Bangladesh Health Watch (BHW), a citizens’ platform for improved accountability of country’s healthcare system through evidence based policy review and citizen feedback, recently conducted two research:

1. Re-visiting the Front Line Health Workers’ (FLWs) working with Covid-19 patients: how far has the situation improved in a month since the last survey led by Professor Dr. Syed Masud Ahmed, Director, Centre of Excellence for Health Systems and Universal Health Coverage, James P Grant School of Public Health and BRAC University.
2. Different aspects of health sector financing of Covid-19 response, led by Professor Dr. Rumana Huque, Professor of Economics, University of Dhaka and Executive Director, ARK Foundation

The findings of the research disseminated virtually on 20 June 2020. The session was moderated by Mushtaque Chowdhury, Convener BHW and the Divisional Advisors of COVID19, BHW working Group Members’ and a few Journalists were present among others. A total 32 participants were present at the event.

 

Different aspects of health sector financing of Covid-19 response:

The findings of the research was presented by the lead researcher Professor Dr. Rumana Huque. The objectives of the research were to identify major areas of allocation and identify gaps, if any; to assess if allocations had been effective, efficient and transparent; and to draw out lessons learnt and implications for budget implementation. The period of the study was 1st January- 5th May, 2020. The study found that despite COVID-19 crisis, health sector remained neglected as a national priority. Out of the 18 stimulus packages announced by Bangladesh government (BDT 1,01,117 crore, 3.6% of GDP) the stimulus package for health (BDT 850 crore) represents 0.08% of total stimulus package.

Lack of comprehensive Covid management observed with less attention on long-term, coordinated and sustainable investments. Despite budgetary allocation, there had been delays in use of emergency fund and in many cases Bangladesh acted like `fire fighting’ and ‘ad-hoc’ basis. The typical bureaucratic and centralised model hampering the participation of all sectors of the society including NGOs. Lack of transparency and accountability in budget allocation and use also observed. The study recommended to increase budget allocation 3 – 4 percent of GDP for health sector and resource should be allocated based on comprehensive need assessment and an execution plan. While making any plan public health needs should be prioritised. Decentralization of decision making and improved transparency and accountability is key for proper resource utilization, as the study recommended.

 

Re-visiting the Front Line Health Workers’ (FLWs) working with Covid-19 patients:

How far has the situation improved in a month since the last survey: The findings of the research was presented by the member of the research team Dr. Bushra Zarin Islam. The original quick telephone survey was done to explore the perceptions and opinions of the FLWs regarding personal protection and safety while attending suspected/confirmed COVID-19 patients and this Re-interview was done to check whether, and to what extent, any change occurred in the areas of concerns expressed in the earlier study.

Total 46 respondents (out of 60 surveyed earlier) from 14 districts and 43 health facilities were interviewed over telephone in six days from 6 to 14 May 2020. 76% FLWs informed that they received PPE while in original study it was 75%. It is observed that only 19.6% FLWs training on PPE while it was 56.7% in the previous study. But among paramedics the percentage has increased 37.5% in May but it was 36.8 in April. Among those who PPE 56% found satisfied. Only overall 8.7% FLWs received training on management while it was 48.3% earlier. Besides PPE other observations are 80%post-graduate doctors were happy with the duty roaster and 24% FLWs informed that authority arranged accommodation at or near workplace for them. Transport and Food was managed by the authority for 28% and 24% respondents respectively, the study found. The study concluded that, the issues raised such as quantity and quality of PPEs supplied, trainings, measures to ease mental health of the FLWs etc. needs urgent attention from the decision-makers in order to have a grip on the current situation until it is too late.

 

Open discussion: Participants shared different comments and suggestion on the two research and beyond which are as follows:

• It would be better if the study on PPE compare the quality based on the guideline of WHO.
• Many doctors and nurses are got infected while treating non covid patients as because sometimes patients are not disclosing the information properly.  Budget is limited but lack of capacity of DGHS to utilize the budget is also a big problem.
• DGHS should improve their overall management capacity including financial planning and management. This is important for effective fund utilization.
• Proper initiatives should be taken to make active the private health to provide covid and non-covid services properly. Private Doctors should start their private practice.
• Track the use of PPE (who uses, what quality, are they properly donned and disposed) and get a qualified opinion on PPE quality. Undertake this in covid and non-covid hospitals. Should be an observational study plus interviews. Will be very helpful in answering the question if so many doctors are dying due to PPE problems. It is important to monitor properly that PPE and other operations are going on as per IPC guideline.
• It is observed that some people are using PPE while not taking care of COVID positive patients. Sometimes we reuse the N-95 musk but it lost effectiveness due to reuse.

 

Divisional advisors can assist BHW to share the findings and recommendations if they get the policy briefs.

• It is important to monitor that duty roaster for doctor and nurse is preparing and maintaining properly.
• Officials of DGHS have lack management capability and wastage is a big problem here.
• BHW may track expenditure of how 10 thousand crore COVID allocation is spent and procurement of testing kit.
• This is also important to see how efficient/cost-sensitive is government's procurement.
• Government should ensure the free flow of information of all projects.
• Government should revisit its experience to manage the Rohingya crisis and the learning could use in covid management. During the first influx of Rohynga government immediately recruited 100 staff for smooth operation.
• World Bank/ ADB has allocated fund but as of today there is no plan how to use this fund. This slowness is challenging.
• Allocated budget in the health sector is not used fully as it is not allocated properly. There is a shortage of human resources but the government is not paying attention to recruitment.
• No budget is allocated for public health and urban health is not addressed properly.
• Decentralization is important to use the budget properly.
• In PPR there is no clause regarding procurement during pandemic/ emergency.
• Infrastructure is not utilized due to the lack of human and other resources. This is due to lack of proper planning.
• Even IEDCR officials are not aware of their mandate properly. This is the reason of CDC and IEDCR conflict. A clear line should be in place between IEDCR and CDC.
• To manage this pandemic Whole of Society approach is important.
• For total reformation government can form a Health Commission. The reformation should be based on the status of population and diseases patterns.
• BHW hope that divisional advisors will extend their hand to assist BHW in advocacy with government.

 

Media coverage: The event got good media attention. At least 15 leading print and electronic media including Prothom Alo, The New Age, The Business Standard, The Bonik Barta published report on the event.