National health policies of a country are important for improving the overall health of the population with the improvement of the health sector and its response to diverse health problems. In Bangladesh, the health sector plays crucial roles in the provision of health services at three tiers such as primary, secondary and tertiary and has contributed much to better health situations in terms of different health indicators such as maternal and child healthcare and life expectancy, compared to many other countries, including South Asian neighbours such as India, Pakistan and Nepal. In this respect, health policies have played important roles, but haphazard health response to the ongoing pandemic reveals the inadequacy of the health sector as well as the present health policy.
Health policy was adopted in Bangladesh for the first time in 2000 and was later updated in 2008 and 2011. The 2011 health policy, which focuses more inclusively on health services and related aspects, with 19 goals and objectives, 16 policy principles and 39 strategies, is relatively good and acknowledges healthcare as a universal right with an emphasis on primary and emergency care. Besides, it puts emphasis on the reduction of mortality, prevention and control of diseases, and focuses on other related aspects including health equity, health education, usage of ICT in the health sector, awareness raising on diverse health problems, health research, and effects of the natural calamity on health, food and nutrition for better health outcomes. Yet, there are some notable limitations in the policy.
The current health policy focuses exclusively on physical health and almost ignores other aspects of health, including mental health, despite the fact that the term “health” is defined in a broader sense as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Such a definition is also acknowledged in the present policy, but its exclusive focus on physical health — disregarding other aspects, especially mental health — makes it a mere national physical health policy. In the absence of a comprehensive mental health policy, it turns out to be a mere dream to improve overall health with a physical health focused policy, when more than one-fifth of the population has some form of mental health problems in the country.
To ensure physical health, the policy considerably focuses on the medical model approach that usually aims at the diagnosis of diseases followed by providing medical treatments to patients. But it lacks adequate focus on access to care in terms of availability, accessibility, acceptability and quality of care. Indeed, emphasis is insufficient, especially on availability, such as availability of quality and modern healthcare facilities at all tiers, economic and socio-cultural accessibility, such as reduction of high expenditure, and addressing health seeking from traditional providers and acceptability — an absence of which drives many to seek healthcare from abroad. Despite the fact that the policy takes into account the quality of healthcare, which is safe, effective, timely, efficient, equitable and people-oriented, there is insufficient stress on some aspects, including patient-friendly services and/or patients satisfaction.
The current policy also provides insufficient focus on health governance, rendered as one of the key factors in balancing the concerns of the government and public sector with the interests of civil society, private players and general people and delivering healthcare services through modernised governance arrangements. It is, in fact, a prioritised area especially in upgrading the quality, efficiency, effectiveness and responsiveness of the entire health system and achieving universal healthcare with improved accessibility. But currently, there is inadequate attention to health governance in a broader sense including responsiveness, even if the policy is considered an option for the development of accountability among all related to the health sector of Bangladesh
There is a lack of policy focus on health diplomacy that represents an important forum for negotiations on global policy issues and shapes and influences the global environment for health. Indeed, pandemics, newly emerging communicable diseases and threats of bioterrorism are now considered direct threats to national and global security. Consequently, there is increasing recognition of health, a key contributor to development, peace, poverty reduction, social justice and human rights, as a goal of foreign policy. Health diplomacy, especially with state and transnational non-state actors, is crucially needed for the prevention and mitigation of communicable diseases, including the COVID-19, which require improved transboundary relations and the commitment of diverse transnational actors to work together. But neither the health policy nor the foreign policy incorporates health diplomacy.
The current policy, moreover, does not put sufficient emphasis on prevention, which is imperative for staying healthy and accessing prompt treatment when necessary. In spite of this fact, the policy takes account of the continuity of vaccination, usually rendered as primary prevention, and some other aspects such as a healthy lifestyle, health promotion and behavioural changes. It almost overlooks some crucial preventive aspects, including eliminating sources of and preventing exposures to environmental and occupational hazards or eliminating etiologic factors that cause disease and injury and mitigating psychological factors of ill-health. It does not put required emphasis on some other crucial preventive aspects, including early detection of infections or diseases, especially among the larger population.
Of course, health, as explained by the biopsychosocial approach, is influenced by many factors, such as genetic or biological, medical care, human behaviours, environmental and physical influences, and socio-psychological factors. Diverse determinants require not only a clinical model approach but also a broad public health approach, which aims at identifying causes of diseases, health promotion, disease prevention and early detection, access to health care, and health of individuals, communities or populations. By reason of the insufficient reflection of broader public health viewpoint in the policy, a vital question remains on whether the health sector of the country can be arranged with the required capacity to effectively deal with diverse physical and mental health problems including epidemic and pandemic like the COVID-19 and expectedly reduce morbidity and mortality in the future.
In my view, the present health policy needs to be revised. In this respect, all the above concerns need to be sufficiently addressed for better contributions of the policy to the development of the health system and improvement of overall health conditions. But emphasis should be given to some important aspects including the public health approach in a broader sense and integration of primary care and public health, especially prevention and health promotion aspects. Of course, the reformulated policy needs to be accompanied by sub-sector policies, but there is a lack of such policies, including the national blood policy. Along with the formulation of some sub-sector policies, harmonisation of some related policies, including the foreign policy, with the health policy is also very imperative.
Of course, the integration of public health, especially health promotion and prevention aspects, and primary healthcare is to be specially noted here. Both have separate identities but share a similar goal of a healthy population, can link community organisations and build a shared platform to catalyse inter-sector partnerships, designed to achieve such a goal using resources in a more efficient and effective manner. In my view, integration can make it easier to address diverse health problems of a given population through regulation of care and providing protective and preventive services with improved coordination between primary health service providers and public health authorities, contributing to a better distribution of health outcomes and enhancing well-being and quality of life.
NB: This article was first published in the Daily Sun on August 26, 2020.
