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The way forward for health care

  • Published at 07:28 pm June 20th, 2016
The way forward for health care

Our national health system has so much to be proud of. Over the last two decades, I have been thrilled to watch as our country made giant leaps in increasing life expectancy, reducing infant, child, and maternal mortality, and reducing birth rates.

We have been a model of multi-sector and international cooperation on public health, and according to the WHO, have either achieved or are on track to achieve the Sustainable Development Goals. In 20 years, Bangladesh has moved from being one of the most disadvantageous countries in the world to becoming a low middle-income nation, as defined by the World Bank.

However, new health challenges threaten our country. Many of these threats are due to environment and lifestyle changes -- unhealthy diets, lack of physical activity, and use of tobacco, leading to a rise of non-communicable diseases.

Both investigation and treatment of NCDs are costly. Therefore, importance should be given to primary and secondary prevention.

In the face of rising NCDs, our own organisation, the National Heart Foundation of Bangladesh, which was established in 1978, has grown to become the country’s pre-eminent cardiac treatment centre. It is a non-government, non-profit organisation.

The foundation is a member of World Heart Federation (WHF) and World Hypertension League (WHL). National Heart Foundation of Bangladesh is playing a vital role for prevention, control and treatment of cardiovascular diseases, research activities, training of manpower, and rehabilitation of cardiac patients.

Many patients can get advice from doctors any time without coming to Dhaka, and can save money, time, and trouble of travelling by using mobile or other electronic devices from any part of the country

Without confining its activities to Dhaka only; the foundation has 35 affiliated bodies in different parts of the country. Our 300-bed hospital facility in Dhaka performs all types of invasive and non-invasive cardiac investigations and treatment, including both closed and open-heart surgery as per international standard.

In addition to the National Heart Foundation Hospital and Research Institute, there are government cardiac hospitals such as National Institute of Cardiovascular Diseases (NICVD), Bangabandhu Sheikh Mujib Medical University (BSMMU), and other non-governmental cardiac hospitals providing excellent cardiac services mainly in Dhaka. But these are certainly not enough, and we need to extend the service facility to other parts of the country.

Jainal Miah is among the scores of people who are released every day from the National Heart Foundation Hospital. The poor schoolteacher from the northern district of Kurigram had a stenting done -- a routine affair.

Hundreds of Jainals walk out of the National Heart Foundation Hospital every month, healthier and better. Government initiatives have vastly improved the quality and availability of health services at the grassroots level, through community clinics and rural health centres.

The likelihood of the average Bangladeshi receiving formal medical care during his or her lifetime has exponentially increased, with the density of physicians having doubled since 2000.

However, we still have a shortage of doctors, nurses, midwives and other health workers, particularly in remote, rural, and hard-to-reach areas to achieve universal health coverage goals.

There is a vital need to scale up care at the local level, and continue to build a modern, well-motivated, and professional health workforce across the country. In the meantime, we are faced with a lack of even basic hygiene and health care information among significant segments of the population.

Another major obstacle to achieving universal health care is the attendant costs. Jainal’s children and a nephew paid for his procedure. Unfortunately, everyone cannot afford the costly treatment.

According to the WHO, more than 60% of health care costs are still borne out-of-pocket by patients. With only rudimentary insurance mechanisms in place, many people still simply cannot afford to go to the doctor.

There is no way to follow up Jainal’s treatment once he goes home. Even simple advice now and then, or a routine periodic consultation of just a few minutes could very well see him through many more years of healthy life.

But he is one of the lucky ones. He knew where to come. He was diagnosed rightly. There are many more whose lives could have been longer, healthier, and happier simply with early detection, advice, and treatment.

Many patients can get advice from doctors any time without coming to Dhaka, and can save money, time, and trouble of travelling by using mobile or other electronic devices from any part of the country

One important weapon in this fight is information technology, and particularly mobile technology. Not only has mobile fundamentally democratised technology, but it is also transforming the face of health care.

Mobile phone records have been used to track outbreaks of deadly viruses like Ebola and dengue, while the mobile network can also be used to reach an enormously broad audience with health information, and can even be used to remotely harvest and monitor data like electrocardiograms and glucose levels.

Many patients can get advice from doctors any time without coming to Dhaka, and can save money, time, and trouble of travelling by using mobile or other electronic devices from any part of the country.

Many patients are ignorant, and do not know what to do immediately after chest pain or heart attacks, or in any medical emergency. The use of mobiles or other electronic devices, and advice from doctors/specialists for immediately taking soluble aspirin, which is cheap and available anywhere, can save lives, even in far flung areas of the country.

Mobile technology is also an important means by which patients and their health care providers can access health information remotely. Indeed, according to the Economist Intelligence Unit, greater patient access to medical information has the potential to dramatically improve health outcomes, and has been deemed the most important benefit of mobile health care by both public and private sector stake-holders.

This was followed by the value of having access to personal health information in allowing patients to contact doctors, specialists, and other health workers to make better decisions about their own health.

The power of mobile technology in overcoming health challenges cannot be unleashed by the government alone. The costs are too high, and our expertise is yet lacking.

Thus, the other major weapon in our effort to broaden health coverage and combat NCDs is public-private partnerships. Across the globe, major technology companies, health care providers, and startups are bringing their technology and expertise to bear in enhancing existing health systems through mobile health care (m-health) and telemedicine.

Smart health care companies are rising to the task, working with national authorities and harnessing mobile technology to fund and provide health care for millions of people in places previously inaccessible. One such example, locally, is the recently launched digital health service Tonic.

The success of such models translates into a myriad of benefits, including reduced costs and increased speed for consumers, wider and more effective platforms to reach the public, and sustainable social business opportunities.

Such innovations are not only taking place in developing countries. In Europe and North America, these ventures are supplementing government-led health services with telephone consultations with medical professionals.

Here in Bangladesh, giving people similar access, as the new Tonic service does, to medical advice as well as health information about lifestyle choices and health funding options, such as easy-term loans and insurance options through cell phones and the internet could be an important means of helping Bangladeshis live healthier lives.