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24 June, 2015 00:00 00 AM
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Improving the quality of healthcare in Bangladesh

Subir K Bhattacharyya

What is health? WHO, UNICEF and other international organisations had initially defined health as the absence of illness. Later, the definition was modified to state that health is the overall physical, mental and social well-being of a person. Still later health was defined as the ability to adapt to change. Human health is related to biodiversity, which in turn, depends on the healthy interaction with the inanimate world. Human well-being primarily depends on the health of the earth’s system of energy exchange. In fact, one can’t be healthy in a society, which is fragmented by “the haves and have-nots” and distressed by sectarian violence and lawlessness as well as environmental degradation.
Harvard Professor Sue Goldie credited Bangladesh for reducing under-5 child mortality by 80 per cent, the highest in South Asia and being on target to reach 2015-MDG5 goal of reducing maternal mortality ratio of 1990 by three-quarters. Despite multiple constraints, the government has taken some concrete measures to fulfill the constitutional provisions of 15(ka) and 18(1) and implemented some schemes laid down in the Health Policy 2011. However, the achievements due to interventions by the government and some NGOs are obscured by inefficient management and ineffective healthcare delivery. The situation has been exacerbated by lack of effective preventive care, corruptions and malpractices by healthcare staff as evident from the recent media reports.
The overall improvement of healthcare encompasses three dimensions: the first one focuses on effective prevention, the second envisages broadening healthcare network to include those areas where there is no qualified doctor/ nurse, and patients get treatment from quacks and so-called faith-healers. The third dimension presupposes improving quality by focusing on patients’ safety and patient-centered care. However, challenges are likely to come from healthcare professionals, who ignore that a significant number of patients, visiting hospitals with the trust that they receive treatment for cure, are likely to fall victims of hospital acquired infections, inappropriate drugs, multiple drug interactions, etc.
Strategies for improvement presuppose identifying challenges, which in preventive side, are: health awareness-building, distribution of leaflets in Bengali highlighting the necessary simple steps such as i) hand-washing with soap/alcohol rub before eating anything, ii) drinking safe/purified water, iii) avoiding fried and street-side food iv) regular exercise, v) avoiding refined sugar or any sweets made with refined sugar, vi) early dinner, vii) enough sleep, viii) nutritious food, ix) disciplined life-style and x) have self-awareness about health and healthy living.
In the realm of therapeutic care, challenges are: public hospitals face no competition, have neither built-in incentive system nor any culture to enforce discipline and conduct rules and punish the recalcitrant; there is no mechanism either to evaluate individual’s performance or that of any healthcare institution. Doctors usually give little time, often less than three minutes, to examine patients and mistreat them; fixated mind-set of hospital staff who overestimate their own performance, care little about the patients’ experiences and don’t know that patients’ satisfaction index is related to clinical outcome. Situation can be greatly improved upon by applying simple management techniques.
Training of doctors/ nurses and paramedics is a sine quo non for improving both preventive and therapeutic care. So, arrangements should be made to train round-the-year two categories of health staff- doctors and nurses belonging to first category to receive training in healthcare management/administration and the second category comprising of village quacks and SSC/HSC passed young men/women to receive training in preventive and primary therapeutic care in their respective Thana Health Complex and be designated as village health worker (VHW) to work in their own village. Some of the women will receive training in midwifery and be designated as birth attendant. The training of doctors/nurses will focus, inter alia, on patient-safety and patient-centered-care, in which healthcare is conceived of as a partnership between patients and health professionals. Doctors will be motivated to obtain feedback from patients about their experience. Hospital administration should lay down protocols for all procedures and surgeries, and standardise treatments. Nurses will be trained to affix in every ward check-lists like hand-washing/ alcohol rubs, use sanitized gowns and gloves and stress on cleanliness. VHWs and Birth Attendants educate patients and their families, among other things, on how to maintain good health, nutrition level and maintain families’ health record. Nurses can be relieved of extra duties by appointing ward clerks.
Building on further institutional capacity would be the next step in the way to improving healthcare. National Health Council (NHC), which is to be headed by the Prime Minister, can provide policy directions and evaluate overall progress in healthcare. The government can constitute a National Accreditation Council with the health minister at the helm and make accreditation a mandatory requirement for all hospitals, and other healthcare providers maintain a minimum standard. A patient and family advisory council can be constituted for all hospitals, which will take care of patients’ concerns including unnecessary diagnostic tests and procedures and coordinate with management board of hospitals.  

The writer is a former ambassador who can be contacted at: [email protected]

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Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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