Medical professionals and civil society in Bangladesh demand a significant increase in budget, as the present allocation is ‘far from sufficient’ to cover the required improvements to keep up with the Sustainable Development Goals.
Doctors had high hopes when the Bangladesh government announced its new budget last June. They were disappointed, as the allocation for the health sector turned out to be slightly lower than last year, i.e. only 4,9% of the total budget, The medical association had demanded an increase up to 8-12 %, still well below the 15% norm set by the World Health Organisation, WHO. To offer the required healthcare the allocation for health should at be equal to 5% of the GDP according to WHO, whereas Bangladesh allocates only one-fifth, or 0,98 % of its GDP to health.
According to the secretary general of the Bangladesh Medical Association the budge is never enough to cover the proposed plan to build eight new medical colleges and specialised services like kidney dialysis to all medical colleges and district hospitals. ‘Nutrition of mother and child, safe delivery and childcare are some of the most import and aspects of healthcare,’ underlines secretary general Choudhury of the BMA, ‘but we haven’t seen any provisions in the budget to facilitate these aspects.’
To provide a sufficient financial budget for the healthcare sector is necessary to deliver quality healthcare for all. But money alone is not enough, notes former policy official Ziauddin Choudhury, pointing at the availability and geographic distribution of doctors in Bangladesh. Although each year thousands of medical graduates leave college, there is a tremendous shortage of doctors, especially in the rural areas. Statistics show that there are only 1,1 doctors per 10,000 people in rural areas compared to 18,2 for the similar number of people in urban areas. And that too, only on paper, since doctors appointed in rural clinics often do not live there.
Doctor absenteeism is a huge problem in Bangladesh, undermining good healthcare for all. And the problem hasn’t changed over four decades, according to Ziauddin Choudhury who worked in higher civil service for many years. While Bangladesh started building government hospitals and clinics in every district and sub district, many facilities in remain underutilised as doctors remain absent. And this even happens despite the fact that government policy demands new graduates to serve a minimum of two-year in rural service. One of the main reasons for rural absenteeism is that urban areas offer doctors more earning opportunities and better living facilities and high quality education for their children.
Tackling absenteeism is not easy. However stricter enforcement of the two-year mandatory service is needed, as well as some monetary incentives such as a remote area allowance to reduce the problem. Only then better health service can be provided. This will also put an end to the rising cast of healthcare for those who can lest afford it. Because, if there are no doctors available at the district hospital, people have to go elsewhere, to the more expensive private hospitals. A study by the health ministry shows that the out of pocket expenditure in Bangladesh is 67% of the total health expenditure, which is the highest in South and South East Asia. A bigger budget and efficiently managed healthcare system is needed to ensure better healthcare for all.