Universal health coverage elusive as preventive measures neglected

Regularly informing people of four upazilas in Faridpur about simple measures like exercising and adopting a healthy diet to prevent diabetes has led to a decline in the prevalence of the disease there by 48%, according to a research.

Consequently, the health expenditure of people in these areas has also decreased, said the research, "Community groups or mobile phone messaging to prevent and control type 2 diabetes and intermediate hyperglycaemia in Bangladesh", published in The Lancet journal in 2019.

However, Bangladeshi healthcare providers – both public and private – mainly focus on curative measures like medicine, hospitalisation and treatment, not preventive measures. Consequently, the country lags behind in ensuring universal health coverage, said medical experts.

Along with curative measures, preventive, promotive, rehabilitative and palliative health services need to be made available to all people without causing any financial hardships for them to ensure universal health coverage, according to the World Health Organisation (WHO).

Despite the fact that WHO emphasises preventive measures to ensure universal health coverage, there are no significant activities in this regard in the country other than the vaccination aspects of the Expanded Programme on Immunisation (EPI) and distribution of vitamin A capsules, according to people involved in this sector.

The Health Policy 2011 emphasises boosting immunisation and nutrition to increase people's immunity, but it does not mention anything else regarding preventive, promotional, rehabilitative and palliative health services.

Dr Abu Jamil Faisal, a public health expert, told the Business Standard, "Covid-19 has taught us how important prevention is. It is not only necessary to increase the number of general beds, ICU beds, and oxygen cylinders in hospitals; emphasis should also be placed on prevention. 

"Steps should be taken to increase awareness among people about preventing all types of diseases. Publicity should be increased, and counselling should be arranged to develop healthy lifestyles and eating habits among people."

He added, "Preventive measures must be enhanced and sustained. We need to increase our preventive capacity. If there is no disease, there will be no need for treatment."

Prevention needed to reduce out-of-pocket expenditure

As part of preventive measures, the Directorate General of Health Services (DGHS) and EPI provide vaccines, vitamin A capsules, and deworming drugs to children and women. Upazila health complexes run activities to raise awareness about diarrhoea, dengue, black fever and malaria. Besides, the authorities sometimes place advertisements in the media to make people aware about different diseases.

Meanwhile, the spread of infectious diseases like malaria and black fever has decreased in the country while the prevalence of non-communicable diseases like heart disease, diabetes, and cancer has been increasing. Currently, 67% of all deaths in the country are caused by non-communicable diseases, but there are almost no visible steps to prevent these maladies.

The out of pocket expenditure of treatment seekers in the country has been increasing as patients with non-communicable diseases often require lifelong treatment. Currently 68.5% of the total health expenditure in Bangladesh is paid from their pockets by treatment seekers. Experts said it is possible to reduce this expenditure if non-communicable diseases can be prevented by informing people about healthy lifestyles and proper diets.

Dr Abu Jamil Faisal said an emphasis on exercise, healthy diet, washing of hands, and wearing of masks will reduce the number of people suffering from non-communicable diseases like cancer, diabetes and hypertension. As a result, people's out of pocket expenditure and pressure on hospitals will decrease too.

Dr Lelin Chowdhury, chairman of Health and Hope Hospital, told TBS, "Unfortunately only curative healthcare has been developed in Bangladesh. EPI provides some preventive healthcare, but promotional, palliative and rehabilitative healthcare do not exist here. It is an imperfect healthcare system.

"A holistic healthcare system needs to be developed in our country. Otherwise, people will not be able to develop a fully healthy life."

Professor Khondaker Abdullah Al Mamun, founder and chairman of preventive healthcare startup CMED, told TBS, "If we want to achieve universal health coverage and develop a full-fledged healthcare system, we need to develop community care, especially preventive care. Otherwise, the nation cannot be kept healthy by building big hospitals."

"Preventive care and primary healthcare can reduce a nation's total health risk, as well as the cost and time needed for treatments."

DGHS Additional Director General Professor Dr Ahmedul Kabir said, "We emphasise the development of medical systems as well as the prevention of diseases. Women will be given the vaccine to prevent cervical cancer from this year.

"In the non-communicable disease corner of upazila health complexes, people are advised to prevent various types of non-communicable diseases, including hypertension and diabetes."

Hypertension Control Programme data indicates that 59% of patients registered for treatment under the programme have had their blood pressure come under control in primary care.