Dengue takes centre stage in health sector

An aedes mosquito. File Photo
An aedes mosquito. File Photo

Though he became a full minister of the health ministry this time, Zahid Malek’s performance has been lacklustre at the best. In fact, it was an accounts officer of the medical education department, Abjal Hossain, who made sensational news, amassing huge wealth through corruption. But it was dengue that took centre stage in the health sector this year.

It was dengue that made a big difference between 2018 and 2019. Everything else was more or less the same. In the budget announced last June, 5 per cent of the total was allocated to the health sector. In 2018 the allocation was 4.9 per cent. There was neither any significant progress nor any drastic failures in the health sector. But the fear remains that dengue may hit hard again in 2020.

Among its commitments made for the 30 December 2018 election, Awami League had pledged free health care for infants under one year of age and adults over 65. It had pledged to set up medical colleges in all divisional towns, provide heart, cancer and kidney treatment in all medical college hospitals, and set up hospitals of at least 100 beds in every divisional town with cancer and kidney treatment facilities. It also committed to increase the number of physicians in the rural health centres, improve the quality of medical treatment and ensure the presence of the physicians. However, no deadline was given to meet these commitments.

At the end of the year the government appointed 4,443 physicians through the BCS exam. This will somewhat address the shortage of physicians at the upazila level. However, the general people still doubt whether these physicians will actually go to the villages. In the latest demographic and health survey, as well as survey of health institutions, it was seen that the quality of health service had deteriorated.

Former president of Bangladesh Medical Association Rashid-e-Mahbub, speaking to Prothom Alo, said it was good that the government has appointed new physicians, but it had not taken any effective measures to ensure that they remained at their posts. And the health ministry hadn’t specified the process of providing free health services to infants under one year old and adults over 65.

Zahid Malek was hardly active as state minister for health, under health minister Mohammed Nasim in the 2014-18 term. But as soon as he took over as health minister this term, he immediately transferred certain officials and employees who had been close to Nasim. The state minister of his ministry was former Chhatra League leader Murad Hasan MP, but Murad was suddenly transferred on 20 May this year to the information ministry. There were speculations that the two of them did not get along.

Corruption prevails

According to the Anti-Corruption Commission (ACC), corruption prevails in the health ministry’s procurement and supply of equipment, appointments, transfers and promotions, training, foreign trips and admission into the medical colleges.

Officials of the anti-corruption watchdog Transparency International Bangladesh (TIB) feel that that funds are being pilfered in political, administrative and programme implementation sectors. TIB executive director Iftekharuzzaman told Prothom Alo, corruption would decrease in the health sector if exemplary punishment was given to the corrupt elements in the sector.

The accounts officer Abjal Hossain of the health directorate’s medical education department and his wife Rubina Khanam, a stenographer in the same office, own three five-storey houses in Uttara Sector 13 and one five-storey house in Uttara Sector 16. They own land in this area as well. They even own a house in Australia. They have amassed such wealth despite having such small posts in the health ministry. This information gathered by ACC appeared in the media at the beginning of the year. The media also revealed corruption involved in the name of training throughout the year.

In November further corruption was revealed in the purchase of books, furniture and other equipment for the newly-opened Sheikh Hasina Medical College in Habiganj.

The authorities failed to conceal their corruption at the Faridpur Medical College Hospital. A curtain for patients’ privacy was purchased for the intensive care unit at a cost of Tk 3.7 million. The authorities resorted to corruption in the expenditure of Tk 411.37 million on 111 types of equipment for the college. And project papers of Chittagong Medical University indicate that prices have been manipulated for certain costly purchases to be made in the offing.

Former general secretary of BMA and Swadhinata Chikitshak Parishad president Iqbal Arsalan told Prothom Alo that significant events of the year include the appointment of new physicians, the start of Sheikh Russel Gastro-Liver Institute and the expansion of the Sheikh Hasina Burn and Plastic Surgery Institute. He also said that Sheikh Hasina being bestowed with the ‘Vaccine Hero’ title was an international recognition of Bangladesh’s success in the health sector. However, the regular reports about the irregularities and corruption reveals the total mismanagement that prevails in the health sector.

Substandard capsules and hospital fire

The Vitamin A capsules which were stuck together and the fire which broke out at Suhrawardy Medical College Hospital are separate incidents, but both served to point out the glaring mismanagement in the health sector.

Children were supposed to be given Vitamin A capsules on 19 January this year all around the country. However, two days before the date, the capsules were found to be of substandard. Reports poured in from all around the country of the capsules sticking together. The health ministry suspended the programme and the government faced huge financial loss. The children were also deprived to the vitamin on time.

Then on 14 February a fire broke out in the evening at the 850-bed Suhrawardy Hospital where there were around 1200 patients. Fire at such an important hospital of the country gave rise to questions.

Health minister Zahid Malek called a press conference at his residence and said that the fire was a wake-up call. He said that an investigation would be carried out and the cause of the fire and the names of the responsible persons would be published.

Separate inquiry committees were formed for the Vitamin A incidents and the fire, but the reports have not been made public.

Dengue takes centre stage

The nationwide outbreak of dengue was the most significant incident of the health sector in 2019. The spread of dengue, the novelty of its incidence, the failure and corruption of the two Dhaka city corporations in this regard, the overcrowding of hospitals, the record number of patients and deaths and such news created a stir.

The Institute of Epidemiology and Disease Control and Research (IEDCR) received news of 264 dengue-related deaths, of which 133 they confirmed were due to dengue. Such widespread deaths caused by dengue hadn’t occurred before.

The World Health Organisation sent experts to Dhaka to help bring the situation under control. WHO entomologist Bhupendar Nagpal provided recommendations to the health ministry and the two Dhaka city corporations about destroying Aedes mosquitoes. Immediately after that, Prothom Alo published a report about another WHO expert Krishanmurthy who had come and given recommendations about the chikunguniya outbreak. His recommendations had not even been opened or read.

Professor of biology at Jahangirnagar University, Kabirul Bashar, told Prothom Alo that there may be a repeat of the dengue outbreak in 2010, similar to that of 2019.

Some success

While the aedes mosquito could not be brought under control, the health ministry managed to provide all sorts of treatment for dengue. The government fixed the fee for dengue tests. Holidays for all physicians and concerned officials were cancelled.

Director general of the health directorate Abul Kalam Azad said, after introduction of the biometric system in hospitals, physicians’ attendance shot up from 44 per cent to 72 per cent. And after monitoring was strengthened, the supply system in hospitals improved and wastage lessened.

Speaking to Prothom Alo about more instances of success, professor of the Dhaka University Health Economics Institute, Syed Abdul Hamid, said that initiative has been taken up to open eight full-fledged cancer hospitals in eight divisions of the country this year. Government officers and employees will receive health insurance.

However, WHO came up with bad news at the end of the year. They said that 72 per cent of the money spent by the people of Bangladesh for health services came from their own pockets. And this was sending 11.4 million people below the poverty line. This was alarming.

Professor Rashid-e-Mahbub said that healthcare-for-all had come to a standstill. People’s expenses were increasing with no initiative to improve the situation in sight.

* This report appeared in the print edition of Prothom Alo and has been rewritten in English by Ayesha Kabir