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Bangladesh Public Health Conference 2008
Dhaka, June 13-14, 2008
Conference Theme
Public health Conference 2008 will
give emphasis to the following cross- cutting themes:
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The role of the State in health
care delivery
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Impact of essential service
package on the poor
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Rational use of medicine
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Public-private partnership
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Public-public partnership
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The Government of Bangladesh
recognizes that the state should provide healthcare to every citizen
of the Republic as health is one of the basic rights. In the early
nineties, GOB started to deviate gradually from the central role of
providing health care to her citizens in the backdrop of donor
policies which promote diversity and competition in healthcare
provision, particularly through the use of private sectors and
nongovernmental organizations. In the past decade Bangladesh
experienced various attempts to promote privatization of health
service providers and attempts to undermine the public provision of
health services. It poses a serious challenge for ensuring equitable
access to quality health care. Moreover, a long standing consensus
that health care reform should be decided by GOB for effective and
proper utilization of aid to improve health care systems has been
eclipsed by accord on the desirability of recipient management of
aid along-side domestic resources thus blurring lines of
accountability, authority and coordination within the health
ministry. Consequences of various reforms are reflected in the
achievement of the performance indicators in the health sector.
The issue of private sector
involvement in health care delivery is debated in both developing
and industrialized countries. It is argued that private sector
provision leads to inequalities, attaches a profit incentive to
healing, and raises costs. Reinforcing privatization in health
sector may have widened the scope of consumer choice but also
increased out of pocket expenses for both public and private
services and restrained the hard to reach group from accessing
health care. The increase in out of pocket expenditure, as well as
the aggressive marketing policies and unethical practices of health
care vendors, pharmaceutical companies for maximizing income point
to severe negative consequences and driving many families into
poverty and are increasing the poverty of those who are already
poor. Untreated morbidity, reduced access to care, long term penury,
and irrational use of drugs are some of the consequential effects.
Objectives:
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To understand the role of the
state in the present health care reform in Bangladesh
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To identify barriers which
impede the enhancement of health care delivery to the poor
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To identify elements and
mechanisms to address the GOB constraints in taking the central
role in making health care delivery effective and equitable
In 1998 the Government of
Bangladesh started to implement Health and Population Sector
Programme (HPSP) later called as the Health Nutrition and Population
Sector Programme (HNPSP), which will end in 2010. The core
programmes is an essential service package (ESP), currently termed
as essential service delivery (ESD) that endeavours to target the
most vulnerable- the poor, women and young children. The package
includes only basic health services and targets only the poor
people. HNPSP is not operating in urban areas partly because rural
areas are seen as more impoverished and partly because health is the
responsibility of the city corporations and municipalities and not
the health ministry. Though ESD aims to improve health of the poor,
crucial question like whether ESD benefits the poor is often raised
in the backdrop of the reforms targeted to deliver effective health
care to the poor. The package of ‘Essential Service’ does not
include secondary, tertiary and super-specialized health care.
Various health reforms undertaken in developing countries has
ensured that the poor will get only a silhouette of total health
care in the form of the ESP/ ESD, which simply overlooks issues like
tertiary, super-specialized advance or critical health care.
Objectives:
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To assess the effectiveness of
essential service package on the poor and vulnerable in our
country
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To comprehend whether ESD is
making our health system inequitable
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To formulate a suitable
alternative to ESD for providing better health care to the poor
Rational drug use
implies that patients receive medications appropriate to
their clinical needs, in doses that meet their
individual requirements, for an adequate period of time,
and at the lowest cost to them and their community. This
means that doctors prescribe the right drug, correct
dose at affordable price with clear information and
instruction about the drug to the patient or guardian.
Ensuring rational use of medicine, notwithstanding, is
one among other requirements needed for fulfilling the
right to good quality health care. Though Bangladesh
formulated its National Drug policy (NDP) and
promulgated Drugs Control Ordinance to ensure that
common people can get the essential and necessary drugs
easily and to ensure the quality and safety of these
essential drugs. Despite significant progress in drug
production irrational drug use, improper prescribing,
inadequate access to essential drugs and uncontrolled
price are key problems, affecting the total healthcare
system gravely.
Objectives:
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To figure out the current
status on rational use of medicine
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To understand whether the
existing national health policy effectively ensures rational use
of medicine
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To comprehend the impact of
drug promotion policies of pharmaceuticals on rational use of
medicine
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To formulate guidelines on drug
policies to access to essential drugs by rational selection
based on a national essential drugs list and treatment
guidelines
Global trend in the
1990s of questioning and seeking to redefine the
relationship between the state and private sector has
influenced thinking in developing countries including
Bangladesh. In fact concrete steps have been taken to
open the door wider for public-private partnership in
areas earlier regarded as the domain of the government.
Increasing acceptance of private sectors and NGOs in
many areas is a case in a point. The thrust of the HPSP
and HNPSP is implementation of the EPS (currently termed
ESD) through decentralized delivery on one-stop service
models, and with increased involvement of the private
sector and NGOs. NGOs are a significant and growing
source of HNP services in both rural and urban
Bangladesh. Assessments of the performance of
partnerships on equity are mixed; the only clear point
perhaps is people's expectation and perception that the
public sector is more equitable. This lack of clarity is
further complicated by the question as to whether or not
equity concerns are less of a problem when the
partnerships involve public/not for profit providers
rather than public/for profit providers or it is
other-wise. There is currently insufficient evidence to
support the case that the difficulties of vulnerable
populations with regard to access and equity are
ameliorated within the non-state environment. This is a
case where societal values regarding policy should take
precedence over a strict cost calculation. Further,
there is consensus that there is vulnerable population
for which protective government measures are necessary.
Objectives:
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To understand the extent to
which private providers help expand access to care for hard to
reach groups.
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To understand Bangladesh
country experiences about issues and problems that arise from
public- private partnerships.
There are contemporary social
movements in different sectors promoting participation as a
prerequisite for claiming human rights. But, various health care
reforms taken in the country had a very limited scope for
participation by citizen and there is hardly any mechanism or an
institutional process for citizen’s participation for ensuring
accountability with respect to provision of comprehensive health
service. Participation contracts enhancing civil society
representatives, vulnerable and marginalized and capacity building
of these stakeholders in terms of leadership is a pre-requisite if
participation is to lead to health service accountability. In
addition to that of community participation, service accountability
requires more investment of resources by the state. In this context
civil society organizations and researchers need to focus more on
partnership between government and the citizens and community in the
form of public-public partnership.
Objectives:
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To understand the present
status of participation of citizens in health care system both
at national and at local level
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To explore the scope of
public-public partnership as a model of delivery that provides
services for the people and is accountable to the people of
Bangladesh
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