A number of corruption incidents in the sector were exposed while shortcomings in the system came under the spotlight
Covid-19, the first pandemic Bangladesh has faced since its birth, has exposed the fragile state of healthcare management in the country that fuels the ongoing debate on reforms of the system.
The poor state of management facilitated the virus’ entering the country, which resulted in the death of a good number of people.
A number of corruption incidents in the sector were exposed while shortcomings in the system came under the spotlight.
Several districts, upazila and specialized hospitals got a huge boost during the pandemic in ensuring the treatment of patients.
According to the Directorate General of Health Services (DGHS), at least 512,496 people tested Covid-19 positive till December 30 while 7,531 people died. A total of 456,070 people recovered from the virus in this time as well.
ERPP project corruption
• Zadid Automobiles -- PPEs -- Tk95 million (9.5crore)
• SRS Design and Fashions Ltd – Face Mask -- Tk35million (3.5crore)
• Sim Corporation -- non-medical face mask – unknown but Tk50 Million (5crore) profit
• Sim Corporation – inferred thermometer -- Tk82.8million (Tk8.28 crore)
• Brain Station 23 – 1 mobile app (50 lac) -- Tk47.5 million or (4.75crore)
• Insha Trade Corporation -- three and five functional beds – unknown –
Five functional bed (with all importing expenses) Company price Tk59,813 but the price showed Tk3,30,000 for each bed (50 bed)
Three functional beds is Tk47,962 (with all importing expenses) that was fixed at Tk2,05,000 for each bed (170 bed)
Source: National media
Experts said if the measures had been taken early on, the situation in the country would have been different. Besides, the quality of the treatment still remains a question.
Dr Rashid-E-Mahbub, chairman of the National Health Rights Movement Committee, said people did not receive the expected services from the hospital.
Corruption allegations in the health sector also brought treatment facilities under a big question, he added.
The government failed to take effective measures to prepare the country’s health system for the crisis for long and such huge changes were not possible to be made immediately as well. The upgrades they were now doing should be continued even if the situation improved, the retired professor said.
Arrival of Covid-19, early management and leadership crisis
Coronavirus became a topic for the public health sector of Bangladesh on January 28 after the Chinese government disclosed the death of 106 people from the infection. Still the country was reluctant to control border movements and air communication.
As a result the country found its first case on March 8 while a study revealed by the Institute of Epidemiology, Disease Control and Research (IEDCR) said the virus had already entered the country in February from various international sources.
Mismanagement was noticed from the beginning of the crisis. Sending 312 passengers coming from China, the birthplace of the virus, to quarantine unearthed massive mismanagement and drew criticism.
The criticism led the Health Ministry and DGHS into committing another mistake when they allowed the Italy returnees on Mach 14 and 15 to go into home quarantine.
It took around 81 days, after the discussion started, to form the 17-member “National Technical Advisory Committee” in the country on March 17. An 8-member public health divisional expert advisory panel was formed on the 60th day after the first detection of the case.
These issues raised questions about leadership. At a time when top leaders of government or health ministers were taking charge of the issue around the world, the ministry and DGHS pushed the then chief of IEDCR into the limelight.
This is not the only area where the authorities took clumsy measures.
A lack of coordination in Covid-19 management was observed when the health authorities failed to convince the top authorities of the country to take early preparations.
As a result, public awareness mechanisms gained distrust and people became reckless. Later on, when the control room was established, leadership remained a question. Corruption in purchasing and other matters increased, which resulted in transfers of several officials, including the unit head.
Even a visible rift between the Health Ministry and DGHS was revealed and Covid-19 management faced another crisis that was later tackled by the government effectively.
Corruption in medical equipment purchase is not new in the country. However, since the start of the pandemic, several syndicates became more active in running scams.
The corruption allegations came to light with suspicions of providing fake N-95 masks to doctors in several hospitals by Central Medical Stores Depot (CMSD) in early April. High officials from the ministry and DGHS, along with CMSD officials were accused in this connection.
CMSD Director Lt Col Shahidullah, before leaving office in early June, alleged that the ministry was involved in corruption. The directors of the two hospitals who raised questions over the N95 mask quality were also transferred.
Procurement of equipment remained at the heart of the corruption during the Covid-19 pandemic.
Two such projects were passed by Ecnec and DGHS Director (Planning and development) Iqbal Kabir was in-charge of them. He was also in-charge of the public awareness program under the integrated control room established in March.
Through the Emergency Response and Pandemic Preparedness Project (ERPP), a World Bank funded project, at least Tk20 crore was embezzled where some 5 companies got different tenders. In most of the cases, they were the only companies submitting the tenders.
On March 21, the DGHS signed a contract with the privately-owned Regent Hospital on providing treatment to Covid-19 patients.
The Rapid Action Battalion later raided the headquarters and a branch of Regent Hospital in Dhaka’s Uttara and Mirpur on July 7 and 8, amid allegations that the hospitals had swindled thousands of unsuspecting patients out of millions of taka on the pretext of providing coronavirus treatment and testing.
In late July, the DGHS and the Health ministry got into a spat over the matter and finally the then director general of DGHS resigned from the post.
Jobeda Khatun Health Care or JKG Health Care was also accused of scamming people in Covid-19 testing.
Their approval was later cancelled after charges against JKG Health Care were brought for providing false reports without testing the swabs collected from the people for Covid-19 tests.
Attempt to break monopoly in purchasing chain
Following the N-95 mask scam incident, the entire team of CMSD was transformed between late May and mid-June. For the first time a director was appointed from the Bangladesh Army at CMSD.
A committee was also formed to ensure transparency. The committee consisted of officials from CMSD, public works department, PM Office and Health Economics Unit with 3 physicians.
Following their takeover, CMSD was able to reduce the purchase price of testing kits gradually to around Tk1,300 which was around Tk2,900 when they took charge. The price of surgical masks came down to Tk6 to Tk25 each, while it was Tk700 for each PPE.
CMSD said they are still trying to reduce the prices as well, for example Tk3.5 for each surgical masks, some Tk450 toTk500 for PPEs.
The price of oxygen cylinders came down to Tk15,000 from Tk27,000.
It was said that for any product purchase, several companies were selected to supply it so that a single chain monopoly would not get a chance to be formed.
Need of Public Health directorate
In 2019, research conducted by the Health Ministry suggested forming separate directorates for Health services, Health education and Public Health.
The ministry separated Health Education but did not form any separate Public Health directorate.
Non communicable diseases are rising at an alarming rate in the country. So it is becoming more important to have a Public Health directorate that will conduct research and counsel on ways of dealing with problems before any diseases emerge.
Professor Dr Benazir Ahmed, head of the Department of Parasitology under NIPSOM, said: “We need to upgrade our several healthcare facilities as early as possible.”
The necessity of the directorate was highly felt during the year.
If the directorate had been in place, the government would not have to form committees. It would save precious time to prepare as well, he added.