Most poor have little access to institutional healthcare: Study
Only 9% of 1,200 households interviewed reported to have health cards while 32% said they were completely unaware of the health card system
More than a decade ago, Shahidul Mondol came to Dhaka to earn more than he used to do from farming at his village in Bogura.
Since then, the rickshaw-puller had been living with his family in the capital until the pandemic reduced his income and forced him to send his family members back home.
But he continued to pull rickshaw to support his family. Ridden with financial hardships, he is least concerned about contracting the Covid-19 infection.
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"Whenever someone of my family falls sick, I go to a local pharmacy to get medicines. If you visit doctors, you have to unnecessarily spend on tests. I do not have money for that," 40-year-old Shahidul told The Business Standard.
Like Shahidul, most of the poor have little access to institutional urban primary healthcare "characterised by both very low population coverage and service coverage", according to a study done by Power and Participation Research Centre (PPRC) in October last.
The findings of the research titled "Road to UHC: Health Realities of Rickshaw-Pullers and Other Urban Poor" were shared in a webinar yesterday chaired by Hossain Zillur Rahman, executive chairman of the PPRC.
Speakers at the programme repeatedly spoke in favour of reforms in the health system targeting universal healthcare coverage (UHC).
In the study, 1,200 households were interviewed. Only 9% of them said they had health cards while 32% said they were completely unaware of the health card system.
The services that the rickshaw-pullers got using health cards were limited to vaccination, family planning, neo-natal care and reproductive healthcare. Only 21% of them could have access to vaccination, 17% family planning services, 15.4% neo-natal care services and 11.8% reproductive healthcare.
Around 0.5-1.5% of the respondents mentioned availing subsidised minor operative services and caesarean section deliveries with health cards.
Since public spending in healthcare is very low in the country, out-of-pocket expenditure is high, which is why poor people like Shahidul go directly to pharmacies to find remedies.
Rickshaw-pullers, however, are not the only group of people deprived of healthcare.
Philip Gain, executive director of Society for Environment and Human Development, said socially excluded communities like Harijans, sex workers and Bede largely remain out of the healthcare system.
Living in appalling conditions, people of Bede community have a higher death rate at birth than the national average. The rate of vaccination is also low among them. Without healthcare, female sex workers suffer from tuberculosis, abdominal discharge, HIV, cervical cancer etc.
Rob Yates, executive director, Centre for Universal Health, Chatham House, London, gave a presentation highlighting the need for ensuring universal health coverage.
He said all people should receive quality health services that they need without suffering financial hardships. And public financing is the key to universal health coverage.
In Bangladesh, 70% of the health expenditure is made out of pocket.
Many countries over the last decade have gradually shifted to high public spending on healthcare, such as China and Thailand.
Chine injected huge public money into its health system after the SARS crisis, which is exactly what Bangladesh needs to do to provide the poor with the healthcare they need, said Rob Yates.
Emerging from the Covid crisis, South Africa is also gearing up to launch national UHC reforms, he added.
The study found lower financial hardship was the top priority of beneficiaries when it came to accessing healthcare, followed by doctor's behaviour, doctor's availability and facility proximity. Evening and night are their preferable times to visit hospitals and doctors.
The research also points out the rickshaw-pullers having spent on an average more than 10 years were not temporary residents of the capital. Eighty-seven percent of them live with their families and 55% did not have any financial linkage with village.
This is the backdrop to the researchers insisting that boosting urban primary healthcare should be seen as "highly productive investment" rather than a budgetary burden.
"Without human development, we cannot attain any targets," said Dr Shamsul Alam, senior Secretary and member, General Economic Division of the planning commission.
From the realities portrayed in the study, he said, "I think we need to put more emphasis on healthcare services, particularly in urban areas."
