The organization recommended gradual reopening of different sectors
Bangladesh Health Watch (BHW), a citizens’ platform for improved accountability of the healthcare system, has expressed concern over the rise in Covid-19 cases.
They suggested a “whole of society approach” to combat the spread of the disease.
In a statement, they said: “We are deeply concerned at the recent steep increase in case numbers and continuation of unnecessary deaths due to Covid-19. On the contrary, Bangladesh remains at the bottom of the league table in South Asia in terms of the proportion of people tested for the disease. We are equally concerned at the failure of much of the population to adhere to basic prevention norms and the rising incidences of fear and stigma in the society. BHW believes that in order to combat a crisis as large and complex as the Covid-19, the country needs a whole of the society approach in which every group and individual is mobilized to fight the scourge.”
The organization made several recommendations to cope with the situation which are as follows:
The issue of re-opening:
Most countries which are easing restrictions have reached their peaks in Covid-19 infection. When the disease will reach the peak in Bangladesh is yet to be ascertained.
Due to many other imperatives such as the plight of the vulnerable sections of the society and the national economy, the government has already opened up the agriculture and RMG sectors and eased restrictions on shopping centres (although we don’t know their Covid-19 effects yet). It should follow such gradual process of sector-wise opening up. In such opening ups, a ‘zoning/cluster’ approach is recommended. For example, choose 10 districts with the lowest number of infections and try the effects of the opening up there. This will help the government find the best way forward with least risk. This would include the opening the educational institutions as well.
Monitor scientifically the effects of the reopening on disease incidences so that any negative outcome can easily and immediately be tracked and attended to for making strategic changes. The country has a number of important institutions which deal with data. Unfortunately, most of these institutions have sadly been inactive or passive. These include the BBS, BIDS and universities. The IEDCR has done a good job of informing the public on test-based progression of the disease during the early days of the pandemic but the vast amount of surveillance data they have in their possession which are collected every week from Upazilas and districts have not been made public. The government should activate, support, and strengthen the capacities of these institutions to assume such monitoring roles. The institutions in the private and non-governmental sectors should also be encouraged and supported in playing this role.
Strictly adhere, religiously implement and scale up the 3Ts (Test, Trace and Treat) and follow the other basic health guidance such as universal use of face mask, frequent hand washing with soap-water or use of sanitizers and social distancing, everywhere including religious sites.
Emphasize primary health care (PHC)
The approach to combat Covid-19 must move from hospital to community through the PHC.
Strengthen and empower the PHC centres at Community Clinic, Union Centre and upazila health complex. These should be the place of first call and should be equipped with the requisite facilities including testing (at upazila level), contact tracing, isolation and initial treatments. The patients in the Covid-19 hospitals should not accept any patients not referred by a PHC centre.
Make use of the thousands of community health workers (CHWs) who are well trained and experienced, trusted and readily available. They can be powerful foot soldiers in creating critical awareness and new norms (wearing mask, hand washing and physical distancing), reducing fear and stigma, and identifying suspected patients and referring them to a PHC centre. They are one of the best groups to engage the greater community.
Commit to a new post-Covid-19 health system
The Covid-19 crisis has proved once more the serious limitations and weaknesses of our existing health systems. Making the best out of the present crisis, we must take advantage of the new realization and take the opportunity to plan for a just, effective, and equitable future health system for the country.
Sadly, the Bangladesh government spends the least in healthcare in terms of the GDP in the entire world. It is time to move the spending up from the current 0.4% to 2.5% gradually in the next 2-5 years.
In order to make the health systems responsive to the needs of everyone, the country should adopt Universal Health Coverage (UHC). It may be mentioned that the government has made repeated commitments to the global community to implement UHC. The 8th Five Year Plan should have an elaborate strategic map of how this will be achieved during the Plan period.
Adopt a ‘whole of the society approach’
The Covid-19 has unleashed a crisis that requires the participation of everyone in the society to overcome it. Unfortunately, the current strategy puts the majority of the society who are outside of the government as passive recipients and simple observers.
The government should reconstitute the different committees (such as the National Committee, Coordination Committee, Division, district and upazila committees) and bring in representatives of different sections of the society including the civil society, NGOs, academics, media, private sector for them to contribute and own the national efforts. The government should facilitate formation of Covid-19 prevention committees in every village and para with the participation of different sections in the community including union parishad members, women, teachers, CHWs, Imams, and others.
The government should immediately constitute a Scientific Advisory Group for Emergencies (SAGE) to advise the government on the best scientific strategy to deal with the emergency. Other countries have such committees and should include experts from all related disciplines including public health, medicine, economics, business, social sciences, and communications.