Bangladesh, a country of 161 million people, only has 0.4 physicians for every 1000 people. By contrast, in India, this figure is 0.7 for every 1,000, and in the UK, 2.8, France 3.4, and Italy 4.1. The initial picture tells us that we need to double the number of doctors available in the country if we wish to have a ratio close to India and 10 times the figure to match the developed world.
The number of doctors available in the country is concerning, but the issue of paramount importance is our pathway to producing good specialist doctors who would be instrumental in delivering the health care needed in Bangladesh, especially now, after successfully meeting the Millennium Development Goals.
I, myself, am a Colorectal Surgeon at Bart’s and the Royal London Hospital with specialisation in managing colorectal cancer.
Almost 90% of my clinical work is related to colorectal cancer management. Working for the Royal College of Surgeons of England and Bart’s and The Royal London Hospital, England. I also head RAHETID -- a pioneering Regional Partner Institute and Hospital of RCS England in Bangladesh for the Region of South-East Asia.
As the head of the institute, my role is to ensure high standards of medical education with support, assistance -- both academic and technical -- and anything else from the Royal College of Surgeons of England and NHS Institutions like the Bart’s and The Royal London.
Under my leadership, the institute would offer a structured training program of the Intercollegiate Surgical Curriculum Program of the UK Royal College of Surgeons, with the opportunity of two years of salaried sub-specialty training in the UK.
This would facilitate a professional qualification to practice as a senior surgeon by Non-European Union Medical Graduates in their home country such as Bangladesh.
The UN’s General Assembly, in September 2015, adopted 17 Sustainable Development Goals (SDGs) to be achieved by the year 2030. In its 17 declared SDGs, after “No Poverty” and “Zero Hunger,” the UN puts “Good Health and Well-being” as the third most important goal.
While an integrated, well functioning, and prepared primary health care system will no doubt play a vital role in the achievement of SDGs, it is important to understand that the global health focus in recent years, on individual diseases and delivery of health care only through this system, may have underestimated the value of the development of co-ordinated surgical services.
Especially when there has been marked demographic transitions, shifting the major causes of death and disability.
Bangladesh has demonstrated significant success in terms of primary health care, sometimes referred to as the “Bangladesh miracle” -- strong health gains with relatively few funds.
The joint donor funded Health, Population, and Nutrition Sector Development Program led by the government of Bangladesh has contributed to significant improvement in a number of very important health indicators. The country has improved in women’s education, economic conditions, and life expectancy.
Bangladesh has duly been applauded and accredited by the international community for its progress in the Human Development Index, associated with more robust gains than some of its neighbours with higher per capita income, like Pakistan or India. Bangladesh’s improvement in health through the Millennium Development Goals, is no doubt very impressive.
However, the 20th century revolution in health, and the consequent demographic transition that the world has witnessed, has resulted in a major shift in causes of death and disability from infectious diseases to non-communicable diseases such as cancer, injury due to road traffic accidents, pregnancy-related complications requiring surgical intervention, heart disease, and so on.
Sadly, a number of factors not unique to Bangladesh are causing serious stagnation and, in fact, is preventing us from reaping the benefits of health care achievements made in the 20th century.
The major causes of death changed globally to new epidemics of non-communicable disease and injuries with the average age of death rising steadily, challenging the finances and capacities of health systems. We in Bangladesh now need significant numbers of properly trained specialists who would be able to deliver cancer care, manage injury and rehabilitate victims of injury, obstetrics and gynaecological surgery, major cardiac and diabetic medical and surgical care, together with anaesthetic care support.
Investment in the development of infrastructure and structured curriculum-based training of specialist doctors can no longer be delayed and definitely cannot be ignored.
Without urgent and accelerated investment in surgical scale-up, low and middle-income countries will continue to have losses in economic productivity, with an estimated cumulative loss of $12.3 trillion (economic loss in productivity due to cancer and injury is estimated at $11.5tn) between 2015-2030. This loss, is in contrast, double the World Bank’s estimated amount of $5tn to $7tn required for achieving all 17 SDGs.
At present, according to the Board of Investment, citizens of Bangladesh spend $2.5bn dollars (or Tk19,698 crore) in other neighbouring countries every year for health care -- almost equal to the estimated cost of the Padma bridge in 2011! If we fail to address the issue with utmost urgency it is again estimated that we will lose 2% of our GDP growth by the year 2030. Is it not time that we wake up to the reality and plan to invest in the proper development of our much-needed health care?
