Shamim Ahmed, Ilias Mahmud and Jahir Uddin Ahmed
Sooner or later, like all other pandemics,Covid-19 pandemic will end. However, this pandemic has already exposedsome significant weakness and poor leadership of our health system.Our health care system, in many cases,seems dysfunctional for majority of the people in Bangladesh.
It is very costly, dreadfully unequal, and awfully unreliable in terms of quality and coverage. There has never been a better time to think more unbendingly about the future ofBangladesh's health system. Therefore, this is an appropriate time to conduct a health system reform that will promote universal access to affordable health care and promotion services to all.
This pandemic reminds us of the Greek philosopher Herophilus, who once said, “When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied.”
News of COVID-19 mortality and morbidity among the most privilegedpopulation group in Bangladesh is a testimony that unless we protect the health of underprivileged people no one is immune from an infectious disease like COVID-19.
Health is a public good and the dream of a healthy nation will remain unreachable if we continue to treat it as a private good.
Catastrophic effects of COVID-19 in the world’s richest country USA is an evidencethat shows us what happens when we serve health as a private good. To prevent suchcatastrophe during any future pandemic, we must strengthen our almost non-existent universal health coverage and public health services.
The current pandemic proved that low investment in public health
and universal health coverage is a threat to public health security
of any country. Our responses to public health emergencies cannot
succeed if any part of the country or group of people is left behind.
People, irrespective of socio-economic status, age, sex and gendermust have access to basic health care services. Universal health coverage ensures that all individuals and communities receive appropriate and inclusive health services without facing financial hardship. Universal health coverage includes full range of essential and quality health care services, from health promotion to prevention, treatment to rehabilitation, and palliative care.
A resilient universal health care system can efficiently respondto public health emergencies through early detection and prevention, without hampering peace and stabilityas well as protecting the economy of the country. The Covid-19 pandemic has already exemplified that pliability is a necessary feature of any health system while addressing complex challenges like a pandemic.
Countries with effective universal health coverage, such as South Korea, Singapore andCanada,have been performing better during the covid-19 pandemic. For an example, Canada's publicly funded health care system is very dynamic, and they have made regular reforms over the past four decades and will continue in response to changes within medicine and throughout society.
Although several changes have been initiated, the basics, however, remain the same. Providing universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay.The basic values of fairness and equity that are demonstrated by the willingness of Canadians to share resources and responsibility are displayed in Canada's health care system and have been reflected in the modifications and major reforms made to the system since its inception.
The system has been and continues to be modified as the country's population and circumstances change, and as the nature of health care itself evolves.In general, Canada's Constitution sets out the powers of the federal and the provincial and territorial governments. Under the Constitution Act, 1867, the provinces were responsible for establishing, maintaining and managing hospitals, asylums, charities and charitable institutions, and the federal government was given jurisdiction over marine hospitals and quarantine.
Before World War II, health care in Canada was, for the most part, privately delivered and funded. In 1947, the government of Saskatchewan introduced a province-wide, universal hospital care plan. By 1950, both British Columbia and Alberta had similar plans.
The federal government passed the Hospital Insurance and Diagnostic Services Act in 1957, which offered to reimburse, or cost share, one-half of provincial and territorial costs for specified hospital and diagnostic services. This Act provided for publicly administered universal coverage for a specific set of services under uniform terms and conditions. Four years later, all the provinces and territories had agreed to provide publicly funded inpatient hospital and diagnostic services.
The current pandemic proved that low investment in public health and universal health coverage is a threat to public health security of any country. Our responses to public health emergencies cannot succeed if any part of the country or group of people is left behind.
Therefore, we propose that Bangladesh should reassess policy priorities and direct greater funding to healthprioritising universal health coverage; increase investment in public health systems such as disease prevention including strengthening the public health surveillance systems and infrastructure; improve working conditions and safety for healthcare workers.
Through a national, integrated health insurance system, we should develop a mechanism to ensure that irrespective of socioeconomic status, people have access to affordable quality health care and promotion services.
Last but not least, prioritising universal health coverage and public health system must become pivotal in our post COVID-19 response or we may be sitting unprepared when another pandemic strikes.
Shamim Ahmed is a doctoral researcher at the University of Toronto, Dr. Ilias Mahmud is an Assistant Professor, Qassim University and Dr. Jahir Uddin Ahmed is an adjunct faculty at American International University, Bangladesh.