Dr. Muhammad Mahtab Hossain Mazed

The medical and healthcare sector in Bangladesh is generally divided into two sub-sectors, public health and medical education. Good health is one of the basic human needs and access to healthcare is a fundamental right of everyone. Health sector is very important for the development of a country and the quality of life of people. Development of medical system is a big challenge especially in developing countries like Bangladesh. In the country's health sector, through various efforts, achievements, failures and changes of the public and private sectors, the improvement of the quality and service system of health care has been possible, but still many problems remain. Medical system is one of the most important sectors of a country. It not only ensures the good health of the people but also plays a major role in the national economy. Although Bangladesh has made significant progress in the medical sector since independence, many challenges still remain. As there are successes in achieving medical care, there are also failures. This article discusses various aspects of the success and failure of the medical system in Bangladesh.

> Success of the medical system'-

1. Major improvements in the healthcare sector
A number of important achievements have been achieved in the health sector of Bangladesh, especially in dealing with epidemics and emergency health crises. In Bangladesh, the birth rate has decreased, the infant mortality rate has also decreased a lot. The Department of Health and other public and private institutions work together to improve the quality of healthcare.

2. Reducing child and maternal mortality

Bangladesh has achieved great success in reducing infant and maternal mortality in the last few decades. Improvements in maternity and neonatal services have reduced the maternal mortality rate from 173 to about 165 per 100,000 live births. Similarly, the infant mortality rate has fallen below 30 per 1,000 live births.

3. Immunization programs and disease eradication
National Immunization Program is being successfully implemented in Bangladesh. As a result many diseases such as polio, tuberculosis, zinc, measles and chikungunya etc. have been brought under control. Apart from this, Bangladesh has been praised internationally as a polio free country. Vaccination for children in the country has reached almost every child in the village.

4. Advances in pharmaceutical industry

The pharmaceutical industry of Bangladesh currently has a capacity to meet 98% domestic demand and exports drugs to around 150 countries. In particular, the drug policy of 1982 played a major role in the development of this industry.

5. Use of health information and technology

Digital healthcare is currently one of the most important advancements in the medical sector in Bangladesh. Healthcare has become more accessible through telemedicine, online appointments, mobile health apps, etc.

6. Public health education
The improvement of healthcare system is not only limited to the delivery of medical services, but also through health education and increasing public awareness, healthcare has become accessible to all. People are now very aware of malaria, dengue, chikungunya, and other health problems and the role of various health campaigns and media in raising this awareness is very important.

7. University and medical training
Many high quality medical educational institutions have been established in Bangladesh, such as Dhaka Medical College, Chittagong Medical College, and Rajshahi Medical College, Government Homeopathy Medical College Hospital is the first higher (graduate) homeopathic medical education institution in Bangladesh. Government Unani & Ayurvedic Medical College & Hospital is Bangladesh's first Higher (Graduate) Unani & Ayurvedic Medical Education Institution. etc. Also, Bangladesh has been able to produce many skilled doctors by sending doctors to various developing countries and providing high quality training. This training and education system has played an important role in improving the quality of the medical sector in Bangladesh.

> Failure of medical system:-

1. Health care disparities
Major inequalities remain in Bangladesh's health system. There is a wide disparity in access to health care between urban and rural areas. Quality medical care is available in big hospitals and health centers in cities, but it is difficult to get proper services and facilities in rural areas. In many remote areas, villagers are left in a vulnerable situation due to lack of proper doctors or health facilities.

2. Inadequacy of treatment and infrastructural problems

Most of the hospitals in Bangladesh lack modern technology and necessary medical equipment. Besides, the infrastructure of many hospitals is very old and service systems are often not functioning properly. As a result, doctors face many problems while providing the necessary services. Doctors are often unable to provide services due to the pressure of overcrowded patients in the big hospitals of the city.

3. Physician status and shortages
There is a huge problem with the number of doctors and their quality in Bangladesh. There is a shortage of doctors in major hospitals in the city, and most of the doctors go abroad after completing their professional careers and studies, creating a huge shortage in the country's health sector. Similarly, many doctors are unwilling to work in the low pay and poor environment, making it often impossible to get proper treatment.

4. Hospital mismanagement and corruption

The quality of medical care in many places in government hospitals is poor. Due to corruption, drugs in government hospitals are sold on the black market, bribes are required to receive treatment, and patients are not properly served.

5. Commercialization of private hospitals

Private hospitals are mostly run for profit. As a result, the cost of treatment goes beyond the reach of the common man. Many hospitals overcharge patients for unnecessary tests and treatments.

6. Neglect of mental health care

Mental healthcare is still neglected in Bangladesh. Very few hospitals and doctors are devoted to mental health care. Social prejudices about mental illness have also compounded the problem.

7. Restrictions on medical education and research

There are many problems in maintaining quality in the medical education system of the country. Bangladesh lags behind in innovative research in the medical field due to lack of funds and opportunities for research.

8. Lack of quality control of medicines

There are allegations of production and sale of some low-quality drugs in Bangladesh. Due to unregulated activities of pharmaceutical companies and lack of adequate quality control, patients often do not get the right quality medicines.

9. Progress in diagnosis is slow

Diagnosis often requires advanced tests, which most hospitals in the country do not have. Lack of advanced lab facilities leads to delay in detection of diseases, hence timely initiation of treatment is not possible.

> Solutions

1. Budget increase in public health sector

Currently the health sector budget is only 2-3% of GDP. It needs to be increased to at least 5-6%, so that government hospitals can be developed.

2. Development of rural healthcare

Incentives should be given to recruit enough doctors in villages. Community clinics should be strengthened.

3. Management Development of Government Hospitals

The quality of service in government hospitals should be improved by reducing corruption, so that people get affordable treatment.

4. Regulation and policy formulation of private hospitals

Specific policies should be made for private hospitals and clinics, so that they provide medical services at fair prices.

5. Expanding mental health care

Mental health centers should be set up in every district and awareness should be raised about mental illness.

6. Investing in medicine and medical research

Funding for medical research should be increased to encourage domestic research and linkages with international research should be established.
Finally, integrated health system means a health system composed of doctors, pharmacists, nurses, medical technologists and health assistants. There is no doubt that there is progress in Bangladesh's health sector including infrastructure in keeping with the developed world. But it is also true that people are losing confidence in the country's medical system due to the failure to build an integrated health system. Because of this, the economy of Bangladesh is also suffering a lot. The current interim period
Among all the organs of state reform under the government, the health sector must be given more priority. It is essential to identify the ongoing crises through in-depth analysis with sufficient time. But it can be made more effective and robust through necessary reforms and developments. However, to protect the overall health of the country's public, proper planning and its corruption-free implementation is the need of the hourThe development of the medical system in Bangladesh is possible by implementing the right policies, ensuring equal health care for all at all levels, preventing corruption, and increasing public awareness.

The writer is a, columnist and researcherFounder and Chairman, Jatiya Rogi Kallyan Society