Health sector in dire straits due to inefficiency, mismanagement, corruption

Discussion is underway about the inefficiency, lack of coordination and failure in the health sector, revealed amid the novel coronavirus crisis. Md. Ehteshamul Huq Choudhury has been working in the health administration and is the secretary general of Bangladesh Medical Association (BMA). He has talked to Prothom Alo’s Sharifuzzaman about vital issues of the health sector.

Ehteshamul Huq Choudhury, replying to Prothom Alo’s first question about the preparation of the health ministry to face the coronavirus situation, said the first patient infected with novel coronavirus disease, COVID-19, was detected in Bangladesh on 8 March. But the first ever patient was detected in China around three months before. Three more months had already gone by since the first patient was detected in Bangladesh. On the whole, analysing the six months, it can be said our health division has failed totally. Either they did not know about the severity of this infectious disease or they wanted to hide it. Some thought the virus will be burnt out in the scorching heat or will be swept away by the rain. As a result, the virus has gained ground and we are lagging behind. But we had the chance to chase it down if we could properly use the time we got.

When it was pointed out that the health division had reiterated their readiness, Ehteshamul Huq Choudhury said he saw lack of preparationl He said, the additional director general (administration) of Directorate General of Health Services said our health division ignored the matter in the first three months. When the World Health Organisation put emphasis on tests tests and tests, the IEDCR (Institute of Epidemiology Disease Control and Research), with 2,000 test kits, said we are ready. What was this bravado based? IEDCR’s work is research, it is not a service laboratory, he added.

Ehteshamul Huq asked, where is the National Institute of Preventive and Social Medicine (NIPSOM) and Centre for disease control and prevention? This was their task. Just a few days ago the health division has started thinking on how many hospitals we have, which districts could see a surge in infection cases, and the type of treatment for COVID and non-COVID patients. He said it cannot be said that the health division has ended its thinking. There is a huge difference between the information the health division presents and the reality out there. “It is shameful that we just made empty noises.”

Responding to a question about what the health division could have done, the BMA secretary general said the first thing is, they could have arranged enough laboratories for tests. “Now you are conducting tests in 52 laboratories, why could this not be done earlier?”

He said the authorities got three months time to prepare. Why could they not set up 64 laboratories in 64 districts? There were machines in several universities, why did they not use those, he asked. He said the universities were ready to work in this critical period. Now the authorities have been buying RT PCR machines at a three-fold price of the original cost. At the same time, they are buying older models made in 2009 in 2020 and not getting better results. Ehteshamul said the authorities could have bought the machines at the original price if they had bought those earlier and could train the physicians and health workers.

A person can infect 2.5-3 people on average. He said Y, Z would not have been infected if we could have detected X earlier and others would also not have been infected from Y and Z. Health division, concerned ministries and other stakeholders gave various decisions at different times which send a wrong message to the people. We’ve brought the garments workers to Dhaka when they went home amid lockdown, then sent them again. We have watched dramatic events about placing the expatriates in quarantine. The situation changed a bit when the highest authority of the government interfered but the damage had already been done by then.

In response to a question about the debate over COVID and non-COVID hospitals, Ehteshamul Huq said, the lesson from China’s Wuhan is that 41 per cent people get novel coronavirus infection from hospitals. It’s true that some foreign hospitals give treatment to COVID and non-COVID patients but their hospitals are constructed following the design for hospitals. This is why they could treat the COVID and non-COVID patients at a hospital. But, he said, the hospitals in Bangladesh are made in buildings made for general or commercial purposes. Those buildings were later designed as hospitals. Without considering these practical issues, the health division started issuing letters to any hospital, saying this has to be transformed into COVID hospital, an ICU has to be set up, etc.

The BMA secretary general said analysis of the directives revealed that the concerned people do not even have primary knowledge of the workings of the health division, let alone a complete and integral knowledge. A dedicated COVID hospital requires ICU, oxygen plant, at least two times more workforce with special training and many other preparations like this. But our health division thought issuing a letter is enough. We cannot say the situation has developed much.

About the physicians’ reaction, he said they were disgusted from the outset. They were made to wear raincoats in the name of PPE. The physicians, though drenched in perspiration, carried out their duties hour after hour in that situation. They were given fake N-95 masks. Complexities arose over their dwelling places. Actions were taken against several physicians for talking about these issues. “We have been calling them frontline soldiers in the fight against COVID-19 and at the same time dilly-dallying over providing them safety gear. The result was inevitable. Around 3000 health workers including 1000 physicians got infected.”

The situation only improved a bit when the highest level of the government intervened. What is the work of ministers, secretaries, DGs, directors and hundreds of officers if the prime minister has to look after these things, he asked.

Addressing the issue of workforce and their promotion in the health cadre, the former additional DG (administration) of DGHS, Ehteshamul, said it is clearly stated who would work at the health division and what would be their qualities. Except a few posts, everyone must have the experience of working at the field level administration. But professors, who do not have an iota of experience of running an administration, are at important posts. This is the situation for 15-16 out of 22 director posts. As a result, they are not contributing substantially in administrative tasks and at the same time the students are being deprived of their academic knowledge.

In response to a question on who brought them in, Ehteshamul said they were appointed as part of quota system for ‘chosen persons’ and sometimes to appease certain ministers, secretaries or DGs.

“It is normal to bring people of your choice ton the administration, but the person has to be qualified for the post. The task of health could be realised through going up the stair one by one. But the person who has not climbed those stairs will not understand anything except issuing letters,” he added.

The BMA secretary general elaborated the matter saying that the current health division DG is a professor of biochemistry. He does not have almost any experience of running an administration. Then there is director (hospital) and director (planning and development). They studied economics and epidemiology. There are many more examples. He said the professors of pre-clinical and clinical subjects have been leading the health sector. A professor will teach, do research, treat patients and if necessary, would be principal or vice-chancellor of medical colleges. This was normal and expected.m

Regarding the tasks of the health ministry, Ehteshamul said he does not sometimes understand what the health ministry is doing. He, however, said he realises the ministry works very slowly.

He said it would be normal for the ministry would seek advice from professionals in this critical period but the ministry has not shown any interest. As a result, the professionals also do not go to them. The task of the national medical association of every country is to give advice to the ministry but the situation is not like that in Bangladesh.

Addressing the issue of irregularities and corruption in procurement at health ministry, Ehteshamul said corruption cannot be seen but the perception is – corruption is rampant at the health ministry. This perception is more credible than the reality now. Health sector is a highly sensitive and technical sector. For the last few years, it seems, procurement was the main task of the ministry. It was busy with what to be bought for the offices of civil surgeons and large and small hospitals and the construction of infrastructure. There’s a process of government procurement. The demand must come from the field. The directorate will finalise the priority and the ministry will approve based on financial capacity. The institution itself will procure some and the large amounts will be done through Central Medical Stores Depot (CMSD). But the reverse happens now, he said. A contractor tells the medical college authority that such and such equipment are to be bought, send a list to the directorate. If the authority does not send the list, the ministry phones for the procurement list. Transfer and suspension are normal for not following the ministry and contractors. Some officials yield to the pressure while some take the benefit by joining the gang. Sometimes, the Anti-Corruption Commission (ACC) takes action but then the person who phoned from the ministry or put pressure becomes invisible. The contractor also shows he has supplied equipment and taken money as per the tender notice. The hospital director and others become the scapegoat. Several of such person are awaiting trial or in jail in cases filed by the ACC after giving work order over telephone. And the actual people who gave the order, it seems, are innocent, he said.

ACC, the ministry, media, intelligence agencies everybody knows about misappropriation of billions of taka through corruption. How could a clerk, Afzal, misappropriate Tk 20 billion alone? Who is his 'godfather'? The persons he had given shares to are not altogether unknown. Did the health DG, director not know anything at all about that? How could he flee the country? The BMA secretary general appealed to the authorities to inquire properly about the wealth of the top officials of health directorate and a few other concerned officials. “Either take action against the corrupt officials or declare nothing happened, everything is alright. But it cannot go on like this,” he said.

Regarding the ministry’s role in curbing corruption, Ehteshamul Huq said. "Let me clarify the matter through an example. There was uproar when the physicians were provided with fake masks. The ministry formed a committee headed by an additional secretary. Remember, the allegation was against one of the seniors of the committee head. He had submitted the report. The situation was made murky. But we could not know who was responsible, who did the corruption. My observation is either most of this ministry is frustrated at the state of affairs are or corrupt.”

Regarding the allegation that the leaders of Swadhinata Chikitsak Parishad (SWACHIP) or BMA and pro-government physician leaders influence the procurement process, promotion and transfer, the BMA secretary general said this was a technique of the bureaucracy to hide their failure. Lobbying is a part and parcel of life in Bangladesh. It is hard to say if a few people do not lobby separately. But why would you listen to that since your task is to work with integrity? if a person is corrupt, he will try to make others liable for that. In the last 10-15 years a lot of corruption happened in the country. ACC filed a number of cases but no SWACHIP leaders were found involved. ‘Me and my office are corruption-free,’ say two plaques outside the room of the health directorate DG and the health directorate. Do you think anyone in this country believes this?

Regarding the achievements in the health sector, Ehteshamul Huq said, we have been trying hard to take the health services at the doorsteps of the people. Bangladesh has achieved distinctive success in primary health care and EPI (Expanded Programme on Immunisation). We are polio-free now and on the way to eliminate malaria. We’ve achieved success in curbing TB and HIV; tetanus and measles are very rare. Bangladesh’s community clinic is a global role model. The country is one the right track to achieve SDGs after achieving the MDGs including maternal and child mortality rates. But the situation is very critical now and this is why many achievements have been eclipsed and the shortcomings have come to the fore.

Talking about his expectations, Ehteshamul Huq Chowdhury said he does not want to see corruption in the health sector of Bangladesh in post-coronavirus times. He further said he did not want to see any official made OSD or given punishment transfer for not favouring corruption. The BMA leader also said he wants an end to mismanagement, lack of coordination and chaos in health ministry and health directorate. He also called for increasing the health budget to ensure proper treatment of the people, procuring advanced equipment and appointing workforce in large numbers.

* Ehteshamul Huq Chowdhury is the secretary general of Bangladesh Medical Association (BMA) and former additional director general (administration) of Directorate General of Health Services

* The interview has been rewritten as a report in English by Shameem Reza