–Dr Samir Kumar Saha–

Goal No. 3 (Good Health and wellbeing) of Sustainable Development Goals (SDGs) called for ensuring healthy lives and promoting wellbeing for all. A significant portion of global population still lacks access to vital healthcare services. To bridge the gap and ensure equitable healthcare provision, addressing disparities is critical. We need to give attention to pave the way for achieving our common objective of Health for all and achieving the SDG targets.

The benefits of ensuring healthy lives for all outweigh the cost, because healthy people are the foundation for healthy economies. Health is one of the basic requirements for improvement in the quality of life. We need to safeguard people who are burdened by high disease prevalence. To do so, we need to strengthen health systems and foster resilience in the face of health adversities.

We need to ensure Universal Health Coverage (UHC), which aims to ensure that everyone can access to quality health services without facing financial hardship. Inequalities continue to be a fundamental challenge for UHC.

Our national constitution also stressed on the health issue. As per Article 18 (1) of Bangladesh’s Constitution, the State shall take steps for improving public health. So, it is our national duty to ensure the UHC.

Bangladesh has made significant progress in health indicators in recent years in spite of her low level of income. This is mainly due to the commitment of the state supported by donors in providing preventive care with respect to child health and family planning.

However, there are serious problems related to both access and quality of curative care that hurt the poor most. Infrastructures for service delivery exist at local level in rural areas but they function inefficiently.

Decentralization of the country’s healthcare system can ensure quality treatment of patients. It is praiseworthy that our healthcare system has improved, but people are yet to find doctors, medicine and other necessary facilities at the grassroots level such as upazila and district levels. People are still seen rushing to medical college hospitals and hospitals in the capital for treatment.

The centralized system has caused indiscipline in the health sector. Many hospitals struggled to provide service while others saw very few patients. In the rural and urban areas, doctors, medicine and other facilities are hardly available as opposed to the urban areas.

The concentrated development in the urban areas attracts people to migrate into cities for a better living and consequently leading towards the root causes of many socio-economic and environmental nuisances. Moreover, the high-density urban living engines the rapid spread of contagious diseases and thereby threatening the lives of millions of people.

The high death rate and affected cases of COVID-19 in Dhaka City, and its nearby areas, i.e., Gazipur and Narayanganj, gives a clear indication of the importance of activity center decentralization. Due to the growing demand for healthcare, it has become necessary to decentralize the health care facilities to the remote areas.

With centralized health system, we will not be able to attain sustainable development goals.

The rapid influx of migrants and increased number of people living in urban slums in large cities is creating continuous pressure on urban primary health care (PHC). The cities are not well-equipped to accommodate these migrants from the point of view of providing basic services. Poor housing, unsafe water supply, weak environmental health services, poor sanitation, overcrowded living conditions, poverty, and the lack of affordable PHC services have resulted in severe health maladies and malnutrition for the urban poor.

Due to the complex nature of urban health problems, there is a need for joint actions and consolidated efforts of different ministries and other stakeholders. Ideally, urban public health sector programmes should be comprehensive, necessitating participation of all public, private, NGOs, community-based organizations (CBOs), civil society, and other stakeholders.

The health care system, in a broader sense, transcends clinical care. It has a close relationship with a reasonably good system of preventive care. Apart from immunization and other medically dependent services, it includes access to safe drinking water facilities, solid waste disposal, prevention of pollution, and access to safe food in urban areas.

The government is now working to provide healthcare up to the grassroots level. We have to expand our health system in such a manner, so that people from upazila do not require to come outside their upazila for treatment. Hence, it is needed to strengthen the capacities of upazila-based hospitals.

If it is not possible to give proper treatment to any critical patient at upazila level hospital, a referral system has to be created for referring such patient to Dhaka. It is needed to transport pregnant women, children and old patients by ambulance to emergency unit of the hospital free of charge. Because, public service vehicles do not have life-saving oxygen and arrangement for giving saline.

If we want to reach the health services to the doorsteps of rural people, it is important to ensure transparency and accountability at all the stages of the health sector. The authorities concerned should ensure the presence of physicians, technicians, nurses and availability of required medical equipment at the upazila level for ensuring quality health service, any type of irregularity should be dealt with iron hands.

Licensees of all unfit hospitals, clinics and diagnostic centres at district level must be cancelled for the sake of providing proper health services to people. Steps should be taken to close license less pharmacies at the rural level. It is imperative to monitor the market in order to keep prices of medicine stable. There are Civil Surgeon Offices at all the district. It is alleged that the inactive role of Civil Surgeons is the main hindrance to development of health service programmes in the country. The matter needs urgent attention.

Health is a fundamental right of people. So any kind of negligence in this regard is unacceptable.

(The writer is former Executive Director, Public Health Foundation, Bangladesh)