Experts say complete reform of healthcare is needed
Bangladesh has emerged as one of the key sources of medical tourists to its neighbouring countries, and the number is increasing every year.
Earlier this year, Nayma khan (not her real name) had a stent implantation at a renowned private hospital in Dhaka. But her health showed no signs of improvement after the procedure, leaving the patient and her family wondering what went wrong.
A subsequent examination revealed that the stent insertion was wrong.
“We found out that the stent was incorrectly placed and it was pushing against a valve in the artery. The hospital authority didn’t inform us about any abnormality after the operation. The right treatment would have been a critical open-heart surgery, which wasn’t possible in the country,” said a relative of Nayma Khan.
Without any further delay, the patient’s family decided to take Nayma to Singapore, where she underwent a successful open-heart surgery and currently is in recovery.
Nayma’s story is not rare. Experiences of conflicting diagnoses from different doctors, wrong treatment at reputed hospitals and erroneous lab reports seem to have created a distrust towards the country’s healthcare system among the wider public.
Experts and industry insiders say the resulting frustration is the impetus behind seeking treatment outside of the national borders.
“People do everything they can to get an accurate diagnosis. They run from one doctor to another, change hospitals and so on. Eventually they get frustrated when they don’t see results. That’s why people decide to go abroad for treatment,” said Professor Dr Syed Abdul Hamid, director of the Institute of Health Economics at Dhaka University.
Not everyone looks at the situation in the same way, however. Characterizing Dr Hamid’s explanation as only a ‘half truth,’ Rashid-E-Mahbub of Jatiyo Shastho Odhikar Andolon said the reason for getting treatment abroad is not necessarily a result of frustration with healthcare at home.
“The number of people obtaining treatment inside Bangladesh is higher than abroad. Some prefer getting regular check-ups or treatments while travelling to a place. I believe it is a phenomenon happening all over the world,” said convener of Jatiyo Shastho Odhikar Andolon, Rashid-E-Mahbub.
Reasons to worry
According to patients, lack of accessibility and easy communication often causes frustration, which causes people to look for better treatment abroad.
Mahfuza Rahman, a diabetic patient with heart disease said she sought treatment in Thailand and India because she was fed up with the treatment she was getting in this country.
“My doctor never gives me enough time to properly explain my problems and pays little attention to what I say. And during any emergency, availing a further appointment is another battle altogether,” the 56 years old said.
One of the obvious reasons behind Bangladeshi doctors being so miserly with consultation time is an extremely high doctor to patient ratio. According to Bangladesh Economic Review, the country has one doctor for every 2,039 people and approximately 0.6 million patients seek medical advice each day.
Dr Syed Abdul Hamid of Institute of Health Economics says a tendency to see only famous specialist doctors further complicates an already weak healthcare infrastructure.
“We have efficient doctors but they are overburdened. There is a need to build a distribution system of patients where senior doctors would only see referred patients,” Hamid said.
Dissatisfaction with lab results also propel distrust among patients.
Farjana Sultana had her mother tested for dengue fever recently. Done at a Dhaka diagnostic centre, the test showed a platelet count of 17,000. She was tested again immediately afterwards when the count changed to 28,000.
“The quality of the labs need to improve. Currently, there is hardly any lab that is completely reliable. There is no accreditation system for labs in Bangladesh. So, there is no way to ascertain and maintain quality.” said Hamid.
The question of affordability
Absence of proper regulatory control seems to have given hospitals and diagnostic labs a free rein.
Fayaz Zaman, a businessman, says seeking treatment abroad was never the first option for him.
“A dangerously wrong diagnosis once nearly killed my father. Much more reliable treatment is available in neighbouring countries that cost us pretty much the same,” said Zaman who now frequents India and Thailand for the medical needs of his family.
Seeing the rising trend of medical tourism in Bangladesh, many hospitals now either have liaison offices or provide access to foreign consultants.
Agent organizations have also mushroomed with rising popularity of medical tourism.
Farhana Ahmed of Health Connect International, which connects Bangladeshi patients to foreignhospitals, says 50 to 60 people visit foreign hospitals through her company every month.
“90% of our clients go only to take treatment, whereas 10% do health check-ups while travelling. Monthly, we provide services to around 50 to 60 patients who travel for treatment.”
A ‘great economic loss’
For Bangladesh’s economy, increasing medical tourism means the country economy is losing the amount of money Bangladeshis are spending abroad.
“India, Thailand, Singapore and Malaysia are the most visited countries by Bangladeshis medical tourists. Because of medical tourism, the country loses huge amount of revenue,” said Rashid-E-Mahbub.
In India, medical tourism contributed 70% to its total health service in 2015-16, among which Bangladesh accounted for more than 35% of the foreign patients and more than 50% of the total revenue from medical tourism, making Bangladesh the largest contributor to medical and health tourism in India.
Impact of budget in overall health sector
After the last national budget, Doctors for Health and Environment, Bangladesh Poribesh Andolon, and Jatiyo Shastho Odhikar Andolon in a joint press brief pointed out that budget allocation for the health sector is the least in Bangladesh compared to other South Asian nations. The organization urged for an increase.
In total, the allocation for health in FY 2019-20 is Tk29,464 crore, which is 1.02% of the GDP and 5.63% of the total budget allocations.
“In the South Asian standard, the allocation should be 12% of the total budget and 3% of the GDP,” said Rashid-E-Mahbub.
However, Hamid believes a reform of the entire medical system is needed to build a strong health sector, and merely increasing the budget is not enough.
Distribution of the budget and purchase of equipments and medicines should take place according to needs.
“The people who are managing hospitals should have the financial freedom to purchase based on requirements,” Hamid said.
“If we cannot work on every level - from developing skilled manpower, doctors’ professionalism, ensuring the availability of necessary logistics - then increasing the budget will not change much,” he said.
Long term planning needed
Describing the management process of the health sector of Bangladesh as a 150 years old system, Rashid-E-Mahbub said, “Instead of playing the blame game, doctors should act responsibly and government should acknowledge its huge responsibility for updating the healthcare sector.”
Both Mahbub and Hamid urged for building a strong taskforce involving expert professionals in order to build a strong management system in the health sector.
They said that there is a need of total and deliberate reform of the entire health sector of the country. Every stakeholder from government, political parties, hospital authorities to doctors should be concerned about it surgency.
Beginning with finding out the loopholes and challenges, the taskforce should make long term plans with a vision for the next 50 years, they said.