Pre-Covid Healthcare Sector of Bangladesh: Is It Ready To Deal With The Pandemic?

Be it for developed countries like the United States or for middle income countries like Bangladesh, the Covid-19 pandemic has been showing the glaring deficiencies of the Healthcare Sectors around the world. This article tries to analyze if the Bangladeshi healthcare sector is capable in such trying times. 

The Healthcare Sector: Where it Stands Now?

Bangladesh has ranked 113 out of 195 countries in the recent Global Health Index of 2019.^[1] However, the majority of the countries below Bangladesh belong to the under-developed category. Most of the regional contemporaries are doing significantly better than Bangladesh.

Country	Rank
Thailand	6
Malaysia	18
Vietnam	50
Philippines	53
India	57
Pakistan	105
Bangladesh	113
Sri Lanka	120

The Achievements

Historically, the Bangladesh Healthcare sector has concentrated more on reducing preventable diseases. Bangladesh has achieved great success in its Expanded Programme on Immunization’ (EPI) programme which is to ensure the vaccines of six preventable diseases namely. tuberculosis, polio, diphtheria, whooping cough, tetanus and measles.(2) According to WHO, vaccine penetration has reached more than 90% of the population by 2018. Moreover, a number of new vaccines like HepB, Hib, rubella, PCV, IPV have also been introduced.(3)

Challenges of Dealing With The Pandemic

There are a number of challenges which might prevent the healthcare sector from dealing with a widespread outbreak of the Covid-19. This article tried to identify them.  

Insufficient Healthcare Providers And Facilities

The population of 160 million is a huge barrier to ensuring proper healthcare services to the entire demography. Despite the WHO minimum requirement of having 10 Physicians per 10,000 people, Bangladesh has a little over 5. Bangladesh is lagging behind its regional contemporaries in this case as well.(5) The numbers of registered nurses per 10,000 is only 2.99, which is similarly worrying.(4) 

This number is especially worrying in the Covid-19 scenario since, in case of an outbreak, there is a possibility of the virus spreading to the healthcare professionals as well. If that happens, it will deplete the already low number of healthcare professionals Bangladesh has.

The scenario is similar for healthcare facilities in general. As of March 24th, 2020, Bangladesh has prepared only 29 ICUs for battling Covid-19.(6) Moreover, despite the international standard requiring 5 ICU beds in a hospital with 100 beds, Bangladesh has only 1,169 ICU beds in the entire country.(7)  

Moreover, the bed occupancy in the government hospitals even before the pandemic hit does not paint a very encouraging picture. 

This indicates that the Public Hospitals of Bangladesh had insufficient beds even before the pandemic had hit. 

Healthcare Services Are Concentrated in The Capital

The indicators showing low healthcare providers paint only half the picture. The discrepancy between the healthcare facilities between the capital and the other regions is vast. For example, despite a national average of 5.268, there are 30.76 doctors for every 10,000 people in Dhaka. The graph below illustrates the gaping difference between different districts.

A similar picture can be drawn from the difference between the differences between the number of hospital beds in government primary, secondary and tertiary medical facilities.

Figure: Number of Hospital Beds in Public Healthcare Services in Bangladesh / Source: Directorate General of Health Services (DGHS) 

Thus, a spread of the pandemic might require transporting patients from all over the country to the capital city. Since Dhaka is already very densely populated, this might end up contributing to even higher spreading of the disease.

Expenditure Behind Healthcare Is Still Very Low

Despite commendable economic improvements, Bangladeshi population still can afford to spend very little on healthcare. As the graph shows, Bangladesh spends the least compared to its regional contemporaries.

This is an important indicator because it shows that in case of the pandemic, a large portion of the population shall be dependent on public healthcare for treatment. If the public healthcare is unable to meet the demands, the government might have to subsidize private hospitals to ensure less expensive treatment for the lower income groups. Moreover, the government shall also have to look for lower priced testing kits to increase testing. 

Winning Against Covid-19 By Flattening The Curve

On March 31st, 2020, the government has announced that the testing of Covid-19 shall be done in 28 facilities in both the capital and outside.(8) Moreover, the private sector has been coming forward to boost the current healthcare service sector to deal with the pandemic. These include the construction of a hospital dedicated to Covid-19 by Akij Group, the announcement of manufacturing of ventilators by Walton, the invention of a new testing kit by Gano Shasthaya Kendra etc.

However, it has been seen globally that even countries like Italy and USA, which have much more developed healthcare sectors than Bangladesh are being unable to treat the increasing number of patients. On the other hand, countries which have managed to stop transmission have been able to stop themselves from being devastated by the virus. Bangladesh should also follow them and the shutdown given by the government till 11th April has been a commendable step towards that goal. Despite the economic slowdown that it might lead to, the lockdown is the best solution to stop the virus from getting out of hand.

Kidwa Arif, Trainee Consultant at LightCastle Partners, has prepared the write-up. For further clarifications, contact here: [email protected]