Health reform commission suggests free primary healthcare for poor
Reza Mahmud :
The Health Sector Reform Commission has made several major recommendations, including providing free primary health services and medicines, introducing a referral system, and monitoring prescriptions to check for unnecessary tests and medications.
In its recommendations, the commission emphasised that 20per cent of insolvent patients get all treatment services free of cost at any hospital, and the authorities strictly monitor that 10per cent of beds at private hospitals are allocated for the poor, members of the commission told the media.
The commission will also propose that private hospitals have a structured salary system for doctors and healthcare staff and pay reasonable allowances to honorary doctors during their training period.
They recommended referral system should be implement from community hospitals to highest facilities.
The 12-member Health Sector Reform Commission, led by Professor Dr AK Azad Khan, president of Diabetic Association of Bangladesh, was formed on 17 November last year. Its deadline was extended until 30 April on 27 March.
Professor Dr. M. Muzaherul Huq, former Adviser of the World Health Organisation (WHO), a member of the commission, told The New Nation, “The commission have discussed with several stake holders of the health sector including different organisations seeking their advices over how to develop the health care system of Bangladesh.”
He said the commission hope the government will take the proposals positively and implement it by phase.
A member of the Health Sector Reform Commission, speaking to The New Nation on condition of anonymity, said the commission will recommend free medicines for primary healthcare, ensure hospitals stock all essential drugs, and make hospitalisation free. He added that while rural Bangladesh has primary healthcare infrastructure, urban areas fall short. To address this, the commission will propose building facilities in urban regions or partnering with the private sector to provide primary care.
Primary healthcare will be positioned as the core of health services at the union level, with each union staffed by two MBBS doctors, one midwife, one lab technician, a support staff, and a guard.
According to the World Health Organization, primary healthcare supports all aspects of health-from promotion to palliative care-delivered in a people-centred way.
A BBS survey conducted last month at the commission’s request found 91.1% of respondents support making primary healthcare a constitutional right. In response, the commission will recommend a constitutional provision obligating the government to ensure primary healthcare for all.
Other proposed reforms include expanding the essential drug list, forming a Bangladesh Health Service Commission for doctors like the Judicial Service, and creating management boards for private hospitals.
Experts believe decentralising primary care will reduce pressure on tertiary hospitals and establish a functional referral system.
Another member of the commission said general practitioners will handle primary care and refer patients as needed. MBBS doctors will receive three years of additional training while on the job.
In urban areas, primary care centres similar to family welfare centres will be set up based on population needs. The commission also proposes strengthening the civil surgeon’s office by appointing one more civil surgeon and two deputies.
Prescription oversight will fall under upazila health and family planning officers and civil surgeons.
The proposed Health Service Commission will be independently run by doctors-from secretary to DG-ensuring better governance and benefits. A member noted this will secure doctors’ jobs and improve incentives, including salary hikes for those in remote areas and researchers, which are currently not possible under existing rules.