Health and Family Welfare Minister Samanta Lal Sen has pledged to take stringent measures against all illicit and unauthorized hospitals and clinics in Bangladesh, aiming to root out corruption within the healthcare sector.
“I have made it clear that there will be no tolerance for corruption. Unauthorized and unlicensed medical facilities cannot be allowed to operate. While it’s not possible to resolve this overnight, these illegal clinics and hospitals must be shut down. Measures will be taken against them,” he said on Tuesday (January 16).
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The Medical and Private Clinics and Laboratories Ordinance, 1982, bars hospitals, clinics, or diagnostic centers from operating without the approval of the health directorate. But repetitive deadly shocking incidents shed light on the irregularities of unauthorized hospitals and lack of compliance with existing regulations.
A five-year-old child passed away on December 31, 2023, following a circumcision procedure conducted by a doctor at United Medical College Hospital in the capital’s Badda.
The minor boy’s father Shamim alleged that his son died due to negligent treatment while being kept on life support at United Hospital from 31 December to 7 January. Later, on 14 January, the health directorate shut down the medical college for operating illegally, without any license. This is not a rare case here. Unexpected casualties and mismanagement in private hospitals often made headlines despite the government efforts to keep the hospitals, clinics at bay.
The health directorate launched a comprehensive nationwide survey last year, uncovering 11,940 hospitals, clinics, and diagnostic centers operating illegally and without proper facilities. Among them, 2,916 had not applied for a license, while others were operating without approval or with expired licenses.
The health directorate responded with a series of raids, resulting in the closure of around 2,500 unlicensed facilities, and the imposition of fines on various clinics. But alarmingly, the owners of such unauthorized healthcare facilities re-open the banned or closed hospitals without following proper regulations. Experts said such an attitude of the authorities concerned is giving space to the owners of the illegal private healthcare facilities to run the activities, which is putting public health in jeopardy.
According to research by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), around 14% of private hospitals in Bangladesh have never filed for registration. This is attributed to various challenges associated with licensing, including short validity, the need for multiple clearances from authorities, prolonged wait times for approval, and high fees.
Why Private Healthcare Is Failing
Once celebrated for their advanced technology and service capabilities, private hospitals and diagnostic centers, which were initially seen as a solution to the public hospitals’ patient influx challenges, have deviated from their commitment to service and plunged into chaos.
A recent Transparency International Bangladesh (TIB) survey exposes the dire state of private healthcare. It reveals profit-driven practices in private hospitals, highlighting a “commission-based marketing mechanism” where referrals are exchanged for commissions. This strategy benefits physicians, facility owners, and middlemen at the expense of the most crucial stakeholders—the patients.
Regrettably, the same profit-driven motives affecting private healthcare have infiltrated public hospitals. Despite being state-funded, these institutions, already strained, should be affordable havens for patients, particularly the less affluent. However, shortages in staff, resources, and bureaucratic obstacles in Bangladesh’s public sector hinder easy access to medical services. Patients endure layers of corruption and mismanagement in the service delivery process.
Given the price that you have to pay and the suffering you have to go through to get a medical service, you may be forgiven for forgetting the fact that access to healthcare is a basic human right, not a privilege.
Private healthcare, now utilized by 63.3% of households across 15,698 facilities, has become a pivotal player. Its dynamics are crucial not only for the multitude of dependent patients but also for policymakers tackling the nation’s expanding health demands.
The private healthcare sector was introduced to alleviate pressure on public hospitals, foster innovation, and retain patients seeking better services abroad. Despite progress in primary healthcare access, the private sector has faced criticism for excessive fees and questionable services. While recognizing the importance of a business motive for privately funded institutions, recent scrutiny reveals a disregard for medical ethics in pursuit of profit. Striking a balance between profit-making and essential medical care is crucial, as the sector must not lose sight of its core purpose.
TIB Executive Director Dr Iftekharuzzaman recently said, “The booming private healthcare sector has helped more people have access to medical services, but those who are involved in the private healthcare services are trying to turn the facilities into business outlets,” adding that the basic standards are not being maintained.
Skyrocketing fees, unregulated costs, subpar treatment, and a shortage of trained professionals are now the synonym for profit-driven health facilities. While enhanced regulation and law enforcement can alleviate these issues, expecting regulation alone to solve everything is unrealistic. A balanced approach, combining stringent oversight with systemic improvements, is necessary for lasting change and improved healthcare services.
Consider the ethical side of referrals in healthcare – a doctor’s responsibility to guide patients to the right specialists, hospitals, and treatments. While legalities might permit certain practices, ethical considerations play a crucial role. For instance, a doctor can choose prescriptions based on relationships with pharmaceutical reps, recommend numerous tests, or set high surgery prices—all legally. This is where ethics, guided by principles like the Hippocratic Oath, come into play.
Some issues, like the scarcity of skilled staff and high equipment import costs, aren’t solely the private sector’s doing. Addressing these requires a comprehensive solution—promoting ethical practices, enhancing monitoring and regulation, and eliminating barriers to a people-centric health service.
