In research I myself have recently conducted, I found that excellent medical services were being provided by the Combined Military Hospital in Dhaka during the ongoing Covid-19 pandemic. Doctors and nurses there were well-equipped and tried to provide very smart services to the patients. But most of the other health facilities were found to have full of flaws and loopholes in the delivery of services. Gonoshahthaya Nagar Hospital at Dhanmondi in Dhaka, visited during the study period, found that they were not well-equipped, and no highly qualified doctors and nurses were available, as complained by the patients and attendants. Moreover, outdoor patients were charged very high without health insurance. Serious allegations were made against them but there was nobody to take care of them in the true sense. In Bangabandhu Sheikh Mujib Medical University, a few young doctors were available during duty time and senior doctors come only for a while during their duty hours. A very cumbersome situation was observed at the Cumilla Medical College Hospital during the visit. Patients were getting annoyed but not getting any service. Out of three government medical college hospitals at Dhaka and one in Cumilla, one similarity was found that during the office/visiting time, most of the specialised doctors were not available. Maximum senior doctors were staying outside Cumilla town. In most of the cases, doctors’ oath and promise to provide treatment to the patients were violated though there are some exceptional cases. While talking to patients and their attendants, it was known that in some cases, lower-grade health workers pilfer medicine and food of the patients. In a private medical college hospital at Cumilla --Eastern Medical College and Hospital -- the situation was such that it was hard to believe it is a medical college hospital. They did not have full-time specialised doctors and nurses. However, some doctors and nurses argued that the unavailability of personal protective equipment (PPE) was the main reason for the flaws in service delivery while some others complained that patients did not try to cooperate with them. Some doctors at private hospitals, visited during the study, blamed the hospital authorities for the poor service condition saying that most of the owners only want to satisfy their pockets with high fees even during the pandemic. Some also said that due to inappropriate medical technological support systems, they could not deliver proper services despite having the intention to give. On weekly holidays, there were no doctors in most of the hospitals though duty should be assigned on a roster basis. Many patients interviewed during the pandemic said they prefer staying at home and dying peacefully rather than dying in hospital due to the unavailability of appropriate services, and the rough and tough attitude of the health professionals.
The study observed from the open-ended questionnaires that Bangladesh is not yet ready for modernisation of the healthcare facilities. It is increasingly evident during the pandemic of the country. Normal patients generally cannot trust doctors and health workers. Even telemedicine and satellite clinics are not properly functioning in the country. Most young doctors and nurses want their posting mainly in the capital city or divisional metropolitan areas or in any lucrative district towns as Bangladesh Civil service cadre members. Moreover, those who are doing jobs are not doing justice to the patients and attendants. Some patients do not trust young and middle-aged doctors. Education provided by private medical colleges, though accredited, is low-standard. No one is properly supervising their education. After graduating, doctors and nurses want to work in metropolitan cities and not in remote villages. If some of them join the government medical colleges or medical hospitals, which are situated outside the Dhaka city, then they want to get transferred to the capital or at least the port city of Chattogram as soon as possible. Corruption and nepotism is a prime loophole in the health sector. The Directorate General of Health Services office is indulging in corruption since the eighties. But the group has now become stronger by creating an oligopolistic market nature of ‘cartel’. The vicious circle could not be broken despite different several government initiatives. The health management system of the country has become inefficient, incapable and ineffective to deal with any health crisis before, during or after the pandemic. They purchase low-quality products at higher rates. A vested quarter of corrupt people, brokers, owners of low-quality hospitals, nursing homes, pathologists, lab technicians, doctors and health professionals are associated with offering ‘false treatment’, giving commission to doctors, billing, procurement, and issuing false reports of COVID-19 like using BCG matrix of cash cow flow. Excessive greediness of some vested quarters is making the situation worse. In the health sector, it is worse than the theory of the second-best.
Some respondents commented that extensive, mindless and illogical use of antibiotics to the patients by doctors was happening during treatment. Some respondents complained about the misuse of medical equipment by the authorities of hospitals. Some respondents, for example, informed that the ICU-equipped ambulance in Rajshahi Medical College Hospital was not used for more than two years. The researcher verified the complaint and found it true. Quite a large number of respondents, including even doctors and nurses, said the installation of medical devices and equipment at different places, especially in government hospitals, was not properly done. Some respondents claimed that they became ultra-poor from the middle-income group to get treatment either for themselves or their family members for the deadly disease COVID-19.
For the study conducted through open-ended questionnaires, the researcher asked questions to patients and their attendants at government hospitals. They all complained that the food quality is so poor that the patients cannot take it. They said that they were compelled to purchase food or bring it from home. When the matter was enquired with the superintendents of various government hospitals, they argued that the number of patients got very high due to the ongoing COVID-19 pandemic putting extra pressure on the food supply. But when the pandemic was receding half of the hospital beds were found empty. One of the hospital superintendents warned that if anyone writes against the ‘true picture’, he will lodge complaints under the Digital Security Act-2018. Even at a private medical college hospital -- Popular Medical College and Hospital -- at Dahanmondi-2 in the capital, it was observed that patients were bound to take low-quality food from the canteen. Moreover, nurses declined to give medicine directly to patients and/or to help them eat or use catheters. They rather referred the patients to the critical care units to use catheters which means extra earnings for the hospital owners. Another important point was found from the open-ended questionnaires that most of the government hospitals lack basic medicine which was supposed to be given free.
From the open-ended questionnaires, the researcher found that there are brokers and middlemen who lure patients to private medical hospitals from the government medical hospitals in exchange for commission. The respondents also commented that the cost of treatment of COVID-19 patients is abnormally high in the private sector and the Directorate General of Health Services failed to perform their duty to the people properly. However, most of the respondents argued that the government has long been struggling to ensure universal primary health services though a vested quarter created some obstacles to the government efforts. All observed that the anti-COVID-19 vaccine must be public goods as demanded by Bangladesh Prime Minister Sheikh Hasina in different forums.
The study found that even some up-market private medical hospitals have employed incompetent nurses who even cannot draw blood for which patients lodged complaints but to no avail. At Square Hospitals Limited in Dhaka’s Panthapath, the authorities have enforced three- to four-tier security measures, which are not found in any Southeast Asian countries like Thailand or neighboring India in JCI-accredited hospitals. This is actually a misdeed supported by the Directorate General of Health Services. Most of the respondents found that maximum public and private medical hospitals are beset by corruption and nepotism. Another important allegation by the patients and their families was that they needed to bribe hospital people, lobby, or use the power of high-ups to get a hospital bed even during the ongoing pandemic.
- Muhammad Mahboob Ali is a professor at Dhaka School of Economics, a constituent institution of the University of Dhaka, and an expert in the field of macro and financial economics, entrepreneurial management and ICT. He can be reached through the email -- firstname.lastname@example.org