Rise in life expectancy, medical costs

There has been progress, overall, in Bangladesh's health sector during the last decade as the population's average life expectancy has increased, and the rate of child and maternal deaths has decreased.

Communicable diseases like tuberculosis, malaria and polio are on the verge of eradication while the treatment of diarrhoea and pneumonia has improved.

However, simultaneously, non-communicable diseases have emerged as a new challenge in the country. The rate of those being affected by, and dying from, different types of non-communicable diseases—like cancer, diabetes and heart disease—is on the rise.

The cost of medical treatment rose during the decade as the health sector was increasingly privatised.

The average life expectancy of a population is an important indicator by which to assess any health system. According to the Bangladesh Bureau of Statistics (BBS), the average life expectancy in Bangladesh was 67.2 years in 2009 and increased to 72.3 years in 2018.

The BBS data shows, in 2018 the average life expectancy was 73.8 years for females and 70.8 years for males.

The average life span has increased due to progress in various social indices, including a decrease in the child and maternal mortality rate, a fall in child marriage, plus a rise in opportunities for health and education.

The BBS says the average life span has been increasing every year.

According to BBS' data, the child mortality rate has fallen by 41 per cent in the last decade. In 2008 the child mortality rate was 3.1 per cent, and it decreased to 1.8 percent in 2017.

In 2008, some 340 mothers—out of every lakh—died during childbirth. The figure has reduced to 169 in 2019.

Bangladesh successfully implemented its Expanded Vaccination Programme throughout the last decade. The Global Alliance for Vaccination and Immunisation conferred prime minister Sheikh Hasina with a Vaccine Hero award on September 23, 2019, for Bangladesh's successes with its vaccination programmes.

The country was successful in controlling communicable diseases—as evidenced by the World Health Organization (WHO) declaring Bangladesh free from polio and tetanus. Significant progress has been achieved in eradicating malaria and tuberculosis too.

In 2009, the rate of people affected by tuberculosis in the country was 387 per one lakh population. In 2019, the figure decreased to 221, according to the Global Tuberculosis Report 2019.

Additionally, in 2008, a total of 84,690 persons were affected by malaria, and 154 of them died. In 2018, the number of people affected by malaria decreased to 10,523 and only seven died.

In 2009 the number of districts prone to filariasis was 19, but now, Bangladesh is free of the parasite.

The rise of non-communicable diseases

In 2011, Bangladesh's death rate non-communicable diseases—like heart disease, stroke, cancer, diabetes and chronic lung disease—caused 52 percent of total deaths; increasing to 67 percent in 2018.

Annually, in the country: 30 percent of the deaths are from heart disease, 10 percent from cancer, 10 percent from chronic respiratory diseases, 10 percent from diabetes, and 12 percent from other non-communicable diseases.

Experts blame changing lifestyles, resulting from urbanization, for the rise in non-communicable diseases. They said the consumption of fast food and junk food are on the rise and physical labour has been decreasing.

 "People are eating increasingly more processed food instead of healthy food. The practice of physical activities is decreasing. Awareness about the non-communicable disease is low because it is not visible. People visit a doctor only after falling ill," said Dr Aliya Naheed, head of Initiative for Non-Communicable Diseases at ICDDR'B.

 "A non-communicable disease is a life-long condition. If it is not treated, the person will meet a premature death. If he lives, his quality of life will be hindered. If the victim is affected at an early age, he or she will suffer throughout his or her life. The disease will badly affect his family and society," she added.

Rising treatment costs

In 2012, 64 percent of Bangladesh's healthcare costs were covered by patients; this increased to 67 percent in 2015. The percentage rose to 72 percent in 2019. The government, NGOs and donor agencies provided the remaining 28 percent.

As per the data from the government agency Health Economic Unit, about 50 lakh people are impoverished every year, in the country, meeting their treatment costs.

Experts say all services available in the government health network community clinic to upazila health complex must be made more effective for health services to reach people's doorsteps.

 "Most of the public's healthcare costs are for medicine. The trend among the people is that they go to the pharmacy or quacks if they fall sick. They prescribe a lot of medicines," said Professor Syed Abdul Hamid, director of Dhaka University Institute of Health Economics.

 "The health system has to be more effective, including the Shastho Batayon, so that people can get institutional treatment easily. Model pharmacies have to be established at the village level. The cost to the individual will decrease if the cost of medicine is lowered," he added.

Privatisation of healthcare services

The last decade saw a rise in the number of private hospitals in the country. Currently, 5,504 of 7,312 hospitals in the country are private. Among the 2,258 government hospitals, 2,004 are at upazila and union level, and 254 are at a secondary and tertiary level. 

Government hospitals have 52,107 beds, while private hospitals have 90,587 beds. 

However, private health care is expensive and out of the general public's reach. Some have also called into question the quality of their services.

There are 5,054 diagnostic centres at the private level.

Expert health care services available in villages

The advance of communication technology has helped the country's health sector reach more people in the last decade. A high-quality telemedicine service is now available in 18 hospitals, at different levels, providing specialist health care to villagers. Web cameras have been given to all upazila hospitals, district hospitals, medical colleges, and institute hospitals.

As a result, an opportunity has been created for specialist physicians working in high-level hospitals to provide consultations for patients admitted to lower-level hospitals.

Telemedicine services are also available at the union's information and service centres.

Telemedicine services are being provided, through Skype video conference, at the country's 22 union information and service centres. The physicians sitting in the Management Information System (MIS) centre at the Directorate of Health have been providing medical advice to the patients, every working day, free of cost.

The Directorate of Health in 2015 introduced the health service named Shastho Batayon. In 2019, some 50 lakh people received health services by calling Shastho Batayon's number, 16263.

Expanding access to healthcare

A number of specialised hospitals have been built in the last decade. The National Institute of Digestive Diseases Research and Hospital has been set up at Mohakhali, in Dhaka, for liver diseases; while the Sheikh Hasina National Burn and Plastic Surgery Institute has been established for burn victims.

Further, the project to construct a 1,000-bed Super Specialized Hospital under Bangabandhu Sheikh Mujib Medical University, a joint initiative by Bangladesh and Korea's governments, is underway.

Medical education also expanded in the decade. From 2010 to 2018, 14 government and five army medical colleges were established.

Five new government medical colleges were commissioned in 2018. Permissions have been given for three medical universities to be established in Chattogram, Rajshahi and Sylhet.