Improving healthcare services in EPZs and SEZs

With a population of 161 million people living in less than 150,000 sq. km. area, Bangladesh is the most densely-populated country in the world. The population density here stands at 1,015 people/sq. km. With the current population growth rate of 1.6 per cent, Bangladesh will be home to 250 million people by 2050.Alongside the growing population Bangladesh is experiencing a social and demographic transition with its industrialisation expanding and the income level rising. It is also exposed to globalisation. Although 71 per cent of the people reside in rural areas, rapid urbanisation (at an estimated rate of 6.0 per cent) is causing a population growth of 2.5 per cent in urban areas, with Dhaka city alone accounting for 40 per cent of the urban population. These factors have contributed to a rising prevalence of Non-Communicable Diseases (NCDs) in the country.Inequity in Bangladesh is high: the wealthiest 5.0 per cent of the population enjoy 30.66 per cent of the national income while the poorest 5.0 per cent consume only 0.67 per cent. Over the last ten years, Bangladesh has grown quickly in terms of its economy and human development, and has significantly reduced the proportion of people living in poverty. The country is likely to achieve its related Millennium Development Goal (MDG) target by 2015. In spite of this success, 47 million people (29 per cent of the population) still live below the poverty line, with more people at risk of slipping back into poverty in the event of any unemployment, illness, or natural disaster.Better health for people means empowerment because it also empowers them to participate in economic and public life. A pro-poor health strategy is central to establishing a harmonious society. Thus, addressing health inequities is a moral obligation. But it is also essential in view of the self-interest in the global arena.Currently 75 per cent of our health care budget is allocated for treatment of chronic diseases such as heart ailment, diabetes and hypertension. Apart from the treatment costs, the chronic diseases have other implications: more than a half of Bangladeshi people suffer from one or more chronic diseases every year, making them the leading causes of death and disability.Chronic diseases affect everyone and the number of people living with chronic diseases is expected to increase over the next decade. The first step toward preventing and treating chronic diseases is education and management.  This is where community health centres or clinics nationwide play a critical role in improving the quality of life for people with chronic diseases. Today, more than 15,000 community health centres throughout the country are supposed to be providing care to more than 100 million Bangladeshis by increasing access to health care services and educational resources.  As local and community-based health care systems in rural and urban neighbourhoods, community health centres are able to provide direct health services that are both affordable and accessible.While increasing the number of community health clinics and improving their quality of service will bring millions of people under health coverage, it is still a challenge for many to find quality health care that could help manage – even prevent – many chronic diseases, because once a disease progresses, a community health centre or a clinic will not be able to treat the patient. Rather, a large hospital which has all the specialty services will have to take care of the patient.  This means community health centres and small clinics are essential components of the health service delivery model, but unless they are linked with the tertiary care hospital the impact of them will be limited.  The government of Bangladesh is supporting the non-profit service providers such as Diabetic Association of Bangladesh for providing high-quality, affordable primary and preventive care. They are serving low-income and medically underserved communities across the country through a wide network of clinics and tertiary care hospitals. But more needs to be done on the basis of Public-Private Partnership to ensure health care for every citizen of the country.The ready-made garment (RMG) sector has been one of the biggest revenue-generators for Bangladesh, contributing 75 per cent of the export receipts. Millions of employees depend on the garment sector for a living, the majority of them being women migrating from the rural areas.  The health problems of these people and their families are similar to those in the rest of Bangladesh. Even though it is compulsory for an employer to provide health services to the garment workers, due to different factors the services the workers receive are mostly not adequate. If there are a cluster of factories in an area, the government should encourage the stakeholders to set up a large hospital in the area to support the clinics within the factories.  Through the partnership and collaboration between the clinics and tertiary care hospitals, people working in the factories and their relatives living in the surrounding areas will have access to proper health care.  Keeping the workers and their family members healthy is unquestionably a good business practice for the employers.Dhaka is the capital, but Chittagong is the lifeline for Bangladesh because of its port and the industries within, but, unfortunately, unlike Dhaka, Chittagong does not have enough health care facilities on offer for its population.  The situation in South Chittagong is even worse than in Chittagong city. From South Chittagong it takes minimum an hour and a half to go to the nearest tertiary care hospital in Chittagong city. The hospitals in Chittagong city are already overcrowded and the clinicians are found overwhelmed. A couple of new corporate hospitals, which are soon to be operational in Chittagong, might be too expensive for the majority of the people.  Both the Chittagong metropolitan area and South Chittagong need at least 10 new large hospitals, similar to the BIRDEM Hospital in Dhaka, to ensure timely and easy access to health care services for everyone.As the government is setting up export processing zones (EPZs) and special economic zones (SEZs) in different parts of the country, including Chittagong, it should think about keeping a provision for establishing 500-bed to 1000-bed tertiary care hospitals in such areas. The people living within those areas and outside should get an easy access to the hospitals. These hospitals will not only ensure easy access to health service when needed, it will also save time and money and ease the rush of patients in the cities.  It will complement the small clinics in the factories and the surrounding areas and will stimulate the economy by creating both direct and indirect employment opportunities for the people. Above all, a quick access to a tertiary care health centre means saving the valuable time for effective intervention by a specialist clinician and it can save lives also.The government of Bangladesh can consider the option of giving financial incentives to the business community to help them set up non-profit, yet self-sustaining hospitals in export processing zones and special economic zones in different areas of the country.The writer is Executive Director of Good Health, Education, and Life (HEAL) Trust, a registered not-for-profit private organisation.  mosherof@goodhealtrust.org