How has the Covid-19 pandemic reshaped the healthcare industry in Bangladesh?
Bangladesh's healthcare workers have done a commendable job in managing the Covid-19 pandemic, despite initial limitations in infrastructure and human resource training.
Our healthcare system is now testing new boundaries, searching for realistic avenues to counter the situation, as we are driven by the urgency to find sustainable solutions as well as ways to maximize healthcare outreach to contain the virus spreading.
In Bangladesh, as well as the rest of the world, the Covid-19 pandemic has dramatically changed how outpatient care is delivered in health care practices.
To decrease the risk of transmitting the virus to either patients or health care workers within their practice, providers are deferring elective and preventive visits, such as annual physicals.
When possible, they are also converting in-person visits to telemedicine visits.
For their part, many patients are also avoiding visits because they do not want to leave their homes and risk exposure.
The hospitals are struggling to raise their non-Covid numbers trying to win back patients’ confidence by saying their facilities to be Covid-safe, at the same time they are highlighting their Covid-19 facility strength to assure Covid-19 patients of the best available treatment.
Going forward, what are the steps we should consider to prepare our health sector for a post Covid-19 world?
One of the biggest concerns is to propel the healthcare system back on its feet and create a viable environment for stable growth.
One such need which has become significantly pertinent is augmented home healthcare service delivery.
Facilities with their focus extensively on gearing resources from hospital to customers' premises will be the future.
Creating efficient trained tech-savvy labour pool, mostly in the form of nurses, patient care attendants, lab technologists and even enabling volunteers by training them for basic health check-up and monitoring, would be the key to achieve sustainable healthcare service delivery model to cater to the increasing load of Covid-19 patients of different severity.
Starting from home sample collection to home health monitoring to home medicine delivery, all will encompass an efficient home care service model, pertinent for such times, leading the way to expand the country's healthcare horizon in this new-normal.
Another requirement of the time is to concentrate on having single specialty centers – where each specialty will be treated in designated medical centers only.
Separating investigation facilities from the service provider out-patient and in-patient treatment areas is also a viable option to think about considering patient safety, where separate areas and timings can be allocated for Covid-19 suspect/positive and non-Covid patients.
How will you rate the current status of employee benefits in the medical profession compared to the engagement and stress they take?
We all know the numbers of doctors and nurses are not sufficient to meet the healthcare demand of the country.
The disparity between supply and demand has become visibly paramount during the current pandemic.
Not only doctors and nurses, other healthcare workers like radiology technicians, paramedics, lab technologists and phlebotomists, all in the face of increasing patient burden and also in risk of getting infected, have added to the service provider shortage.
We lost many senior doctors to Covid-19, which is a grave intellectual loss for our country.
Considering their dedication and engagement for serving the community and also the stress that they have to take, the employee benefits definitely need to improve.
Soon after the outbreak, our government initially laid out some benefit schemes though that was not very clear and yet to be implemented to earn the trust from the healthcare force that they are adequately valued.
Private sector providers recruited extra human resources on a locum basis to meet the increased patient demand; additional monetary remuneration was also given, however all these are contingency measures to meet the surge during the pandemic.
In the wake of the pandemic, for medical professionals and all healthcare workers, we need to have clearly laid out work hours with remuneration specified for government and private sectors, including extra perks for additional works like risk allowance, extra-hour allowance, family allowance etc.
What is the current status of health workers ratio to population and what can we do to overcome challenges in that regard?
As per statistics of World Bank and Bangladesh Bureau of Statistics, both healthcare facilities and labour resources in Bangladesh are much lower when compared to the world average.
In Bangladesh we have 0.58 physicians (the world average is 1.7) per 1000 population and 0.29 nurses (the world average is 3.8) per 1000 population. This is a very poor scenario.
To overcome these, as a short term measure we should think of increasing paramedical support care forces and training them for basic care, checking vital measures, reporting and escalation as needed.
On a long term basis, we should focus on some selected specialty areas like emergency medicine, pulmonology, radiology, critical care medicine and launch focused training endeavours to have skilled doctors and nurses in these areas.
Bangladesh is a key source market for medical tourism in countries such as India, Singapore, and Malaysia. Why do you think people in our country prefer obtaining medical services abroad?
Mostly lack of trust in the country’s healthcare system stemming from conflicting diagnosis and investigation reports from various centers and in some cases bitter experience from any local center make our people opt for treatments abroad.
Many want to have their treatment plan verified by a doctor/hospital abroad; many feel going abroad for treatment is worth a try for critical patients.
Moreover, these patients are comforted by the smiling assuring caregiver demeanour of foreign hospitals in their spick and span facility, along with their hassle free one-stop service delivery and excellent communication at all step, making them even feel that the exorbitant cost of treatment is worthwhile.
What can Bangladesh do to reverse this trend?
Amid the pandemic, many people who used to go for treatment abroad for small to big reasons, for routine or emergency treatment, had to come to local hospitals because of the travel ban.
This was an opportunity for local hospitals to give them a trustworthy service and gain their confidence.
Many of these patients availing service here in local hospitals were happy.
This needs to be a collective effort.
Local hospitals must gear up and have an introspective survey.
Patients should not feel lost and confused with their diagnosis and state of health and they must feel that, however serious and dire their condition might be, they are at the right place which is trying their best to give them the right treatment.
Even relatives of non-resident Bangladeshi communities will prefer to avail their treatment from local hospitals as the reputation increases and trust comes back.
In your opinion, what challenges does Bangladesh face in implementing a universal health coverage system? How can we overcome those challenges?
In Bangladesh, more than 70% of the health expenses are made out of pocket expenditure as we do not have a properly designed health insurance facility in the country, neither in government nor in the private sector.
We need to assess patient requirements and lay down an inclusive and sustainable health insurance plan which will cover people from all genres ensuring none of us keep away from health coverage.
The government should have its own health insurance plan and should let private operators design their own, suiting the needs of patients from all strata.
Shagufa Anwar can be reached at [email protected]
