Several factors are found responsible for an individual or a household becoming poor. Joblessness or lack of assets, immovable or otherwise, remains at the top of the list.
That high health expenditure could also be a leading reason behind the people falling into the poverty-trap does not occur to most people. But the truth is that the factor has been throwing a large number of people in abject poverty every year.
A person none other than the country's health secretary revealed the number of the high health expenditure victims at a function organised on the occasion of the Universal Health Coverage Day on Saturday in Dhaka. The health secretary said an estimated 5.0 million people are 'slipping' into the poverty line every year due to 'catastrophic' out-of-pocket health expenditure.
Thus, the trend mentioned by the high government official has been negating the government efforts to reduce the rate of poverty in the country.
Unfortunately, the government has not been doing enough to create a situation where the poor and low-income people are not required to spend much from their own pockets on meeting their health needs.
Unless the situation improves in the public health sector, the number of people becoming poor due to high out-of-pocket (OOP) expenditure on health would go on rising every year.
Most of the OOP expenditure is made on non-communicable diseases or NCDs. The number of people afflicted with NCDs has been rising without a pause every year.
The middle class and the affluent section of people seek treatment in private health facilities which, expensive as they are, remain beyond the reach of the poor and low-income people.
The latter is left with no option other than crowding the premises of government hospitals and clinics. However, before reaching these facilities they usually spend some money on private doctors and medicines.
Getting access to the government hospitals that treat patients suffering from NCDs has never been easy, particularly for people living in places outside Dhaka. The capital city accommodates most specialised health facilities, both private and public.
The government medical college hospitals and Sadar hospitals located in district headquarters, in most cases, have limited facilities and manpower to treat patients suffering from NCDs. That is why patients across the country rush to Dhaka to have access to the specialised hospitals that, too, do not have the logistics and manpower to take in all the patients. Thus, the onrush of patients and the hospitals' failure to treat them have given rise to a pitiable sight.
A visit to any of the public-sector specialised hospitals and the major medical college hospitals in Dhaka would show how difficult the situation is. Hundreds of patients will be found lying on the floor for non-availability of seats. Many more remain in the queue even to get a place on the floor.
Though health officials claim otherwise, the patients in these hospitals are required to buy most medicines from their own pockets.
The NCDs, usually, require treatment for a longer period. That takes an economic toll on patients and their families. Many patients failing to meet medical expenses do often suffer and, at one stage, die without treatment. Many families, after exhausting all their resources, borrow money from friends and relatives to meet the medical expenses of their ailing members. Only the families caught in such a situation do know how painful the experience is.
While speaking as the chief guest at the event organised to observe the Universal Health Coverage Day, the health minister himself highlighted the shortcomings of the country's health sector. He said, in addition to having enough medical equipment and other facilities, the health sector needs enough qualified manpower and resources to ensure universal health coverage.
In this context, he referred to the shortage of manpower. According to the minister, the country has 90, 000 doctors, including 60,000 in the private health facilities, and 100,000 nurses against the requirement of 0.2 million doctors and 0.6 million nurses.
Similarly, the health budget has always been inadequate as against the requirement. The per capita health expenditure in Bangladesh is as low as $50 while the same is between $10,000 and $12000 in Europe. Even the neighbouring countries do spend more on health.
In a situation where the state spends a paltry amount on health, the people are left with no other alternative but to spend more from the pocket to meet their health expenses. Thus, the out-of-pocket expenditure on health remains as high as 67 per cent in Bangladesh. The estimate being an average one, it does include the expenditures made by all sections of the population, including the middle-class and the rich. The fact remains that the poor and lower and middle classes cannot afford such high out-of-pocket expenditure and suffer.
The issue of inadequate allocation for health has always been discussed in the media and relevant other forums. But that did not help much. During the ongoing Covid-19 pandemic, the subject has got far greater attention. Yet the budget for the current financial year has failed to accommodate such a concern, in terms of resource allocation. Then again, there are mismanagement and financial irregularities in the health sector.
The government is spending a substantial sum on mega projects. The implementation of such projects is necessary for the greater interest of the nation, no doubt. But is it not an equally important job for the policymakers to address the health issues confronting the people?