Discuss About The Innovation Universal Coverage In Bangladesh.
Health workforce or health human resources are defined as all individuals who are engaged in actions, the primary intent of which is to enhance the overall health and well-being of all citizens. Health workforce has been identified as one of the integral building blocks for an efficient health system. The field of health workforce deals with several issues such as, formulation, development, management, information, retention, and research on human resources that are essential for the healthcare sector, thereby improving the population health outcomes. An analysis of the reports suggests that health levels are relatively low in Bangladesh, which has been categorised as a low income country (Crisp & Chen, 2014). Due to huge population, Bangladesh faces a double burden of communicable and non-communicable diseases. In addition to these, some of the other health problems also involve environmental sanitation problem, and prevalence of malnutrition. This formed the rationale for choosing Bangladesh as the country (Alam et al., 2013). Bangladesh has also been identified as one of the major countries with severe shortage in health workers. Owing to the fact that healthcare workers form the backbone of an appropriate healthcare system, the following report will analyse the health workforce profile present in Bangladesh and the challenges faced by it, followed by a recommendation to mitigate the shortage of healthcare professionals in the country, using the WHO framework.
Human health resources have been identified as an integral limiting factor that determines the health of a population, besides range of behavioral, socio-economic and environmental factors. Close correlation exists between the concentration of efficient and qualified health workers such as, nurses, dentists, doctors, and midwives, with the major health outcomes such as, coverage of immunization, outreach of primary health care services, and maternal and child welfare (Truth, 2013). The Dhaka declaration recognises the critical importance of effective healthcare workforce for functioning of the health systems, to achieve the targeted goals. It also identified misdistribution, with respect to geography, gender, inappropriate levels of competency, and lack of dedication, amongst the healthcare workers, directly responsible for poor health outcomes in Bangladesh (Mahtab et al., 2015). In this regard Bangladesh has been recognised as one of the countries with severe shortage of healthcare workers. The current demographic scenario in the country is also characterized by a continuous increase of the population (Chowdhury et al., 2013). Presence of ethnic minorities, who do not have access to appropriate healthcare resources, also contributes to poor health outcomes among the population. Evidences exist about the causal relationship between low socioeconomic status and lack of health literacy among the vulnerable population.
Rates of morbidity and mortality are found to be significantly lower among people living in Bangladesh, due to their poor nutrition, harmful lifestyle practices, social exclusion, and lack of access to appropriate healthcare. Due to lack of health literacy, the overall consumption of healthcare services in Bangladesh is comparatively low than other developing countries (Hoyler et al., 2014). Evidences also exist that focus on increasing the overall per capita consumption levels, in order to achieve average levels of health outcomes. Recent reports state that Bangladesh has succeeded in lowering rates of under-five mortality, by approximately 60%, from 146 deaths/1,000 live births (1991) to 65 (2007). The nation has also shown remarkable progress in health and population over the past 30 years, in terms of reducing child mortality (El Arifeen et al., 2013).
Research studies also emphasize on the fact that the burden of non-communicable diseases has reached approximately 26% of the population, who are found to be undernourished. 46% children suffer from severe underweight problems as well (Adams et al., 2013). Bangladesh ranks first among countries where children suffer from malnutrition. The National Health Policy was published in the year 2011, with the aim of ensuring basic rights to adequate healthcare services to every citizen. The policy also wants to ensure presence of an effective healthcare system, which responds appropriately to the health needs of the nation (Prince et al., 2015). Moreover, pursuit of the policy will also help in fulfilling demands of the citizens, in addition to empowering and inspiring the healthcare providers.
The human resources for health country profile are considered essential by the Ministry Of Health And Family Welfare. This profile is generally used as a source of data for the human resources of the country, which in turn helps to measure its progress towards achievement of the Millennium Development Goals. It has been estimated that one third of the total healthcare workforce is accounted for by public health personnel that is represented by doctors and nurses. Approximately 38% of the staff are unskilled and work in Administrative Services, either as menial stuff or support personnel. Approximately 155,000 healthcare workers are available within the system, against the sanction the number of posts 187,500 (Ahmed et al., 2013). Moreover, estimates also suggest that 38% of allopathic doctors work in the public healthcare sector, while approximately 35% are under the jurisdiction of the MOHFW (refer to appendix).
Further reports suggest that the there has been a rapid increase in the density of medical doctors/1,000 population, upon comparison to other professionals such as, nurses and midwives, or medical technicians. The density of medical doctors was estimated to be around 0.28 in the year 2003, which rapidly increased to 0.40 by 2012. Significant shortage also exists in the number of medical technologists in Bangladesh, which can be attributed to the fact that the rates were 0.07 in 2012 and 0.04 in 2003 (National Institute of Population Research and Training, 2009). Identification of Bangladesh as one of the countries that faces a major crisis in the healthcare workforce was established by the Health Care Provider Survey 2007, which included different types of healthcare providers, working in the formal and informal sectors (World Bank Report, 2013). This facilitated the representation of a comprehensive picture of the existing healthcare scenario in the country.
Figure 1- Distribution of health workers in Bangladesh
(Source- )
Findings from the survey suggested that the density of physicians and nurses had increased over the last decades, from 1.1 nurses and 1.9 physicians in 1998 to 2.1 nurses and 5.4 physicians in 2007. However, the increase was quite lower than the average health workforce, estimated from low income countries (WHO, 2014). A slight increase was also observed in the density of dentists as well. However, significant disparities exist between the density of qualified healthcare professionals such as, physicians, nurse, and dentists, when compared to other South Asian Countries (Human Resources Management Unit, 2013). This falls significantly short of the projected estimates by the WHO, which is crucial for achieving the MDG targets. The data presented above and in the appendix also indicate that there exists an overwhelming urban bias related to the distribution of formerly qualified healthcare providers. This inequitable distribution shows more concentration of the professionals in regions of Dhaka and Chittagong. The community health workers associated with non-governmental sectors are found to be concentrated in rural areas. Inequitable distribution of drug retail outlets also demonstrates their unhindered expansion across the nation.
The health workforce plan of Bangladesh has the primary objective of addressing the challenges that are associated with shortage of qualified healthcare professionals, inappropriate skill mix of the nurse to doctor ratio, inequitable distribution of healthcare personnel, and poor health literacy. This health workforce plans to improve the existing conditions in both urban and rural regions of the nation. It intends to implement an approach that will focus on delivery of optimal quality healthcare services to all citizens, regardless of their socioeconomic status. This plan will also help in eliminating the imbalances that threaten the potential capacity of the existing health care system in Bangladesh. Some of the major challenges that will be eliminated by the plan encompass the problems faced by rural communities, in recruiting qualified healthcare professionals and providing training and education opportunities to the existing staff. The plan will also help in identification of the need for an improved educational partnership between medical and academic institutions to improve commitment of healthcare workers to workplace diversity in the nation.
There is a need to stimulate investments in the development of decent jobs in the healthcare sector in Bangladesh, particularly for the women, owing to the fact that only 20-30% healthcare personnel are females. Urgent action must be taken for the development of policies related to the existing labour market in Bangladesh, which in turn would foster the need of enforcing a sustainable and qualified health care workforce in the nation. The existing government policies related to health should also be addressed for identifying the systemic issues, which in turn would result in subsequent changes in the health labour market and would reduce rates of public failure (Gaziano et al., 2015). Motivating the youth, who form a large proportion of the entire population, and creating provisions for their training and education would empower them and facilitate their engagement in jobs related to the healthcare human resources. This can be achieved by gathering funds and sponsors that would help the youth to enroll them in the educational and training institutes present across Bangladesh.
Efforts must be taken by the governmental policies of the country to prioritise their investment in all kinds of education and training. The policies should focus on shifting away educational models from narrow subject specialisations and should build in locally relevant competencies in near future. This can be achieved by scaling up high quality education, which will assist all healthcare workers to acquire skills that are required in their profession, which in turn would help them match and the meet the healthcare preferences and demands of the entire population. Appropriate training and education will also allow the healthcare professionals to work according to their full potential. This in turn can be facilitated by addressing all kinds of geographical inequities that exist in the country. Removing such inequities between the rural and urban areas would help in strengthening youth education and facilitate their employment in the healthcare sector.
Disparities exist between men and women in their ability to gain adequate access to healthcare services or be a part of the healthcare workforce in Bangladesh. Status of women in the country has been identified as a major obstacle to their development in the healthcare work force. Therefore, they must be provided opportunities to gain better excess of healthcare services and should also be allowed to work in partnership with men at different levels of the healthcare sector, including policymaking stages (Khera et al., 2014). Economic participation of females should be maximized, which in turn will lead to their empowerment by reinforcing skills of leadership and addressing all forms of inequity and gender bias that exists in health labour market and education system.
Integrated patient centred healthcare services are imperative for reaching universal health coverage (Reich et al., 2016). Optimal health care services should focus around the health needs and preferences of people and the community, rather than on the prevalence of diseases. The country should focus on implementing reforms service models that emphasize on hospital care, instead of preventing rates of diseases (Quayyum et al., 2013). Efforts must also be taken to deliver integrated community based and affordable ambulatory and primary care to all people, with a special attention to those living in underserved areas. This can be facilitated by adoption of appropriate policy and social business models that will help in serving the disadvantaged people.
The governmental policies should try to harness powers of communication technologies and cost-effective information technologies for enhancing health education and literacy among all sections of the society (Ahmed et al., 2014). Use of appropriate mobile and wireless technology will also help in a better communication between patients and physicians, in addition to constant monitoring of patients living in remote regions of the country (Agarwal et al., 2015). Digital technologies will also help in enhancing access of all people to necessary healthcare services, and will improve responsiveness of the existing systems thereby enhancing delivery of primary health care.
Effects must be taken by the government to gather adequate funding from international and domestic bodies, in addition to private and public organizations, for the enforcement and implementation of appropriate health financing reforms that will help in investing in the correct skills and working conditions for all health workers. Sustainable health financing can be secured through public revenues (Balabanova et al., 2013). Political commitment and societal dialogue will play an important role in bringing about macroeconomic reforms in the country that will also attract co-investment from the private sector.
Bangladesh should focus on building capacity of the health human resources and systems for detecting and responding to major public health emergencies and risk. It should ensure investment in international health regulations that includes development of skills of the health workers in humanitarian settings, while ensuring their protection and security (WHO, 2016).
International mobility of healthcare workers will also bring several benefits to the country. However, it should take efforts to negate or eliminate the adverse effects of migration and should optimise the skills and qualifications of the workers, while safeguarding the rights of the migrants (Bryan, Chowdhury & Mobarak, 2014).
The country should build a fit-for-purpose workforce across all the healthcare sectors that are involved in the labour market. It should involve the civil society, public sector, private sector, health worker association, regulatory body, trade union, and training institutions, for promoting collaboration at all levels to support investments in the healthcare workforce
The nation should also undertake a robust analysis and research of the existing health labour market, with the use of several methodologies and metrics, for strengthening accountability evidence and action related to the workforce.
Conclusion
Thus, it can be concluded that low income countries, such as, Bangladesh have shortage of qualified healthcare workers, which has drawn attention in recent times that can be attributed to the threat towards attainment of Millennium Development Goals. All countries present in the Southeast Asian region have been identified to suffer from common health workforce associated problems that concern skill mix, shortage of workers, work environment, migration, poor knowledge base and other geographic inequities.
Owing to the shortage of qualified healthcare providers in the country, all patients, specifically those who belong to the lower socioeconomic status of the society and represent the disadvantaged population are forced to seek health services from non qualified healthcare professionals, working in the informal sector. Thus, there is a need to advocate issues associated with human resource and situational analysis on the agenda.
References
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