The government has initiated health reform efforts, prompting various proposals and analyses from different sectors. Multiple committees have been formed and dissolved, indicating diverse perspectives on the approach to health reform. Nonetheless, the ongoing discussions at various levels are encouraging.
Advancing even a single step towards health reform would pay tribute to the martyrs of July-August 2024.
The critical question is: where do we begin? Addressing the longstanding issues in the health sector could start by ensuring that healthcare services reach every individual at the grassroots level. This endeavour requires the government to possess the political will to implement necessary actions, overcoming any obstacles that may arise.
Achieving national consensus is essential in this regard. All stakeholders must clearly define and agree upon the scope of healthcare services. Healthcare should encompass more than just medical treatment and medication; it should include initiatives aimed at maintaining public health and preventing diseases.
Preventing illness is the core objective of healthcare services. In cases where illness occurs, prompt access to healthcare professionals is crucial, as delays can exacerbate problems. Therefore, accessible primary health centres offering emergency services are necessary.
It's important to distinguish between patient treatment and public health maintenance. Patient treatment is hospital-centric, focusing on individual care. In contrast, maintaining public health involves community-based initiatives, such as ensuring safe drinking water, providing playgrounds for children, and maintaining clean environments to prevent diseases like dengue.
A robust, community-based primary healthcare system can serve as the foundation for addressing our health challenges. Globally, primary healthcare is recognised as the cornerstone of effective health systems. However, in our country, it remains inadequate and neglected, leading to overcrowding in tertiary and specialised healthcare facilities.
Each union (and each ward in urban areas) should have at least one comprehensive primary health centre. This requires coordination between the health and family welfare departments, integrating union health centres and family welfare centres with community clinics. These centres should offer not only healthcare services but also basic diagnostic facilities.
The Government of Bangladesh has pledged to the United Nations to achieve Universal Health Coverage (UHC) by 2030. This goal is attainable if primary and emergency healthcare services are provided nationwide through community clinic-style primary health centres, equipped with necessary personnel and resources.
While many rural areas have community clinics and union health sub-centres, urban regions lack such primary health centres. Occasionally, NGOs offer limited maternal and child health-nutrition services at the ward level in cities. There is an urgent need to develop primary and secondary healthcare infrastructure in urban areas.
To implement UHC, community clinics and union health centres must be reinforced with doctors, public health professionals, nurses, medical technologists, and field-level health workers. These centres should provide not only diagnostic and treatment services but also preventive and health promotion activities. They should refer complex cases to secondary or tertiary healthcare facilities as needed.
In metropolitan areas, primary healthcare is often sought at outpatient departments of major medical colleges, which also offer secondary services. Due to the lack of alternative options, patients have no choice but to visit these facilities, leading to overcrowding and compromised quality of care.
Upazila Health Complexes should be developed as primary and emergency healthcare hubs, serving as the focal point for both urban and rural healthcare services. Strengthening local health authorities (Upazila Health Officers) is crucial, with expanded autonomy in funding, staffing, and procurement. Additionally, skilled personnel should be appointed for financial management, IT, and information management at these complexes.
Primary care physicians should receive postgraduate training and degrees to be recognised as specialists. Similar to secondary and tertiary hospitals, primary healthcare centres should have specialist doctors supervising medical graduates. Nurses, midwives, medical technologists, and field health workers should also have access to advanced training, with continuous professional development opportunities for all health personnel.
Patient health information should be stored, analysed, and utilised through digital means. An effective e-health system would significantly enhance the efficiency of healthcare services at the grassroots level, facilitating immediate information exchange among primary, secondary, and tertiary healthcare institutions.
Developing the necessary infrastructure and allocating sufficient resources are imperative. Health sector funding should be viewed not merely as an expense but as an investment in building a healthy nation. Preventive health measures and health promotion activities contribute to national well-being and alleviate the financial burden of treating long-term and complex diseases.
Research has shown that spending on public health and primary care significantly boosts national income. At least 70% of our health budget should be allocated to establishing and operating primary and emergency health centres, starting with the upcoming budget or through special allocations beforehand.
Primary healthcare is recognised as the backbone of any country's health system. It plays a crucial role in ensuring affordable, sustainable, and equitable healthcare. As part of health system reforms, enhancing primary healthcare can provide accessible, affordable, and quality health services for all.
Mushtaq Hossain, Public Health Specialist, Part-time Lecturer, Public Health and Informatics, Jahangirnagar University
BDST: 1303 HRS, JAN 13, 2025
