Crisis of confidence hits the health sector

Viquarunnesa Begum is a physician who had long served in the health ministry. In 2009 she left the ministry to take up a position with the World Health Organisation. She is now a consultant with a private firm. After she underwent the required tests, on 1 September the Institute of Epidemiology, Disease Control and Research (IEDCR) informed her that she had tested positive for coronavirus. Viquarunnesa Begum told Prothom Alo that she had gone to government hospitals and was extremely dissatisfied with the treatment.

On 2 September Viquarunnesa Begum had gone to the Kurmitola General Hospital in the capital city. No cabins were vacant there so she went to the Sheikh Russel Gastroliver Hospital. Describing the condition of the hospital she said, the cabin had no curtains, no soap or hand wash. She received attention only four hours after she got there. She finally left and got admitted to a private hospital.

Viquarunnesa Begum is not the only one who has lost confidence in these hospitals. The people in general have no faith in hospitals and the health sector. Researchers say that very few people trust the health sector.

In a study conducted during the coronavirus outbreak, the United Nations Youth and Students Association of Bangladesh, it was seen that the confidence of 24 per cent of the people in the health sector was at a low level. Only 23 per cent had confidence in the sector. The confidence of the remaining 53 per cent was medium.

The research covered various issues including the common people’s trust in the health system, their trust in the health providers and the confidence of the physicians and other health workers in the health system.

The researchers have prepared a 59-page report in this regard. Also, Reader in Medical Anthropology and Global Health at Sussex University in the US, Shahaduz Zaman, research analyst at the Bangladesh office of International Food Research Institute, Mohammad Nahid Bin Khaled, and executive director of Public Health Foundation, Taufique Joardar, have written a research article based in the information from this study.

Chief researcher and executive director of Public Health Foundation, Taufique Joardar, speaking to Prothom Alo, said, “A large section of the population have no confidence in the health sector. This is a dangerous trend. The government, the civil society, public health experts and the media, must all take an initiative to restore this trust.”

Alongside the prevailing weaknesses in the health sector, further discrepancies have appeared during the coronavirus pandemic, the researchers said. These included a lack of preparation, weak coordination and leadership, as well as corruption, low quality service, discrimination in treatment or no treatment at all due to weaknesses in leadership.

‘The emperor who had no clothes’

A leading public health expert of the country, pointing to inadequate budget in the health sector, low quality service and focus only on specialised medical treatment, said that the pandemic had revealed the truth, like the story of ‘the emperor who had no clothes’.

In the story, the emperor had pranced around town in the nude, given to believe he was wearing extremely fine fabric. Everyone praised his clothes nevertheless. Only one young boy spoke the truth, “The emperor has no clothes!”

The pandemic, likewise, has revealed the true state of the health sector. The first case of coronavirus in the country was detected on 8 March and on 18 March the first COVID-19 death was reported. Then as the number of patients increased, so did pressure on the hospitals. There were allegations of the hospitals not providing treatment.

Several patients even died after rushing to and fro, being unable to get admission into any hospital. Where to get treatment for coronavirus? Where to get admitted? Such questions gave rise to a general social anxiety. People rushed from place for sample testing.

Amidst all this anxiety and uncertainty, allegations of corruption arose about health sector officials being in collusion with JKG, Regent and such shady establishments. Even the pandemic failed to halt corruption.

The researchers undertook this study on people’s confidence in the health sector at this critical juncture of the pandemic. Questions were sent to 517 respondents through social media and internet and their responses collected from 10 to 1 June. Of the respondents, 318 were male and the rest female. Their ages ranged from 10 to 50 and beyond. And 92 per cent of the respondents were university graduates. Also, 9 per cent of the respondents had contracted coronavirus. Other than this, the views of 50 physicians, public health experts and health workers were taken through 7 group meetings from 15 to 17 June.

Truth revealed

The study has revealed the truth, commented professor of Dhaka University’s health economics institute, Syed Abdul Hamid. He said that this high rate of no-confidence of people in the health system was revealed in an earlier research of Dhaka University, conducted before the pandemic.

The researchers took the opinion of the people regarding whether the health sector gave priority to the interests of the public, whether there was transparency in providing services, whether treatment was provided in keeping with the proper rules and methods, whether those seeking treatment were provided with proper and quality service, whether the authorities were efficient and careful about maintaining secrecy of the patients’ details, whether deprived and maginalised people received services, and so on.

Among the respondents, 46 per cent said they had a low opinion about the health system. And 19 per cent said they had trust in the system. The remaining 35 per cent said they had medium confidence in the system.

Of the respondents, 24 per cent said they had little confidence in the physicians, nurses and other health workers. On the other hand, 23 per cent said they had confidence. And 53 per cent of the respondents said that they had medium confidence in the service providers.

Physicians and public health experts said that corruption, lack of leadership and the propensity to violate the law had prevailed in the health sector from beforehand. At the outset of the pandemic, many officials had said that physicians do not need personal protective equipment (PPE). The physicians had to use inferior quality PPE or buy their own. That is why many physicians were unable to have strong confidence in the health system.

Confidence is essential

The researchers said that if people lacked confidence, they would avoid taking health services. This would lead to further transmission of the virus and increased number of deaths. If people had no trust in the health sector, they would look to alternative means of treatment. This leads to both health and financial risks.

If the people could have confidence in the system, the scope to avail services would increase, health resources would be properly utilised, the people could avail regular services and people’s health would improve.

The way ahead

Professor of Dhaka University’s health economics institute, Syed Abdul Hamid said that emphasis should be put on primary healthcare to boost people’s confidence. He said that people at the lower rungs of society were not getting treatment. And high level hospitals faced a pressure of patients. Quality treatment could not be provided as there were less physicians and more patients. This affected people’s confidence.

The researchers presented recommendations at the end of the report. They said, initiative must be taken with advice from the experts to address the identified weaknesses. Also, discussions with politicians would have to be arranged in order to address the issues of corruption, law, improved health services and curbing disparities. And the service providers must be included in discussions about restoring confidence in the sector.

*This report, appearing in the print and online editions of Prothom Alo, has been rewritten for the English edition by Ayesha Kabir.