Health sector reform in Bangladesh: five key recommendations

Despite making significant strides, the health system in Bangladesh still faces major challenges, including systemic inefficiencies, fragmented service delivery, and inadequate resource allocation. These issues lead to inconsistent care and disparities in health outcomes, particularly affecting rural and underserved populations. People suffer from both a lack of access and a dearth of standardised quality in healthcare services. Furthermore, in terms of healthcare delivery, the private sector has significantly outgrown the public sector, both in capacity (i.e. number of hospital beds) and the number of health professionals employed. While this has increased access, out-of-pocket expenditure as a percentage of the health budget has also grown to be one of the highest in the world, pushing many into poverty when faced with major disease episodes.

Here are five key recommendations for reforming the health sector in Bangladesh towards Universal Health Care:

1. Implementation of a Common-Standard EMR System
   One of the most impactful reforms would be the implementation of a common-standard medical/health summary for all citizens, tagged with and accessible through NID. This system would ensure that every individual has a standardised medical record accessible across all healthcare facilities. The benefits of this reform are manifold:

• Efficiency in Healthcare Spending: A unified medical summary would help healthcare providers avoid redundant tests and procedures, thereby reducing unnecessary healthcare costs.
• Effective Referrals: A standardised medical summary would facilitate efficient referrals between primary, secondary, and tertiary care providers, ensuring that patients receive timely and appropriate care.
• Early Diagnosis and Better Treatment Outcomes: With comprehensive medical histories readily available, healthcare professionals can make more accurate diagnoses and tailor treatments to individual needs, leading to improved health outcomes.

2. Strengthening Primary Healthcare Services
   Primary healthcare is the cornerstone of an effective health system. Strengthening primary healthcare services in Bangladesh involves:

• Expanding Community Clinics: Increasing the number of community clinics, particularly in rural and low-income urban areas, to provide accessible and affordable healthcare services. These clinics serve as the first point of contact for many patients and play a crucial role in preventive care.
• Training and Retaining Healthcare Workers: Investing in healthcare worker training and creating incentives to retain them in underserved areas. This includes continuous professional development and career advancement opportunities.
• Preventive Care: Emphasising preventive care and health education to reduce the burden of communicable and non-communicable diseases. Community health programmes focusing on vaccination, nutrition, and hygiene can significantly improve public health.

3. Upgrading Health Infrastructure
   Improving the physical infrastructure of healthcare facilities is crucial for delivering quality care. This includes:

• Upgrading Existing Facilities: Renovating and equipping existing hospitals and clinics with modern medical equipment and technology to ensure that healthcare providers have the necessary tools to deliver effective care.
• Building New Facilities: Constructing new healthcare facilities in regions with inadequate access to services, reducing the burden on existing facilities and ensuring that more people receive care.
• Maintenance and Management: Implementing robust maintenance and management systems (including audits) to ensure that healthcare facilities remain functional and efficient. Regular maintenance schedules and proper management practices can prevent equipment breakdowns and facility deterioration, along with reducing leakages in the public health system.

4. Proper Use of Healthcare Financing
   Adequate financing is essential for sustaining health sector reforms. Recommendations for increasing healthcare financing include:

• Government Spending: Increasing government expenditure on health to ensure that essential services are adequately funded. This can be achieved by allocating a higher percentage of the national budget to the health sector.
• Public-Private Partnerships: Encouraging public-private partnerships to leverage private sector resources and expertise in healthcare delivery. These partnerships can help bridge funding gaps and improve service delivery.
• Health Insurance Schemes: Expanding health insurance schemes to cover a significant portion of the population, thereby reducing out-of-pocket expenses and financial barriers to accessing care. This can include both public and private insurance options.

5. Development, Improvement, and Continuous Training for the Health Workforce
   A well-managed health workforce is critical for the effective functioning of the health sector. Key strategies include:

• Workforce Planning: Developing comprehensive workforce plans to address shortages and ensure an equitable distribution of healthcare professionals. This involves forecasting future workforce needs and planning accordingly.
• Continuous Professional Development: Providing ongoing training and professional development opportunities to keep healthcare workers updated with the latest medical knowledge and practices. This helps maintain high standards of care and improves job satisfaction.
• Incentives and Motivation: Implementing incentive programmes to motivate healthcare workers, particularly those serving in remote and underserved areas. Incentives can include financial rewards, career advancement opportunities, and improved working conditions.

Conclusion
Reforming the health sector in Bangladesh requires a multifaceted approach that addresses the various challenges faced by the system. By implementing these reforms, Bangladesh can build a more efficient, equitable, and effective healthcare system. These measures will not only improve health outcomes but also ensure that all citizens have access to the quality care they deserve.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.