The State of Healthcare Industry in Bangladesh [Part-I]
Since its independence in 1971, Bangladesh has been struggling with providing its populace with a proper health care system. Recent statistics suggest that it has been making progress throughout the years. Here, we are going to look into the nature and mechanism of the industry, what problems it is facing and how those problems can be faced with existing resources.
The Healthcare industry of Bangladesh
Bangladesh currently has a population of approximately 160.9 million with a density of 1,034 people in every square kilometer. Average Bangladeshis have a lifespan of 71/73 years at birth (as of 2015) which is 46% higher from 1970. The birth rate currently stands at 2.16% while the death rate is 46 children in every 1000.
The maternal mortality rate is 0.24%. Mothers in impoverished families often suffer from malnutrition which results in their bearing undernourished babies. A 2008 report by One World South Asia says that every 3 to 4 minutes a baby dies in Bangladesh which shockingly amounts to 120,000 babies dying every year. However, the situation has improved significantly in last few years with a sharp decline in children mortality rate.
Several factors contribute to the detriment of health in Bangladesh: rapid growth of population (2.7% annually), nutritional problem (lack of knowledge about health and nutrition), and environmental sanitation (according to a survey, only 32% of latrines in rural areas maintain the international sanitary latrine standards), general health problems and communicable diseases.
Bangladesh has made a notable improvement in the area of immunizing children under the age of five. A renowned British medical journal The Lancet noted that Bangladesh’s under-5 mortality rate has fallen to 65 per 100 live births in 2006 from 202 in 1979. The Ministry of Health and Family Welfare (MOHFW) also published a report stating the rate of fully immunized children to be at 52%.
The Nature of Health Services
Healthcare in Bangladesh is provided in three major categories. The type of service a patient need is determined by the medical necessity. The service categories are defined as follows. The primary care is given to people in need of general health care. This type of care is commonly provided by family practice, pediatrics, internal medicine, and sometimes gynecologist.
The secondary care is more intensive in nature than the previous one. It is provided by certified physicians upon requests from the primary physicians. Hospitals like Dhaka Medical College Hospitals, BIRDEM treat people needing secondary care. The type of specialized consultative care, tertiary health care, is facilitated by specialists working in a center that has personnel and facilities for investigation and treatment of special health problems.
Medical Professionals and the Industry
There is a growing popularity of getting into the medical profession in Bangladesh. Albeit that trend, the country still remains among the 57 countries recognized by WHO in 2006 for having a severe scarcity of trained medical professionals.
According to reports of MOHFW published in 2012 and 2013, there are currently 64,434 registered doctors, 6,034 registered dentists, and 27,000 midwives. The figures indicate a physician density of 0.036%.
Another recent report of WHO says that for every 1000 people in Bangladesh, there are only 0.3 doctors and 0.3 nurses. Furthermore, cumulatively there are less than 23 doctors, nurses, and midwives per 10,000 populations.
Public Health Care Services
There is a total of 128 public medical intuitions that provide secondary and tertiary level health care to both in and out-patients. Of these 128 institutions, 53 are district hospitals, 11 general hospitals, a medical university in Dhaka (BSMMU), and 63 other types of hospitals.
The total number of seats for patients in these hospitals is 27,053 among which district hospitals, medical/dental college hospitals, and BSMMU have respectively 7,850, 11,960, and 1,212 functional beds. Consequently, for every 5,657 people, there is only one bed in the secondary and tertiary care hospitals and one bed per 12,696 population in the medical colleges. These statistics, needless to say, are disappointing.
Non-public Health Care Services
The private medical institutions are clustered mostly in the capital and large cities. Other informal services (Kobiraji, homeopathy) can be found in other regions. An important fact to note is that there is no organized body to oversee these informal services. The authenticity of the services, thus, is dubious.
Asia-Pacific Observatory on Public Health Systems and Policies reports that there are a total of 2,983 registered private hospitals around the country which provide 45,485 functional beds as of 2013. The bed-density in the private sectors then stands at 0.031%.
Another significant aspect of the health care industry is the new trend of startups. This type of startups is initiated by a new breed of entrepreneurs who want to bring affordability and speediness in the health care system by introducing technology. Doctorola, the partner of this report, is such a startup that helps people get doctor’s appointment through website and mobile phones.
Government Funding: In spite of a stable GDP growth of 6-7% throughout the previous decade, Bangladesh government has been reluctant to spend more in the health sector. According to WHO, a mere 2.8% of the GDP of economy is being spent as health expenditure whereas the percentage hovers around 8-12% in the developed countries.
WHO also suggests that the ratio between public money to private money should be 3 to 1 while on the contrary, the government expenditure in health sector amounts to only 37% of the total health expenditure.
Private (Out-of-Pocket) Expenditure
The rate of current government expenditure clearly indicates that private money is still financing the major portion of the health care industry. The rate of out-of-pocket spending is 61% in Bangladesh which is quite depressing compared to other countries in the South Asia.
Foreign Investment and Donations
Bangladesh has been recieving investments and loans from countries and international organizations in the healthcare sector. Notable bilateral investors are Australia, United Kingdom, United States, Germany, and others.
The World Bank has been an avid helper in the health sector. Bdnews24.com reports that WB has approved a loan of $150 million to the ‘Health Sector Development Program.” With this additional financing, the loan granted by WB totals $508.9 million, as of June 2016. Besides World Bank, other multilateral donor organizations are UNICEF, Asian Development Bank, and the European Union.
Problems and Possibilities
The health care sector in our country is beset with a number of hurdles. A survey done in 2012 found out that out of 152.5 million population, only 10 million people (that is less than 1%) is covered by some sort of formal health protection. Another survey by the Household Income and Expenditure Survey points out that only 24.6% of Bangladeshi families are covered by the social safety net program introduced in 2010.
The growth rate of GDP has remained stable at 6% in Bangladesh. Economists predict an even higher rate in the near future. As GDP soars, the government must take steps to increase its spending in the health sector and make plans to insure more families.
The health care industry is a diverse sector. As the famous medical journal, The Lancet puts it, “health systems are complex and no simple recipe exists for success.” Should the problems are addressed with due diligence, we can most certainly hope for a booming industry and a healthy nation.
Sources and references
1. Ministry of Health and Family Welfare (MOHFW)
2. Bangladesh Bureau of Statistics
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