Prologue:

Health as a term does not just mean absence of illness or disease. It means and includes physical & mental wellbeing. Therefore, health that considered as one of the basic human rights is very important from socio-economic view. Nevertheless, unfortunately the global population has been encountering a lot of threat & challenges to survive with good health. Rapid globalization, urbanization, chemical explosion, environmental pollution and natural disaster are some of the potential barriers towards maintaining good health and happiness. At the same time social inequalities, injustice, poverty, human violence and terrorism linked with social and economic development obviously increasing the burden of diseases and disabilities especially in the developing countries like Bangladesh. As a third world developing country consist of a high-density population, it is essential for us to have an effective & pro-people health policy. However, it is a disgraceful matter that still we are in a fiasco to ensure health facilities to every citizens of the country. Our constitution does not address it directly and adequately. Government also failed to make peoples’ health as one of their central concern of governance. As a result, a huge proportion of our total populations are devoid of health care facilities.

Conception of Health:

An understanding of health is the basis of all health care. Health is not perceived the same way by all members of a community including various professional groups (e.g. scientist, teachers, engineers, ecologists, health administrators, etc.) giving rise to confusion about the concept of health.

Health is a common theme in most cultures. In fact, all communities have their concepts of health, as part of their culture. Probably the oldest definition of health is the ‘absence of disease.’ Many culture consider health & harmony equivalent, define harmony as ‘being at peace with the self, the community, god and cosmos. The ancient Greeks & Indians shared this concept and attributed disease to disturbances in bodily equilibrium.

However, during the past few decades, there has been a reawakening that health is a fundamental human right and worldwide social goal. Health is not mainly an issue of doctors, social services and hospital rather it is an issue of social justice.

Definition of Health:

Health is one of those terms, which most people find difficult to define although they are confident of its meaning. Therefore, many definition of health have been offered from time to time. According to the Oxford English Dictionary, Health is soundness of body or mind or that condition in which its functions are duly and efficiently discharged. According to Webster, Health is the condition of being sound in body, mind or sprit, especially freedom from physical disease or pain.

The World Health Organization (WHO) in the preamble of its constitution gives the widely accepted definition of Health, which is as follows:

Health is a state of complete physical, mental & social well being and not merely an absence of disease or infirmity.

In recent years, this statement has been amplified to include the ability to lead a ‘socially and economically productive life.’ The WHO definition envisages three specific dimensions- the physical, the mental & the social. Nevertheless, during the past few years a new philosophy of health is acquired which may be stated as below:

 

• Health is a fundamental human right.

• Health is intersectoral.

• Health is an integral part of development.

• Health is central to the concept of quality of life.

• Health involves individuals, state & international responsibility.

• Health and its maintenance is a major social investment.

• Health is a worldwide social goal.

Right to Health:

Historically the right to health was one of the last to be proclaimed in the constitution of most countries of the world. At the international level, the Universal Declaration of human rights established a breakthrough in 1948, by stating in article 25. The preamble to the WHO constitution also affirms that it is one of the fundamental rights to every human being to enjoy the highest attainable standard of health. Some countries have used the term ‘right to health protection’ which is assured by a comprehensive system of social insurance that provides material security in cases of illness or accident and the right to be cared for by society in old age and invalidity.

In an increasing number of societies, health is no longer accepted as a charity or the privilege of the new, but demanded as the right for all. In most developing countries where resources are limited, the governments cannot provide all the needed health services. Under these circumstances, the aspirations of the people should be satisfied by giving them equal right to get available healthcare services. The responsibility for health does not end with the individual and community effort. In all civilized societies, the state assumes responsibility for the health and welfare of its citizens. Therefore, the constitution of Bangladesh should provide that health is a major public concern & state responsibility. Still in this aspect, we are at stake.

For some time our national commitment to an effective public health system has been on the wane. Many people are now opposed to the financing and provision of medical services and have recast healthcare more as a matter of consumer choice rather than a public right. Many too have taken a similar view about disease prevention, treating it more as a personal matter and not a public responsibility. The result is that, instead of the public health system we wanted, the present setup is ill funded, fragmented and unprepared for a nationally coordinated response to any health crisis. Physicians, hospitals, the pharmaceutical industry, insurance companies, and government agencies today dominate healthcare. Patients must navigate their healthcare by moving across a variety of providers.

Condition of Our Healthcare Services:

A female patient of age 28-named Amena Begum came to a Thana health complex hospital with a gynecological problem. Doctor wanted to see the infected site. Nevertheless, she disagreed to take treatment as the doctor was male & there were no female doctors. After 3 months, she admitted in the same hospitals with same disease when the case became more critical. This states the condition of our health sector.

Chart: health condition of Bangladesh at a glance

 

Topic                                                   Number

Government Hospital                                589

Registered Private Hospital                        2271

No. of Bed in Government Hospital           38171

No. of Bed in Private Hospital                   36244

Registered Doctor                                    49994

Registered Nurse                                      23729

Doctors in Government Services               12382

Nurses in Government Services                14377

Trained Midwives                                       5000

Total Population                                         143.9 million

Masses of people in Bangladesh face a perilous situation due to hazardous health conditions in the country, according to reports from health workers and the World Bank. The main source of these conditions is the poverty and backwardness maintained and deepened by capitalist rule. According to the survey of the government in April 2009, the total numbers of registered doctors are 49,994 & nurses 23,729. According to the health department of Bangladesh government, there are estimated one doctor for every 2860 people and one nurse for every 5720 people. According to the public health specialists, one doctor required 3 nurses and 5 assistants. The proportion is 1:3:5. But in Bangladesh the proportion is1: .54: .27. According to the WHO the estimation of doctor and nurse for every 10,000 people in South Asian countries are as follows:

 

Country               Doctor            Nurse

Bangladesh            3                      3

India                    6                      13

Srilanka                 6                      17

Pakistan                 8                      5

 

This summary states that our work force in health sector is very poor. According to the health department, 12,382 doctors and 14,377 nurses are working in government health sectors. They are serving in 589 government establishments including Thana Health Complex, District Hospital, Medical College Hospital, Specialized Hospital and Research Institute. The most pathetic information is that maximum portions of these 12,382 are serving in cities, metropolitan towns or areas alongside the towns. Therefore, the sceneries of rural areas are more formidable. In some areas there, only one doctor runs a total health complex or hospitals. He has to manage about 300-400 patients everyday. A report in Prothom Alo states that there is only one doctor in Sadullapur health complex of Gaibandha. There total posts for doctor are 20. But government appointed only five. Among them two went to deputation, one went to abroad for higher studies and the remaining one is busy with government duties. So there is only one doctor to look after the whole health complex.

According to health department, 6861 posts of doctor and 16707 posts of nurse & medical assistants are still empty. The reason behind this is most of the doctors are interested to practice privately. On the other hand, every year thousands of ill Bangladeshis go abroad in the hope of getting better; in spite of huge costs of travel, hospital care & surgery. This large-scale exodus of patients reflects the dismal condition of health care in Bangladesh. Wrong diagnosis & medical negligence are rampant even in the most prestigious hospitals. This has led to a deterioration of public trust in medical professionals. Many patients complain that doctors refuse to talk to them properly or explain what their ailment is or how they will be treated. Those who can afford it & those who manage to scrape up their savings or use whatever source of funding they have opt for going thousands of miles away where they believe they will get the proper treatment.

 

Governments’ Duties to Ensure Proper Healthcare:

Health is a fundamental human right. This implies that the state has a responsibility for the health of the people. In 1978, the Alma-Ata conference called on all governments to formulate national policies, strategies and plans of action to launch and sustain primary health care as part of national health system. As a result, national governments all over the world are striving to expand and improve their health care services. All over the world it is considered that health care is completely or largely a governmental function. So our government should be more responsible about this. As we are a third world developing country, our health care services must be based on two basic principles. They are as follows:

1. Accessibility and availability of basic health care services to all (irrespective of income, gender, religion, ethnicity and place of residence).

2. Prevention of diseases.

 

At the same time, our government should perform some more duties to ensure proper health care for its people. These are as follows:

• To ensure that right to health for the citizen must be addressed in our constitution properly.

• To increase opportunities to provide health care in a more collaborative and cooperative approach.

• To ensure most effective and affordable care for each and every individual of the country.

• To establish a system whereby medical practitioners are periodically reviewed.

• To establish greater awareness and public understanding regarding health care.

 

Peoples’ Demand:

The term health and family welfare services cover a wide spectrum of personal and community services for treatment of disease, prevention of illness and promotion of health. The purpose of health service is to improve the health status of population. Therefore, people should have certain demand on health care system. Peoples’ basic demands about health care system are as follows:

• Prevention should be the basis of our health policy.

• Health care services must be pro-people & consensus based.

• Health care services should be devoid of disparity between rural & urban areas.

• Health policy must contain effective program for reduction of mental illness and promotion of social health.

• Government must ensure medical equipments, transports, essential drugs, vaccines and other necessary logistics in every health complex.

• Health care services must be including schoolgoer children, pregnant women and heavy workers.

• Government should ensure learning of medical ethics & practical training for doctors, nurses, midwives, medical assistants and technicians.

 

Epilogue:

Raihana Begum, a garments worker went to Mitford Hospital for kidney problem. Doctors give her three tests. But all her savings finished doing one test. So she failed to do other tests and as a result deprived of proper treatment. It is due to increasing treatment fees 4times in government hospitals. Raihana informed that though treatment fees increased but the service is decreasing day by day. This represents that our doctors are not so much humane & responsible towards the patients and our health care services are inadequate. Our health administrators often deny the rights of the patients. But if we can provide an effective health care service according to peoples’ expectations only then we can assure proper health care & right to being well for every citizen of the country.

 

writer : student, Sher-E-Bangle Medical College.

fahim_ccc1095@yahoo.com

 

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