The Struggle of the People of Bangladesh for Affordable Medicine

Crowds of distressed paupers baked under the sweltering Bangladeshi sun, clamoring to get into a run-down building. Impoverished mothers clutched their shrieking children, defeated. Naked babies roamed around, looking for relief. While this scene may seem like a catastrophic incident of human suffering, it is actually a quotidian experience of a Bangladeshi native’s struggle to obtain accessible healthcare on a daily basis from a dilapidated clinic. This is only indicative of the need for systematic transformation of its healthcare from the ground up, as well as a remediation of major national issues. For throngs of people, this was a faint glimmer of hope in an otherwise dismal reality. Impoverished masses trek from all over the nation to free clinics when word of its temporary pop-up nature spreads to the people.

Being an American-born with Bangladeshi heritage myself, I have heard anecdotes referring to those within the medical profession taking advantage of the vulnerable due to the lack of regulation. Some doctors tell patients that they wouldn’t be able to perform the operation without bribes, and some even require patients to purchase their own medical equipment! The reason why so many of these cases go unreported is that these doctors often target the poor and vulnerable who have no power or knowledge of how to hold these medical “professionals” accountable. The corruption only begins in this most basic level. Misappropriation of public funds by government officials has robbed the Bangladeshi people of a humane lifestyle. Understanding how corruption seeps from every branch of Bangladesh’s government, especially the Ministry of Health and Family Warfare, to the players within the healthcare system themselves will allow us to address how to remediate national issues with concrete plans that wholly benefit Bangladeshi society.

The fundamental issue within Bangladesh’s ineffectual healthcare system lies primarily in its overcentralization of resources, and those who live in rural villages experience an imbalance in the quality and access to healthcare. This methodology clearly reflects the social inequality that stems from an inherent catering towards the elite. This lack of universal healthcare access is particularly dangerous for the poor, and life-threatening for those with serious illnesses. As Mostert et. al. puts it, when there is “inadequate access to medical care and medicines for poor cancer patients results in abandonment of treatment and low survival rates”. There is a direct link between overcentralization which leads to ineffectual healthcare infrastructure with limited access to all citizens, and as a result, the lives of the poor are at stake. Even among the few functioning public hospitals, accessing healthcare is no easy task.

The government claims that it provides healthcare free of charge at the primary, secondary, and tertiary levels. Despite this, it is alleged that health professionals throughout Bangladesh take bribes for services that should be paid by the government. In fact, “40.2 percent of surveyed people fell victim to various irregularities and corruption in receiving services in public hospitals, compared to 33.2 percent in 2010” (Ahmed et.al. 20). Not only is there rampant corruption within the federal ministry level, the various health professional within the healthcare system are reaping profit at the expense of the poor due to a weak regulatory structure.

Bangladesh is one of the most densely populated countries in the world, so universal healthcare is no easy task. The healthcare system is split into 4 sectors: government, non-governmental agencies, donor organizations, and private. This system faces many challenges. For instance, health systems are too centralized in the main cities of Bangladesh, despite most of the population living elsewhere. There is also little to no regulation of healthcare services, especially in the private sector, due to the ineffectual government. Most of the credit for this dysfunctional healthcare system goes to the Ministry of Health and Family Welfare, which has limited institutional capabilities and poor management.

Bangladesh suffers from a severe shortage and unequal distribution of healthcare workers due to incompetence and corruption in this ministry. The lack of coordination between ministries has also obstructed the implementation of primary healthcare in rural areas. As a result, this leads to the deterioration of medical equipment and facilities. The ministry has delayed processes for training enough skilled healthcare providers in the public sector, leaving many to turn to unofficial healthcare providers that utilize alternative care. The government also demonstrates a lack of concern by the low allocation of funds to the budget. When evaluating national quality-of-care, problems fall into either one of two buckets: undertreatment and overtreatment. When patients are undertreated, they are deprived of essential care or receive delayed treatment.

Overtreatment is when unnecessary, inappropriate, or ineffective treatment is provided in the form of diagnostic tests, procedures, and medication. Both of these issues inhibit Bangladesh from achieving universal health coverage with problems ranging from, “inappropriate prescription of medicines by drug retailers and village doctors, to low levels of patient satisfaction during interactions with providers, and provider complaints of lack of staff and supplies, lack of training and supervision, and large volumes of patients constraining quality”(Hort et. al 4). The need for a structured system that will keep medical professionals accountable in the primary, secondary, and tertiary levels is overwhelming, for Bangladesh’s lack of infrastructure only adds to the problem of overall national health. One of the basic determinants of health is indicated in access to clean water and sanitation. Bangladesh lacks both. The nation is dealing with the largest level of mass poisoning of a population in history.

The groundwater that is used for drinking has largely been contaminated by inorganic arsenic; in fact, “….of the 125 million inhabitants…between 35 million and 77 million are at risk of drinking contaminated water”(1093 Smith et. al.). This describes the large scale nature of contamination in the water supply, in that around half of the population is drinking water that will only foster and exacerbate health issues. Moreover, this statistic depicts a divide between those who have access to clean water and those who don’t. Resources and capital are too concentrated in urban areas, where the majority of wealthy Bangladeshis reside. Even with international funding from UNICEF that built tube-wells in rural villages, “…about 62% of the 32,651 tube-wells sampled” (1095 Smith et. al.) possessed dangerous levels of arsenic.

The connection between contaminated water and health issues is evident historically with, “surface water sources in Bangladesh…contaminated with microorganisms, causing a significant burden of disease and mortality. Infants and children suffered from acute gastrointestinal disease resulting from bacterial contamination of stagnant pond water” (1093 Smith et.al.). In other words, generational health issues result from the pollution of surface water sources in rural villages. If resources were to be sufficiently appropriated throughout the nation instead of being concentrated primarily in urban areas, clean water technology could lighten the burden of mortality.

Bangladesh’s health care system is clearly under great duress and faces numerous intractable issues; despite this, the government allocated a measly 3.4% expenditure of its gross domestic product on health services (Ali et. al. 130). Evidently, the first step to developing a properly functioning healthcare system is to force the government to recognize healthcare as a greater priority. The fact of the matter remains—if the government only cares about its citizens enough to allocate 3 cents of every dollar to their well-being, where is the rest of the money going? In order to achieve universal coverage, it is becoming more and more evident that investment from the private sector is necessary to facilitate the development of a functioning healthcare system. The government is not doing enough to provide supplies or trained professionals in many parts of Bangladesh. Rural areas are hit the hardest with, ”absenteeism rates…over 60 percent…living outside the service village, being female and poor road access increased the likelihood of absenteeism among physicians” (Lewis 17). Groups that have been traditionally oppressed since Bangladesh’s conception continue to face daily struggles that inhibit their ability to survive.

The inadequacy of Bangladesh’s healthcare extends beyond the system itself to negligence in national issues issues that contribute to declining public health. In, “Contamination of Drinking-water by Arsenic in Bangladesh: a Public Health Emergency,” Smith et. al. elaborate on public health emergencies, such as contaminated water supplies and its effects on the population, but don’t clarify why these large-scale disasters continue to exacerbate health issues. The slow recovery is, in part, due to corruption within the government. In, “Governance and Corruption in Public Healthcare Systems,” Lewis focuses on the main challenges which are corruption and mismanagement that hinder healthcare delivery in developing countries.

Although Smith et. al. agree that a rapid allocation of resources is necessary to facilitate prompt interventions, they fail to recognize government negligence and simply blame stagnation on a “weak economy” (Smith et. al. 1096-1097). In fact, health is Bangladesh’s second most corrupt sector (Lewis 14). This leads many of the citizens to pay most of their own healthcare needs in which out-of-pocket expenditure was 61% in 2011. (Ali et. al. 131). This means that the already destitute people of Bangladesh need to give up more than half of their hard-earned taka(money) on health services, when the government should be allocating more money to the public health sector in order to service the underserved and marginalized populations. In its current state, the Bangladeshi government is not equipped to better the healthcare system on its own in the public sector.

The best way to facilitate rapid expansion in healthcare is investment from public and private sources. Subrahmanyam states, “governments have human resources and material but lack participatory approaches. NGOs(non-government agencies) and self help groups, conversely, are known for their flexibility, ability to reach the poor and to empower marginal groups, challenging gender-stereotypes, while advocating and implementing participatory development.” The government may have the resources, but they can’t access the rural areas the same way NGOs can, mainly due to gross corruption and mismanagement. If the government worked in conjunction with these organizations, Bangladesh can witness monumental impact.

In fact, the effects can be seen already. Structure is definitely needed in Bangladesh, where healthcare operates like the wild west with doctors selling out their services without restriction or regulation. Already, the country has, “a growing private sector primarily providing tertiary level health care services…Bangladesh still does not have a comprehensive health policy to strengthen the entire system”(Islam et. al. 366). The preliminary effects of the privatization of healthcare are only present on the tertiary level, which is medical school hospitals. Again, these healthcare facilities are only present in wealthy urban centers. If the private sector branched out and targeted a systemic, national takeover of healthcare, greater masses of people would be able to access basic services.