‘95pc of the country’s healthcare providers are in the informal sector’

A webinar on the role of informal healthcare providers and the impact on the health policy, jointly organised by Health Alliance Bangladesh and Jeeon, was held on Thursday.

The webinar was presided over by former director of the Institute of Epidemiology, Disease Control and Research (IEDCR) Abu Mohammad Zakir Hossain. The key note was presented by Jeeon founder and chief executive Rubayat Khan. Moderated by acting convenor of Health Alliance Bangladesh , Mahrukh Mohiuddin, the webinar was addressed by joint chief (health wing) of the planning commission AA Md Muhiuddin Osmani, public health expert Aftab Uddin, acting dean of Brac School of Public Health, Malobika Sarkar and Indian health economist Jishnu Das.

Jishnu Das suggested that small but pragmatic and effective initiatives be taken to gradually include village doctors in the mainstream of public health.

The Bangladesh’s informal health sector, especially the important role of village doctors, was highlighted at the webinar. In the keynote presentation, Rubayat Khan said, 95 per cent of the healthcare providers worked in the informal sector and they provided services to 70 per cent of the country. Drawing attention to their role during the COCID-19 outbreak, he said, due to their commitment to the community, they carried on their work despite the risk to themselves and their families. Yet their contribution found no recognition in the country’s health policy.

The discussants agreed that the failure to recognise this informal sector was nothing new and questions and debates in this regard continued down the years. Muhiuddin Osmani said there was scope for doubt concerning the quality of service in this sector and questioned how justified would it be for the government to promote the sector without adequate research and evidence. He hoped that if trained physicians could be posted all around the country and made to be people-oriented and service-oriented, then the dependence on village doctors would be reduced as in Thailand.

The other speakers said it would take time to implement such a plan and to reduce the popularity of village doctors. They would continue to play an important role for at least the next two decades. Highlighting this reality, Malobika Sarkar said that even if we wanted, we cannot ignore or discard these thousands of healthcare providers. She proposed that an overall study be carried out in this regard. Based on the research, ways to utilise their services could be devised and included in the health policy.

Mahrukh Mohiuddin, said we want a health system that is people oriented and that will ensure health for all.

Jishnu Das pointed to the Indian experience in this regard, particularly that of West Bengal, and said that if the government directly gave recognition to this informal sector, that would amount to recognising the failures too. He suggested that small but pragmatic and effective initiatives be taken to gradually include these village doctors in the mainstream of public health. He said based on the trust and dependence that the people had on these service providers, they could play an important role in the management and tackling of COVID-19.

Rubayat Khan highlighted such an initiative by the Savar upazila health officer, where the services of over 2000 village doctors were used to tackle COVID-19, with promising results.

Dr Aftab Uddin pointed to certain research of icddr,b where the quality of village doctors’ service was improved through training and where incentives could play an important role. Jishnu Das said in India it was compulsory for village doctors to have registration and also nine months of training.

In his closing speech, Professor Zakir Hossain said that there were three times more untrained village doctors than qualified physicians in the country. He said that there were questions concerning the quality of service provided by these village doctors, but added that qualified physicians faced similar questions too. He proposed that a plan be drawn up for the next 10 to 15 years for these untrained doctors in the informal sector so that the informal health sector could be brought to a win-win position.

Winding up the discussion, the webinar moderator and acting convenor of Health Alliance Bangladesh, Mahrukh Mohiuddin, said we want a health system that is people oriented and that will ensure health for all. Rather than wasting time on what was done in the past, she hoped that a forward-looking and people-oriented plan would be drawn up and implemented for the informal health sector in the country.