Health of the nation

MORE or less everybody, from experts to policymakers, researchers to general service recipients, agree on one thing.

Despite all the problems, over the last two decades Bangladesh has made huge progress in the health service sector.

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The government health service structure has been expanded even to the most remote of rural areas. Average life expectancy has increased, and the death rates of children and mothers has been lowered.

Furthermore, vaccination programmes against many deadly diseases have achieved country-wide success, while the availability of pure water among rural people has increased significantly. The population growth rate over the last decade has decreased, yet at the same time health consciousness among the public has increased significantly.

The improvements can be seen in government and non-government sectors. Non-governmental organisations (NGOs) have played a key role at the grass-root level in the provision of health care.

One of the main concerns in Bangladesh is the health of pregnant women and new-born babies. Great progress has been made in ensuring that every infant is born safely and is healthy. Similarly, progress has also been made in ensuring that mothers receive adequate nutrition, security and nursing from pregnancy onwards.

Amzad Hossain Mollah is one of those who witnessed this remarkable improvement. For the last 19 years, he has been worked as a health programme organiser for an NGO in Rangpur.

"In the past, anaemia among pregnant women of the area was virulent," he says, "and the death rate among mothers and infants was very high.

"There was a lot of superstition among the people. Families would not properly feed pregnant women, fearing the baby would be a bigger size, which would make the delivery more difficult. Pregnant women were not allowed to eat mutton or lamb, because people thought this would result in a hairy baby."

But Mr Amzad says these erroneous ideas have significantly reduced now.

The severity of anaemia among pregnant women has been reduced dramatically, and they are no more prevented from eating healthy meals.

The health service of Bangladesh has long tentacles. It is well spread from upazilas to districts. Where there are gaps in the government's provision of health care, NGOs usually step in. Many are now involved in the registration of pregnant women, ensuring they are regularly checked-up in family welfare centres.

Evidence of this can be clearly seen at the Gorol Family Welfare Centre in Lalmonirhat district.

It is one of several of such centres which have been established in the Union Council level, where the number of doctors and beds available is also reported to have increased.

At the Gorol Centre, we saw many women come for check-ups. We spoke to two of them, Asma Begum and Namita Rani Roy. Both their first children were born at home, and there were no complications either during the delivery itself or in the care they received afterwards from qualified midwives.

Expensive private clinics
But it cannot be said that health-care in Bangladesh remains completely free of troubles. If someone needs to go to the hospital for a more complicated delivery, problems can arise.

Dr. Zafrullah Chowdhury, Projects Coordinator of the Gonoshasthaya Kendra NGO, says that in reality there are not enough doctors and nurses.

If any woman faces an abnormal delivery or if someone goes to the upazila-district level hospitals for a caesarean operation, he says, they invariably find that either there is no anaesthetist, or that he or she is not available at the time.

"Then patients have no option but to turn towards private clinics which are very expensive," he says.

Dr. Chowdhury says that there are still cases where pregnant women have to wait such a long time before being admitted to hospital that they die before they get there.

A visit to the Jamalganj Upazila Health Centre in Sunamganj district -- in north-eastern Bangladesh -- shows just how severe this lack of doctors and nurses is.

Although it is located in a haor area (surrounded by water for most of the year) it serves not just the people of Jamalganj. It is also the only closest hospital for people of the surrounding remote areas. The patient load is very high. There are supposed to be nine doctors but now there is only one, an over-worked Dr. Abul Kashem.

Going there in the morning, we found him extremely busy, treating at least 300 patients every day. Some come here on foot from 10-15 kilometres away. Those who are seriously ill come here by boat, rickshaw or are even carried by people on their shoulders.

Dr. Kashem says that the supply of medicine to this hospital is far less than required.

We saw the same picture in other parts of Bangladesh -- especially in Lalmonirhat and Kurigram districts in the north of Bangladesh. In each case, medicine supply is limited compared to the demand of the hospitals. Patients are required to buy many essential medicines from outside of the hospital. Although people are supposed to receive a free health service, in reality, this does not happen often.

Saju, the brother of heart patient Mohammad Ismail, came to Kaliganj Health Centre in Lalmonirhat complaining that not only did he have to buy medicine, he even had to buy syringes from outside of the hospital.

Dr. Khalid Ahmed Saifullah, resident doctor of the hospital said that they often have to tackle their patients' angst due to the lack of medicine.

"There is not a single ECG machine in the hospital. So it is not possible to diagnose heart patients properly," he says. "As a result, patients are often prescribed medicines on the basis of speculation, which might be harmful for them. But most of the times there are no other way out."

The worst situation can be observed at Union Health and Family Welfare Centres, which are often closed due to the lack of medicine. When we visited the Janjaigir Union Family Welfare Centre in Kurigram, we found it to be locked. Dwellers of the surrounding areas reported that there is no certainty when the Centre will open.

Vimkhali Union Welfare Centre of Sunamganj was also found to be under lock and key. The owner of a neighbouring shop, Kripesh Dutt, told the BBC that usually the centre is open but it is now closed indefinitely as there has been no supply of medicine for several days.

Health workers say that recently the government has increased the number of beds in the upazila and district level hospitals, but no additional doctors have been recruited.

Dr. Abdul Hakim, resident physician of Sunamganj district hospital, told me that his hospital was recently upgraded from 50 beds to 100 beds.

Human resources
He says that there should have been a corresponding increase in doctors -- from 19 to 39 -- but so far that has not yet happened.

Although there are doctors for caesarean operations, there are no anaesthetists. They are called form the nearby town of Sylhet, which is 50 km away.

In most cases, there is no other option left but to turn away pregnant women who need a caesarean operation. These patients are then forced to go to expensive private clinics.

Medics and health workers point out that many of these problems are due to a lack of human resources.

The Health Minister of Bangladesh, Dr Khandaker Mosharraf Hossain, the human resources question is the biggest challenge of the health sector.

In order to deliver effective health services, he says, it is necessary to recruit as many doctors and nurses as possible.

"Of course, if we are to do this, we require more investment in the health sector," he says, "but unfortunately we only have a limited budget for this."

Bangladesh Sanglap 5: "What are the ways to improve the health service?" will be broadcasted today (Thursday) at 8 pm after the BBC's Bengali programme 'Probaho', in shortwave metre band of 31 and 41 (at 9395 and 7520 KHz) and in Dhaka at FM 100 MHz.

The programme will be televised in Channel I television on Sunday at 8pm.
The Daily Star is the BBC's print media partner for this programme.