Primary healthcare recommended as basic right in constitution

The health sector reform commission has submitted its report to chief adviser Professor Muhammad Yunus. The report makes roughly 32 recommendations.

The commission submitted this report to professor Muhammad Yunus at the state guest house, Jamuna around 11:00 am today, Monday.

The main recommendation of the commission is to amend the constitution to include primary healthcare as a basic right.

It has been stated in the recommendation that a separate ‘Primary Healthcare Act’ has to be enacted to implement this constitutional commitment.

This will define citizens’ rights and the state’s responsibility regarding access to free primary healthcare. This will also ensure long-term fairness and accountability in the health sector.

The commission has recommended revision of several laws and enactment of some new ones. It has been stated in the recommendation that all relevant existing laws have to be reviewed and updated.

In addition to that, some new laws have to be enacted to ensure patient protection, financial allocation, accountability, and adequate preparedness in emergency situations.

The new laws proposed by the commission are- Bangladesh Health Commission Act; Bangladesh Health Services Act; Public Health and Infrastructure Act; Bangladesh Safe Food, Drug, IVD and Medical Device Act; Drug Pricing and Receipt Act; Healthcare Provider and Patient Security Act; Allied Health Professional Council Act; Hospital and Diagnostic Accreditation Act; Health Protection Act; Women's Health Act; Cancer Regulation Act; Child Development Centre Act; Bangladesh Medical Research Council Act; Health Information Protection Act; and Sustainable Financing in Health Sector Act.

Meanwhile the list of laws that need to be amended includes Bangladesh Medical and Dental Council Act, Medical Education Accreditation Act, Nursing and Midwifery Council Act, Bangladesh Pharmacy Council Act, Tobacco Control Act, Municipal and City Corporation Act, and so on.

The report recommended the formation of Bangladesh Health Commission. It states that an independent and standing ‘Bangladesh Health Commission’ has to be established. This commission will provide strategic advice to the parliament and the government in formulating health sector-related policies. Additionally, it will also formulate national strategies, standards of services and service-providing institutions, and clinical guidelines.

The commission will regularly review the effectiveness of the healthcare system, quality of services, and overall cost effectiveness. Based on that, the commission will provide constructive opinions and guidelines for development of the implementing agencies and the government. This commission will be held accountable directly to the head of the government. It will send an annual report to the parliament every year.

The report also recommends the formation of Bangladesh Health Service. It stated that a new autonomous and profession-based civil service- Bangladesh Health Service (BHS) has to be formed including all the staff working under the ministry of health and family welfare as well as the existing health cadres and other related cadres to ensure professionalism, efficiency and accountability-based quality of services.

The formation of an independent Public Service Commission (Health) has also been recommended in the report. It stated that an independent Public Service Commission (Health) has to be formed to regularise and to bring transparency in the recruitment and promotion process of the health sector.

The recommendations made in the report includes that the government has to provide primary healthcare service completely free of cost (at subsidised prices in some cases) to ensure universal access to this service so that no citizen is deprived of primary healthcare due to financial obstacles.

The report further recommends that healthcare has to be made even more accessible for the public by strengthening secondary healthcare on upazila level. Specialised (tertiary level) medical services have to be introduced in district hospitals, so that decentralisation of services is ensured, pressure of patient on medical colleges and national institutes can be reduced, and nobody is deprived of specialised treatment because of geographical location.

The establishment of at least one full-fledged hospital with state-of-the-art facilities and world-class tertiary care in every divisional headquarters has to be ensured, which will serve as a regional referral centre for complex and specialised treatment. These hospitals can either be established anew or the existing institutions can be upgraded in phases. An average consultation time of 10 minutes per patient and availability of the required number of service providers needed for that has to be ensured. Besides, a weekly prescription sample verification system would be introduced.

The ultra-poor, who comprise 20 per cent of the country’s total population, will receive all services free of cost in every hospital. Blood transfusion services, laboratory services and pharmacies in all secondary and tertiary level hospitals of the country will remain open 24/7. There has to be an effective quality improvement board and a continued education system for quality improvement in hospitals.

It has been stated in the recommendations that universal accessibility of essential drugs has to be recognised as a basic health right. Every citizen of the country based on their need has to be provided with essential drugs free of cost (i.e. at the primary health care level and in the case of the ultra-poor) or at subsidised prices.

For that, government pharmaceutical organisations have to be reformed and strengthened through modernisation and structural reforms. Plus, the strategic procurement system has to be strengthened to procure quality medicines at affordable prices from the private sector. Pharmacies need to be kept open 24 hours in every government hospital and primary health care centre to ensure easy access of essential drugs.

These pharmacies will be operated under the national pharmacy network. The value added tax (VAT) as well as other taxes and tariffs applicable on anti-cancer, anti-diabetic, anti-hypertensive drugs and anti-biotic enlisted as essential drugs would be zero. On the other hand the VAT and duty tax on health supplements and high-priced drugs including vitamins, minerals, breast milk substitutes and probiotics need to be increased. This will increase the accessibility of essential drugs for the public on one hand, and strengthen revenue generation by increasing the tax on less essential and luxury items on the other.

The report also recommended prioritising emergency treatment as a specialised and essential healthcare service. This needs to be established as a recognised medical affair in the public health system. Emergency departments at the secondary and tertiary level hospitals have to be gradually brought under the management of these specialists, so that the extent and quality of emergency medical services increase significantly.

The recommendations also mentioned that a National Pharmacy Network, a National Diagnostic Laboratory Network, a National Blood Transfusion Network, and a National Ambulance Network have to be established to ensure accessibility, quality, and coverage of the health services. These services will remain connected and operate across the country through a unified digital platform as per the defined standards of their respective fields, so that the public can access these services easily, quickly, and reliably.

The report also recommended establishing a modern digital complaint platform to ensure that service seekers’ complaints are addressed.