Hospital industry in Bangadesh

Bangladesh, a least developed country, with an infant mortality rate of 6.5 per cent, 75 per cent child birth without trained attendant, 90 per cent children with some malnutrition, prevalence of hypertension among 12 per cent of its population has posed a major challenge to arrange medical treatment for them at affordable cost. There is only one hospital bed for 3151 people, one doctor for 4572 and one nurse for 8460 -- is one of the lowest ratios in the world. Per capita government expenditure is only 26 dollars whereas a country like Maldives spends 220 dollars per citizen a year.

Existing private hospitals/clinics with morethan 25 beds in Dhaka City
In spite of the efforts of the government to finance and provide essential services, only 30% of the health expenditure is met from the public sector. Other sources are: traditional and homeopathic, private modern unqualified, private modern qualified clinical, private diagnostic, NGOs and non-profit qualified and unqualified pharmacists.

The healthcare scenario is evident from a recent survey on service delivery under the Health and Population Sector Programme financed by CIDA, which reveals "People are increasingly turning to unqualified practitioners instead of government and private doctors for treatment, making a drift away from government health services over the last five years." It also reveals "unqualified practitioners are the major providers of curative health care. As many as 60 percent of health service users preferred unqualified medical practitioners, 27 percent used private medical practitioners and only 13 percent turned to government health services."

There were improvements in the health status of the population over the last decade. Infant mortality rate has declined from 94 to 67 per thousand. Population growth rate has slowed down from 3 per cent in the 1970s to 1.5 per cent in the late 1990s. Total fertility rate is now 3.3 per cent compared to 6.0 per cent in the 1970s.

But fever/pyrexia, dyspepsia/gastric/peptic ulcer, diarrhea, dysentery, common cold/respiratory infection, malaria, rheumatic fever, high blood pressure, and influenza are still the leading causes of morbidity in Bangladesh.

In Bangladesh, the ongoing challenge of world's highest death rate from road accidents, prevalence of diabetes and highest death rate of women during child birth can only be treated properly by introduction of modern medical treatment facilities through establishment of more modern hospitals at government and private level.

Current situation with respect to access to health care is far from satisfactory. It is often assumed that the lack of resources, both public and private is the main reason. The available hospitals and clinics cannot also assure modern treatment to the intending patients. The result is that the hospitals in Kolkata have long queues of patients from Bangladesh. Bangladeshi patients for treatment abroad spend an estimated foreign exchange equivalent of 3000 crore per year.

US$17 billion Indian health care industry comprises roughly 4 percent of the country's GDP. With an estimated global revenue of $2.8 trillion, health care is the world's largest industry. In India it was only possible due to liberalisation from the 50-year yoke of command economy. In Bangladesh also it is possible that health industry will work as driving force to boost national economy. Bangladeshi doctors are mostly meritorious and it will not take much time to reach to world standard provided they get chance of working with world-class specialists and equipment.

In this backdrop it is a good sign that in the last decade private entrepreneurs have come up with health care provision within the country. Recently STS Holdings Limited has established 450-bed world class Apollo Hospital on 12 bighas land in the Bashundhara residentilal area of Dhaka City. In order to blend global expertise with the local physicians the hospital will have local doctors and foreign consultants. Facilities like advanced cardiology, cardiac surgery, neurology, neuro-surgery, urology, uro-surgery, endocrinology, gastroenterology, critical care, orthopedics, and other secondary cares exist.

In the recent past it has been observed that Lab Aid and Sikder Medical College Hospital started providing modern cardiac care services to the patients and by now has gained reputation. Now with the advent of world class Apollo Hospital it is expected that more Bangladeshi patients will tend to have treatment here at less expense avoiding botheration of going abroad. The next intention of the investors to establish nursing college, medical college and world class hospitals in Sylhet, Chittagong and Bogra will only augment the present efforts of providing cheap but first class treatment to the patients of Bangladesh. The government through facilitation to make the path of investment easier should properly value this.

Open-heart surgery costs around $34,000 to $70,000 in the UK. In the US, cost of routine open-heart surgery runs as high as $150,000. Whereas in India, open-heart surgery costs $3,000 to $10,000 in the best of hospitals. The expenditure is expected to be lower in Bangladesh also. This cost difference is going to be a decisive factor in the marketing of health care industry. In future, effective marketing could even divert patients from other regions who are going to the US or UK for treatment to Bangladesh. The advent of world class hospital will also provide opportunity for the Bangladeshi doctors to work with the specialised doctors which in due course will enable the hospitals to run depending absolutely on Bangladeshi doctors.

They will also provide free treatment through free bed (Apollo 10%) to the poor patients. But to ensure such treatment for greater number of people of the country will require continuous efforts of both government and private entrepreneurs.

Only a decade ago India was roughly 50 years behind the US in this field. But over the last 10 to 15 years this gap has closed fast, with high-tech super-specialty hospitals coming up all over the country. Most Indian private hospitals are trying to improve quality by employing qualified manpower with better salary structure, training and arranging for continuing better education for their doctors. It is likely that Indian health care will be close to global standard in the coming years. For Bangladesh also the day seems not too far if the present trend of growth of private health care industry continues.

The government alone cannot meet the challenge of ensuring modern medical treatment for such a vast population as ours. In this case facilitation for establishment of private international standard hospital requires government patronisation in the shape of tax-free import of equipment, allowing foreign doctors to join to fill up vacancies in the places of non-availability of local doctors specialists and by providing land at a lower price. Government attitude of privatisation and liberalisation of health industry will work as a key for resurgence of the health sector in Bangladesh.

Government is responsible for enactment and enforcement of laws. Hence it is the duty of the government to play a pivotal role to pave the way for creating an enabling atmosphere to encourage domestic and foreign investment to strengthen growing hospital industry in Bangladesh. Such step will only augment the government efforts in discharging its constitutional obligation of providing healthcare for all. The declaration of the government to allow tax free import of medical equipment for the referral hospitals are yet to be materialised. On the other hand, provision of obtaining permission /no objection from more than 24 different departments causes delay and monetary wastage for the investors. The procedure needs to be simplified. If the government plays positive role for flourishing the health care industry, the day will not be far away when it will pose itself as a major driver for economic development of the country.

Md Giashuddin Ahmed is a former Joint Secretary.