Of the many development programmes the incumbent government announced immediately after assuming power, taking healthcare to the doorsteps of the people is highly important. The allocation of Tk6.94 billion, almost double the previous year's allocation of Tk3.55 billion accounting for 7.4 per cent of the national budget marks a major policy shift. But it still falls far short of the World Health Organisation (WHO)-recommended allocation of at least 15 per cent of the national budget. The WHO also recommends expenditure of 5.0 per cent of Gross Domestic Product (GDP) on health to achieve universal health coverage and reduce out-of-pocket expenses for the people.
There is no guarantee, however, that allocation alone will bring about the delivery of health service. As Health Minister Sardar Md Shakhawat Hossain tells parliament that of the 41,806 posts at the upazila level, 9,407 are vacant. Equally disturbing is the fact that as many as 485 X-ray machines in 310 such health centres and 395 ultra-sound machines in 252 health complexes are now out of order. This is a clear sign of mismanagement of health administration. The National Electro-medical Equipment Maintenance Workshop and Training Centre is the only entity responsible for repairing the out-of-order machines. It takes up to six months to get a malfunctioned or inoperable machine repaired. Such a centralised system is to blame for the inordinate delay. Decentralisation of repairing function is the right option.
What it points to is a lethargic process out of sync with the emergency of healthcare so important for immediate response to critical and terminal medical cases. Allocation of fund is fine but more important is how it is used. In many cases, the fund is not even used for the purpose it was meant. Even modest investment can make the miracle happen if sincerity, seriousness and integrity of people involved in developing the infrastructure are there.
True, there is a dearth of not only the medical machines and equipment at the upazila health centres, but also a crisis of health workers who can help connect between ailing people at the grassroots level and the community health centres. This government has a plan to recruit 100,000 health workers to address the problem. Now public health experts, researchers and even some government officials suggest that the existing 10,000 trained paramedics can do the task successfully. They should be integrated into the system.
Indeed, the suggestion was made at a discussion organised by the Swisscontact Bangladesh's Astha Project in association with BRAC James P Grant School of Public Health at a city hotel. The participants suggested the obvious. Paramedics are an important link in the health chain of the developed countries. Once the distress call is made, a team of paramedics rushes to the scene and provide the primary live-saving care before hauling the patients to a hospital. They are familiar with the initial care system so important for survival of critical patients until they reach hospitals for specialised treatment.
The success of paramedics in this country, as a BRAC study found, is quite appreciable. Community paramedics have a success rate of 73 per cent in detecting foetal heartbeat compared with 36 per cent for general healthcare providers. In pregnancy and blood testing, their record is even higher at 81 per cent and 57 per cent compared with 46 per cent and 33 per cent for different other providers. If they are integrated with the healthcare system as envisioned by the government, the missing link will get restored. Healthcare can indeed be reached to the doorsteps of the people courtesy of their dedicated service. The aim is to go for a transformative strategy aimed at achieving universal health coverage. It beats barriers like patients' locations in remote areas, poverty and isolation.
This can be done by making arrangement for specialised transport facilities like well-furnished ambulance and air ambulance. The paramedics also need to be trained further to meet the demanding task. Their instant response to a health crisis can make a difference between life and death. Let a pool of trained and skilled paramedics be developed in the interest of universal health coverage in this country.
nilratanhalder2000@yahoo.com