Bangladesh has been an outstanding example of healthcare achievements over the last few decades. However, these successes would have been more and more, if there were less corruptions and administrative mismanagement in health sector.
Recent Transparency International Bangladesh (TIB) report elucidate the extent of corruptions in Bangladesh healthcare system. The report focused on the bribes involved in appointment, transfer and promotion of doctors; disarray in private sectors specially in diagnostic centers and pharma companies; informal payments at the point of care and finally health workforce shortage in the rural areas.
Healthcare is a team work. It requires a team consists of doctors, nurses, pharmacists, lab technicians, ward-boy, cleaners etc. It is true that the doctors play the vital role in providing care to the patients, yet others’ roles are crucial. Usually, when we talk about the corruptions and low quality of care in public health sector, we only point our finger towards the doctors.
Are the doctors solely responsible for these chaos?
One of the major complaints against the doctors is they do not go and work in the rural areas where they are posted by the government. In my view, I also find the doctors guilty for these unauthorized duty-offs. However, we also should think why these doctors are not performing well. People mostly think they do it only for earning more money – which is not true for all cases. There are many other reasons behind this problem. For instance, the accommodation and security issues are most serious problems for the doctors posted in rural areas. The proportion of female doctors in our country is now 50% or more. They are suffering from these issues pretty bad. Moreover, discords from the local leaders and political pressure make it more difficult for the physicians to work in rural areas.
Informal payment has become a part and parcel of public health sector. An antecedent survey named “Corruption in Service Sectors: National Household Survey 2012” done by TIB figured out that 21% of households who received services from public hospital were victims of informal payment. The average money spent on informal payment was 258 BDT (approx. >3 USD) in 2012, said the report. People incurred these informal payments for having a faster services, for ambulance service, for trolley services and bandage & dressing services.
Interestingly, the doctors are not involved in any of these services. Mainly the 3rd & 4th class employees are responsible to provide these services. They have unions and these unions control everything! As a doctor, if you want to stop these nuisances, you will not be able to do so. They have political backup and lobbies and they are very much united when it comes to their rights and privileges.
Few years ago, when I was a medical student, there was a proposition of converting Dhaka Medical College as Dhaka Medical University. I am not going to discuss the pros & cons of this proposition; but we saw a strong opposition and protest from these people! It is because, in a university, the doctors and administrations would have more administrative power and they can regulate and take actions against these informal payments.
Again, as a doctor, if you raise your voice against these people, it is sure that you will get harassed by them. In many hospitals the nurses and other subordinates do not listen to the doctor in charge. Unfortunately, the media never talk about these issues. They are more interested in bullying doctors for all the corruptions in healthcare system.
There has been a tremendous mushrooming of private sector in healthcare in the last 2 decades. There are thousands of private clinics and diagnostic centers all over Bangladesh. Unfortunately, these private institutions are not regulated and monitored properly by the assigned authorities. So, the corruptions in this sector is rampant and explosive. The money-making-minded owners of these clinics and diagnostic centers do corruptions in every possible ways to increase their profit margins. They also put pressure on the doctors to give more investigations and prescribe more medicines. Of course there are some bad doctors, but others are doing it by pressure – it’s like a vicious cycle.
Finally, I want to say, if we really want to make positive changes in our healthcare system, then we should work together as a team; not blaming the doctors all the time. We also need administrative reforms and strategies to encourage more accountability from all cadres involved in healthcare service delivery and beyond. Implementing appropriate law enforcement and stopping political nepotism is mandatory for stopping corruptions in health sector.