Catching criminals cannot be the job of a respected government minister — even if the scope of that work, as part of administrative responsibility, extends into the private sector. Given the sheer scale of the task, this is not an effective approach, nor is preventing crime the sole objective of any ministry. There are far more important matters that deserve a minister’s attention. Policymakers themselves have taken on the responsibility of improving healthcare for the very people who elected them. Their core task should be to build, update and strengthen a system that can automatically handle irregularities or rule violations. One way to achieve this is through a flawless framework for overseeing staff transparency, work quality and outcomes. At the same time, supervisors must be strictly warned that failure will not just draw a reprimand — it could cost them their jobs. Under this arrangement, the official at the top of this chain would be directly accountable to the minister. This accountability must apply to both the public and private sectors. The system must also ensure that lower-level supervisors are, in turn, accountable to their superiors. But while accountability is an important task, it is not the only one.
What catches people’s attention first
In hopes of improving both the quality and reach of health-sector services, the minister has been eager to catch wrongdoers. Undoubtedly, achieving these two goals is the expected work of this sector. But when taking punitive action against violators becomes the primary focus, missteps can occur. There have been instances where the ministry ultimately had to reverse its own decisions. In signaling its firm stance that no irregularities among healthcare providers would be tolerated, the ministry appeared to rush to handle an extremely complex situation without a full analysis of the broader picture. We commend the minister’s good intentions, but the health sector is an extremely complex, difficult and high-risk field. It is a vast and diverse sector encompassing countless issues, skill sets, ranks, equipment and technologies, as well as a wide range of mindsets, perspectives and personalities. The sector’s true impact often remains deeply hidden or unclear.
What the priorities in the health sector should be
People are not fully satisfied with the health services they receive and the complicated, difficult process of obtaining them. We must understand that not everyone who needs healthcare receives it, and even those who do often face delays. One reason for this lies in people’s own behavior when seeking healthcare — such as chasing after unqualified quack doctors and wasting time and money on ineffective treatment. As a result, providing services becomes complex, expensive and time-consuming for qualified, skilled doctors, which often leads to failures in saving lives. But the government also bears responsibility for this delay. The public’s ignorance is, in truth, a reflection of the government’s own shortcomings. Before the situation grows complicated and treatment becomes difficult, the government must devise a strategy to deliver timely healthcare to everyone who needs it. This strategy should have two dimensions: first, ensuring that information about patients who need care reaches healthcare providers in a timely manner, and second, ensuring that recipients are satisfied with the care they receive. These two issues concern the reach and the quality of services. Expanding the reach of services must depend on ensuring the desired quality; otherwise, people will turn away even if a service center or hospital remains open. If quality cannot be maintained, efforts to expand the reach of services will also fail. To make the expansion of services meaningful and visible, the Health Sector Reform Commission initially recommended conducting an upazila-based survey. Its purpose was to identify the health problems specific to each upazila’s population, which may differ from one another. In the next stage after the survey, the government must ensure the presence of an adequate number of appropriately skilled healthcare providers — that is, determine what type of provider is needed, in what numbers, and where, along with the process and conditions for their recruitment, placement and promotion. Healthcare providers must be equipped with the necessary supplies (such as medicine, equipment and other materials) and an adequate, suitable working environment (physical infrastructure). In addition, a sufficient operating budget must be ensured so that no disruption occurs under any circumstances. This budget should cover areas including cleanliness, security, supervision to ensure the desired quality of service, monitoring to review progress toward goals, and review and evaluation of the outcomes of various services, programs and activities. To ensure discipline in the health sector and the safety and management of service recipients, providers and institutions, and to ensure that people can receive treatment within the country rather than having to travel abroad, attention must also be given to establishing and managing centers of excellence hospitals and developing medical tourism. Other needs include an adequate number of beds of all kinds — including ICU and CCU — and service providers in hospitals, updating employment terms and reorganizing responsibilities, and reviewing procurement and purchasing policies, and
adopting effective methods based on this, and decisions related to decentralization of authority, among others, are also important.
Above all, however, there is a need for a strategy capable of preventing illness, controlling and limiting it at the outset, and rehabilitating patients. This strategy has two dimensions: first, raising public awareness about why illnesses occur and how to achieve the benefits of good health and nutrition. Second, detecting illness as soon as it appears and preventing its spread. This requires strengthening mass communication activities to raise public awareness, and strengthening the surveillance system for disease incidents to facilitate timely control measures. These two programs should be given the highest budgetary priority, since they offer the best possible returns. At the outset of formulating appropriate plans and an adequate budget, the ministry must apply sufficient time, experience, depth and wisdom. Weaknesses in planning and budgeting will later fail to meet public expectations, and no amount of heroic effort afterward to avert that failure will be of any use. The second priority should be formulating effective sector-based policies and strategies that take into account a cross-sectoral perspective — health in all sector policies. This requires a change in the framework for policymaking and decision-making. Responsibility for formulating these plans and strategies should be entrusted to those with deep knowledge of this sector and related sectors. We must accept the reality that this highly complex and technical sector cannot be left in the hands of people who lack the expertise to provide knowledge-based, experience-driven and technology-dependent decisions or solutions.
A major reform is needed to place clinical care and public health service management under separate authorities. Treating patients and preventing and controlling illness are two entirely different and, in some ways, opposing domains; separating the two is therefore essential.
Ensuring the quality and quantity of services requires an adequate number of medical and public-health education institutions across various provider categories, along with quality-assured operations at these institutions. Quality operations require a proper teacher-to-student ratio, an adequate number of qualified teachers, sufficient teaching materials, effective training and training manuals, and the accreditation and research capacity of training institutions. Teachers need to practice improved teaching methods and conduct so that they can instill the same qualities in students who will go on to work as doctors, nurses, paramedics and support staff. To this end, the Health Sector Reform Commission has recommended providing appropriate remuneration, rewards, compensation, allowances and bonuses to teachers, to discourage them from private practice, and to providers working in remote areas, to encourage them to remain there; however, it has also called for punitive measures against negligence in duties or abandonment of posts despite these benefits. A specific policy needs to be formulated to facilitate the implementation of this strategy.
The ministry must deeply understand the problems facing the health sector, such as unsuitable structures, duplication of activities, inefficiency and a lack of coordination among activities and programs. These activities and programs are, in many cases, scattered across various sectors or run in a disorganized, repetitive and inconsistent manner. As a result, delivering similar services through multiple agencies, offices and sectors is driving up costs unnecessarily.
To expand the reach and quality of services and ensure the satisfaction of service recipients, certain laws need to be amended and new legislation is required. These include: accreditation of hospital quality; proper pricing of medicines and the Drugs and Cosmetics Act 2023; the City Corporation/Municipality Act (2010); repealing the Community Clinic Health Assistance Trust Act 2018; introducing a universal primary healthcare law; introducing a healthcare financing law; amending and renewing the laws of various health-related councils; a law on the management and transparency of hospitals and diagnostic laboratories; the Bangladesh Medical Education Accreditation Act 2023; a law based on the Bangladesh Medical Research Council; and a health protection law
(which should more accurately be called a healthcare management and safety law). Specific regulations are also needed to govern and control sectors such as public and private hospitals, clinics, diagnostic centers, pharmacies, blood transfusion centers and ambulance services, alongside involving the private sector in these services where necessary.
The minister of the Ministry of Health and Family Welfare surely understands that irregularities cannot be curbed through law-and-order measures alone — not even if a police officer were assigned to every single citizen. We hope our esteemed readers understand why. If the minister focuses on making the entire system more efficient and effective, rather than spending time chasing wrongdoers, he will be able to solve these problems far more effectively; a strong, efficient system will not only automatically curb crime but also multiply the overall effectiveness of the entire sector, ultimately creating a “win-win” situation for everyone. Among the policies, strategies and plans the ministry will approve, some will concern law-based governance and oversight; others will require reform and the legal backing needed to make that reform permanent; and still others will involve program-based services, human resource development and management, documentation and report-based information, public participation in reviewing plans and performance, appropriate and adequate infrastructural design for healthcare centers, and medicine- and technology-based services. These tasks will require technical experts to formulate the relevant policies, plans, strategies, action plans and legal frameworks, which will ultimately be approved by the ministry and implemented by the executing branches of the Ministry of Health and Family Welfare. Drafting this will take at least six to eight months, and implementation will require at least two years — only then will the system begin running on its own momentum. Our experience shows that no government shows interest in implementing complex reforms, new strategies, plans or measures during the final two years of its term, even if those measures might seem unpleasant or uncomfortable to only a small number of people. But to live comfortably in a house, one must first furnish it thoroughly and skillfully — this cannot be done by hammering in a nail here and there.