Health sector needs visionary leadership to improve services

Bangladesh significantly lags behind in achieving universal health coverage, and has also scored poorly in the Global Health Security Index and the Health Inclusivity Index. Despite notable progress in specific health programs such as the Expanded Program of Immunisation (EPI), the Covid-19 vaccination program, and kala-azar elimination, there is much work to be done.

For instance, to attain universal health coverage, the current Service Coverage Index score of 52 out of 100 must be raised to at least 80 by 2030. Additionally, the individual's share of total health expenditures should decrease from the current 68.5% to 30%. 

According to 2021 data, Bangladesh ranks 95th out of 195 countries, with a score of 35.5 out of 100 in the Global Health Security Index. This index evaluates nations based on six factors: preventing the emergence or release of pathogens; identifying and reporting epidemics; responding quickly to epidemics; committing to strengthening national capacity; assessing overall risk environment; and evaluating country vulnerability to biological threats. 

Bangladesh receives the lowest marks in "sufficient and robust health sector to treat the sick and protect health workers" and "prevention of the emergence or release of pathogens."

It also has the lowest overall score (30.8) and the lowest scores for each of the three index components out of 40 nations, including the value of health to a country, inclusive health systems, and community and individual empowerment.

The existing standing on various health indices does not align with national aspirations and development goals. However, it is crucial to recognise that health information, service delivery, and accessibility are not solely dependent on the health sector; they are influenced by politics, social policies, economic policies, drug policies, education policies, legal systems, and governance systems.

Despite the formulation of health policies in 2000 and 2011, there has been minimal implementation. The "Health Care Financing Strategy" from 2012 and the outdated 'Operational Plan' approach are also examples of policies not effectively put into practice due to issues like a shortage of competent workforce and a lack of coordination.

Over the past 20 years, meaningful changes in the health sector have been elusive. The splitting of the Ministry of Health and Family Welfare into two divisions has created divisions, and post-Covid-19, there is little optimism for positive outcomes from the public health system. The root cause lies in policymakers' incomplete understanding of the health sector and its management, leading to a lack of effective policies and resource allocation.

There is a growing relative discrimination between certain government employment cadres and medical professionals, further hindering the development of the health sector. The infiltration of politics into the medical profession has led to partisanship rather than a pursuit of excellence, negatively impacting the government health sector's quality and efficiency.

Private healthcare, despite being paid for, fails to deliver high-quality treatment due to inadequate oversight and control by the health department. This has led to people seeking medical care overseas, posing a threat to the nation's economy, security, and general well-being.

Two potential solutions can help. 

One involves forming a robust private sector alliance led by a social enterprise, creating a consortium to provide high-quality services and establish a referral network. 

The other solution is to establish a private hospital network with referral facilities owned by both foreign and local entities, with at least half of the ownership held by domestic entities. Government cooperation is essential in both cases to protect national interests.

The author is a professor at the Institute of Health Economics, University of Dhaka.