High quality healthcare means the right care, at the right time, in the right place, and by the right care provider. Such healthcare minimises harm and resource waste and leaves no one behind.
Unfortunately, many countries around the world, Bangladesh included, fail to meet these requirements and struggle to provide healthcare services that deliver clinical value to patients, and meet the needs and preferences of patients.
Poor quality healthcare, thus, prevails in countries at all levels of economic development, manifesting every day in inaccurate diagnosis, medication errors, inappropriate or unnecessary treatment, and inadequate or unsafe clinical facilities or practices.
The implications are devastating for patients and their families. In low and middle-income countries, for example, 10 per cent of hospitalised patients can expect to acquire an infection during their stay, compared with seven per cent in high income countries.
In Bangladesh, nearly 6.4 million or four per cent of the country's people are getting poorer every year due to excessive costs of healthcare, according to a recent study conducted by the (icddr,b). These poor people became the worst victims of weak governance in the health sector.
The poor people cannot pay for healthcare services available in the private sector, while public healthcare facilities are meagre. With poor health, the country's workforce is unable to contribute to a dynamic economy. Mention may be made that health is crucial for any country's development.
Bangladesh has achieved many of the Millennium Development Goals (MDGs), but a stronger commitment is needed to achieve the Universal Health Coverage (UHC). The goal of the UHC, as declared by the World Health Organisation (WHO), is to ensure that all people obtain the health services they need without suffering financial hardship when paying for those.
Though Bangladesh has so far performed well in the health sector, achieving the UHC is still a far cry. Life expectancy in Bangladesh is now nearly 70, which is 65 both in India and Pakistan. Child death per 1,000 live births is 46 in Bangladesh, while it is 61 in India and 72 in Pakistan.
In Bangladesh, 64 per cent of the total health expenditure comes from people's pockets, while 26 per cent comes from public fund and 10 per cent from external funding by NGOs and development partners.
Inadequate and inefficient public healthcare and profiteering in the private healthcare sector are two major reasons behind such colossal private spending. People in the remote areas and urban slums are heavily deprived of healthcare. Addressing this issue should be given top priority.
Government officials and those in the corporate sector enjoy some sort of health coverage, while the poor segment of the population has very little access to healthcare. For that matter, the exiting existing public health facilities should be streamlined and made effective to achieve the UHC.
Bangladesh has so far done well in primary health coverage. But it might be difficult to attain similar success in the next phases as more deaths are being caused not by infectious diseases, but by non-communicable ones such as heart diseases and cancer now.
Achieving the UHC should be high on the government agenda as the issues of poor governance and resource constraints must be addressed immediately. The people are already spending a huge amount of money from their pockets for healthcare. But they are still not getting quality healthcare, and millions of them are getting poorer.
Improving access to care, especially for the poor, through UHC is not enough to achieve better health outcomes. Urgent action should be taken by the governments, clinicians, patients, civil society, and the private sector to help rapidly scale up quality healthcare services.
For that matter, the governments should develop national quality policies and strategies that address the foundations of quality health systems. Building quality health services requires a culture of transparency, engagement, and openness about the result.
While high quality healthcare for all may seem ambitious, it can be achieved in all settings with good leadership, robust planning, and intelligent investment. Of course, quality care requires some investment, but it is affordable, especially when the costs and consequences of poor quality are considered.
In other words, investment in quality health care contributes to growth in human capital and economic development. So striving for universal quality health coverage is not just an investment in better health - it is a commitment to building a healthier and more productive society.