20% of insolvent patients get all treatment services free of cost at any hospital, and the authorities strictly monitor that 10% of beds at private hospitals are allocated for the poor, members of the commission told TBS.
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The commission will also propose that private hospitals have a structured salary system for doctors and healthcare staff and pay reasonable allowances to honorary doctors during their training period.
Recommendations will also include the creation of a unique ID for each patient and the introduction of e-prescriptions.
The 12-member Health Sector Reform Commission, led by Professor Dr AK Azad Khan, president of Diabetic Association of Bangladesh, was formed on 17 November last year. Its deadline was extended until 30 April on 27 March.
Professor AK Azad Khan told TBS earlier that the commission will submit its report after Eid.
Dr Abu Muhammad Zakir Hussain, a member of the commission, told TBS, "We will recommend providing free medicines for primary healthcare. Hospitals must stock complete medicines, and hospitalisation will also be free for patients."
He added, "While rural areas in Bangladesh have primary healthcare infrastructure, urban areas lack sufficient facilities. In this regard, we will propose building infrastructure in urban areas or contracting the private sector to provide primary healthcare services.
"We will recommend making primary healthcare the hub of health services at the union level. Each union will have two MBBS doctors, one midwife, one laboratory technician, one support staff, and a guard."
According to the World Health Organisation, primary healthcare enables health systems to support a person's health needs – from health promotion to disease prevention, treatment, rehabilitation, palliative care and more. This strategy also ensures that healthcare is delivered in a way that is centred on people's needs and respects their preferences.
Last month, at the request of the Health Sector Reform Commission, a survey conducted by the Bangladesh Bureau of Statistics (BBS) revealed that 91.1% of respondents want primary healthcare services to be made a mandatory constitutional right.
The commission will recommend including in the constitution a provision that legally binds the government to ensure primary healthcare for all citizens.
In addition, the reform commission is set to recommend expanding the list of essential drugs, establishing a Bangladesh Health Service Commission for doctors similar to the Judicial Service and forming management boards for private hospitals.
Experts suggest that decentralising primary healthcare will reduce the burden on tertiary care and establish a referral system.
Professor Dr Syed Md Akram Hossain, a member of the commission, said, "The general practitioner system will be implemented in primary healthcare, where practitioners will refer patients if necessary. MBBS doctors will work as general practitioners, and they will receive three years of training, which they can complete while working."
The commission is emphasising the implementation of a referral system and making further treatment conditional on reference from the GP of the locality.
"In urban areas, there will be primary healthcare facilities similar to the family welfare centres, based on the population size," he further said.
Strengthening the civil surgeon office
The commission will recommend strengthening the office of the civil surgeon by appointing one additional civil surgeon and two deputy civil surgeons.
The upazila's health and family planning officer and the civil surgeon will have the authority to monitor prescriptions.
Health Service Commission to be formed for doctors
The commission will recommend establishing an independent Health Service Commission for doctors, similar to the Judicial Service. This will increase doctors' benefits and allow healthcare decisions to be made by doctors themselves.
In the Health Service Commission, from the secretary to all positions, everyone will be a doctor. The director general will hold the rank of secretary.
Dr Abu Muhammad Zakir Hussain said, "With an independent Health Service Commission, doctors will have job security. All their current benefits will be maintained, and this change aims to further enhance those benefits.
"For example, under the current service rule, there is no opportunity to increase the salary for those working in hard-to-reach areas. This will be addressed, and salary increases for researchers and academicians will be possible."
