Prof. Dr. M. Muzaherul Huq :
The health system of Bangladesh has four key factors in its structure and functioning. Though the government sector is huge, other sectors such as the non government and private sectors are increasing very fast, as are of their private investments. The non-government organisations, and donor agencies are also playing a significant role in health sectors as part of the health system. The government by contribution is solely responsible for policy, regulation, and provisions of health care services from primary to tertiary levels.
There is no proper coordination among all these stakeholders in managing healthcare establishments, in the country. Rather, duplication of more of our health care services.
Lessons learnt from Covid management
After more than one year of sufferings if we look back to analyse the management of Covid-19, we can give an example of Vietnam and other countries which have done better in managing Covid.
“Preparedness to deal infectious disease is a key ingredient for protecting people and securing public health in time of pandemics such as Covid-19”, as per a UN resident coordinator blog, Vietnam. When in Vietnam there were only 16 cases in a village close to Hanoi, a 3 week village-wide quarantine was employed affecting 11000 people. As a result there were no further cases for 3 weeks. It was followed by an imported case from UK. Vietnam closed its border and suspended flights from China at the same time. It was important to contain the virus transmission completely to safeguard the economy. It was followed by other international flight from UK, USA and other part of the world while requiring all travellers entering the country including Vietnamese for quarantine. While there was never a nationwide lockdown but the Prime Minister issued a 2 week nationwide physical distancing which was extended another week in major cities and hotspots. Both the army and local government were mobilised to provide testing, meals and amenities to all quarantine facilities free throughout the period. People were advised to stay at home, nonessential business were requested to close with limited public transport. The measures were grand success.
The people of Vietnam were exceptionally compliant with government directives as a result of trust built up by the ministry of health supported by WHO and other UN agency. Poor and vulnerable populations across the country were protected by a social protection package.
If we consider the success story of Vietnam as a similar economy, culture and socio-demographic condition who could fight Covid-19 without pitting economic growth, Bangladesh with similar socio economic condition could have achieved the same success with political will of the government.
But if we look at our country and management of Covid we find a nation with complete unpreparedness for the pandemic to prevent contamination, its detection and management.
We started with one laboratory with RT PCRs, test kits and at national level. Hospitals and doctors, nurses and other health and allied health workers were not prepared or readiness with required treatment and management.
The first wave was eventful with the wave take many lives mostly ageing population and with co morbidity.
The diagnostic facility was limited though slowly it reached to a few districts and eased the situation with some improvement with more designated hospitals fro Covid management. The 1st wave taught us the lessons like health awareness in Covid as well as early management and management in critical conditions. With a break we had the second wave.
The country was better prepared with more people abiding the health rules of putting musks, keeping distances and sanitising or washing their hands. Govt also restricted movements of people and tried to be strict to ensure health rules. Upazila, district hospitals were better equipped for early diagnosis and management.
It was observed during the second wave that early diagnosis and management saves more lives. The country was more prepared to address the diagnostic issue and early management, which saved many lives.
The government deserves appreciation that after a primary failure to procure vaccines it was successful to manage vaccine from other countries particularly from China and Gavi. Government also deserves credit that Bangladesh now has an agreement with China to produce vaccines in phases locally.
The shortcomings of management of Covid contamination and spread were the contact tracing, quarantine and isolation of patients and its early management. Hope there is no third wave.
But Bangladesh must be prepared for a 3rd wave till it is completely eradicated, which is yet to know when the world will be successful in eradication Covid from the world.
We need to fortify our Upazila health complexes with all preparedness for early diagnosis and management. District hospitals need to be well equipped with in built oxygen storage and supply, HDU and ICUs with Ventilators and properly trained nurses, Doctors and technologists as well as RT PCR labs.
We are to keep in mind that early diagnosis and managements are the keys in saving lives. Upazila hospitals must have early diagnosis facilities too to start early management. Rapid antigen and other diagnostic test facilities must be available in Upazilas.
Other important factors to be kept in mind are the involvement of people and their participation in the management of Covid.
With the present Covid situation below 2% deserve appreciation of the combined role of people and government in bringing down the death and infection rate among the population. But we are to be vigilant to maintain the trend while immunising our population.
We must achieve herd immunity as early as possible because the immunity is short lived and we might need a third dose as a booster.
In summary with the present situation of COVID, We need to strengthen our peripheral Upazilla health system and its referral system with national tertiary health establishments.
Primary responsibility of the government is decentralisation, establishing a functional district Health Authority or office of the civil surgeon with full functional autonomy. Further down, we must have a functionally strengthened Upazila Health System. These will help us to have a strong health system to serve our total population with uniform improved services available close to them to improve their health and nutrition status. A healthy nation is always a wealthy nation.
(Prof. Dr. M. Muzaherul Huq is former Regional Advisor, World Health Organisation).
