Health sector reform: Many plans, little progress on system overhaul

Infograph: TBS

In the past year, medicine prices have not increased in the private sector; the prices of 33 essential drugs produced by the state-owned Essential Drugs Company have decreased, cancer medicine prices have dropped by 5-10%, and the cost of cardiac stents has also fallen.

Despite all these successes, there has been little real progress in the health sector. With the sector programme discontinued, many ongoing activities have been disrupted. Over the past year, senior officials at the health ministry have spoken about various plans – launching GP clinics for urban primary healthcare, forming a pharmacy network, and expanding the list of essential drugs – but implementation has yet to begin.

Professor Dr AM Zakir Hossain, member of the Health Sector Reform Commission, told The Business Standard, "Over the past year, the health ministry has focused heavily on two areas – community clinics and medicines. They reduced the price of cardiac stents and visited community clinics. 

"But they have not addressed the issue of reorganising the system. As long as structural reform does not happen, everything will work only for a limited period, and solutions will remain individual-centric. If the person is good, it will work; if not, it won't. Without structural reform, there will be no lasting impact."

Last Thursday, at a press conference outlining the health sector's achievements over the past year and its future plans, the health adviser and the chief adviser's special assistant on health announced the identification of 10 major crises in the sector.

Experts said, if it took this long to diagnose the 10 diseases, when will they be cured?

Public Health Expert Dr Muhammod Abdus Sabur told The Business Standard, "In the past year, this government has only made noise. We've been hearing for months that a pharmacy network will be established, 100 urban clinics will be set up, and the essential drug list will be expanded; but there's no sign of implementation. 

"There's talk of setting up three specialised hospitals in three corners of Bangladesh. If the election is in February, then they have only five months left. When will they start the work?"

He added, "The ministry heads are saying that when recruiting for 37 medical colleges and 4 medical universities, it was impossible to find impartial candidates. But they didn't look for impartial people. The government had an opportunity to end the past practice of partisan recruitment and instead search for impartial candidates, but they didn't do that."

Unless an elected government comes in February and takes steps to improve the health sector, there's nothing to hope for now, said Dr Sabur.

Even after three months, there has been no visible progress in implementing the recommendations of the Reform Commission formed to reform the health sector. 

The Task Force Report on 'Re-strategising the Economy and Mobilising Resources for Equitable and Sustainable Development', chaired by KAS Murshid, former DG of the Bangladesh Institute of Development Studies (Bids), recommended reforming public hospitals, starting with a selected Dhaka hospital. 

It proposed appointing professional administrators, forming a new governing board, using real-time dashboards for complaints and performance tracking, and allowing youth and citizen groups online access to key indicators. It also urged permitting FDI in the tertiary health sector from leading hospital groups like Bumrungrad or Gleneagles. None of these recommendations have yet been implemented.

Dr Nazrul Islam, Associate Professor at the University of Southampton and Research Editor at the British Medical Journal, told The Business Standard, "If this government had addressed the allegations of corruption, irregularities, or partisan influence in the health sector by setting clear criteria and reforming the recruitment process to be transparent and reproducible, it would leave examples for the upcoming elected governments to follow. 

"Now, since time is short, rather than being grandiloquent and generic, the government must be pragmatic in prioritising one or two of the issues it has identified to ensure they are implemented properly."

In the past year of the interim government, apart from transfers of personnel from the Directorate General of Health Services to various medical colleges, hospitals, and health complexes, there has been little change. However, even in leadership reshuffles, political influence remains as strong as before. 

From the time the interim government took office until 3 August this year, 8,276 officials have been transferred. Many deprived doctors have been promoted. The shortage of manpower in the health sector remains acute.

Health sector paralysed without sector programme

Under the sector programme, all activities in the health sector, including procurement, are conducted through various operational plans. The 4th sector programme ended in June 2024. The interim government decided to exit the programme and prepared an exit plan. But implementation of the plan has not yet begun, resulting in the suspension of supplies for tests and examinations – from X-rays to ultrasounds – to upazila health complexes and district hospitals. 

Community clinics have been without medicines for months, and district hospitals are facing shortages of medicines for non-communicable diseases. Rabies vaccines and antivenoms are also in short supply in hospitals, and snakebite deaths are occurring regularly due to the lack of antivenom.

Dr Syed Akram Hussain, member of the Health Reform Commission, told The Business Standard, "The health sector has shown success in routine work, especially in the case of the Milestone School accident, and though treatment for those injured during the July movement was delayed, much of it has now been resolved. Though it took a long time, the promotion backlog has been cleared. 

"However, the new financial system the health ministry is transitioning to after leaving the sector programme has not been organised as it should have been. Reforms, in the way we understand them, have not progressed much. Reforming the health sector is difficult for a single ministry – it is an inter-ministerial issue and requires the intervention of the chief adviser."

Movements that had to be handled

During the Awami League government's tenure, 16 government and nearly 200 private MATS colleges were launched in the country. Although several thousand students have graduated from these colleges, job opportunities for them are scarce. 

These students protested for more than three months from January to March this year, a movement the Ministry of Health had to address. Health workers recruited under the Covid-19 Emergency Response and Pandemic Preparedness (ERPP) project also protested for a long time. 

Since July, students of Unani and Ayurvedic medical colleges have been protesting for the formation of an independent council. Following student protests over hall facilities, Dhaka Medical College was shut down for 20 days.

What the govt says

Senior officials at the health ministry say that with the resolution of 10 identified problems, the process of reforming the health sector has essentially begun. They will not be able to complete all the work.

Professor Dr Md Sayedur Rahman, special assistant to the chief adviser for the ministry of health and family welfare, said the quota system for medical admission tests has been abolished. The internship in medical education will now be 18 months, including six months in a rural area.

To ensure people's access to safe and quality medicines, the ministry is planning to create a pharmacy network. Md Sayedur Rahman said, "A grocery store and a pharmacy are not the same thing. Dispensing medicine is a specialised task that requires pharmacists. We are taking steps to increase investment in this sector and recruit graduate pharmacists. To avoid conflicts of interest, we have also taken legal initiatives to ban all types of gifts from pharmaceutical companies to doctors."

To address manpower shortages, 7,000 doctors will be recruited.

And to solve the problems of lack of transparency and impunity, procurement has been digitalised, he added.