Bangladesh not prepared to tackle sudden increase of non-communicable diseases: Health Watch Report

A new report indicates Bangladesh’s health system is not prepared to tackle the challenges of non-communicable diseases such as heart attack, stroke, cancer, diabetes and chronic lung diseases that account for over half of the total deaths in the country.

James P Grant School of Public Health at BRAC University published the bi-annual ‘Bangladesh Health Watch Report 2016’ on Thursday.

It called upon the government to make primary level health facilities “the focus of all activities” including prevention of those diseases.

It also urged the government to establish a “comprehensive surveillance system and registry” for the major non-communicable diseases or NCDs at the national level including monitoring and evaluation of NCD programmes.

Prevention of risk factors such as fast-food and tobacco has also been stressed.

Member of the Parliamentary Standing Committee on Youth and Sports Nahim Razzaq MP, Diabetic Association of Bangladesh President Prof AK Azad Khan, Gonoshasthaya Kendra founder Zafrullah Chowdhury, DFID Head in Dhaka Jane Edmondson, and BRAC Vice-chair Mushtaque Chowdhury spoke at the launch.

Mushtaque Chowdhury said the report was aimed at pointing at issues that need attention.

NCDs are regarded as the major barriers to economic growth and social development. Four in five die of NCD-related diseases in the world.

Bangladesh is at a crossroads as it is currently undergoing a demographic transition towards relatively ageing population and an epidemiological transition in which NCDs are rising.

In Bangladesh, NCDs, according to a WHO report in 2014, account for 59 percent of total deaths. Of these, cardiovascular diseases contribute the highest 17 percent followed by chronic lung diseases at 11 percent and cancer 10 percent.

But health service delivery is less focused on preventive care at primary and secondary levels. There is no standard operating procedure for referrals, according to the report.

Equipping the health care centres with basic NCD medicines, equipment, skilled workforce and a functional referral system is “necessary with commitment at the highest level to address the emerging NCD epidemic in the country”, the report added.

At primary healthcare level, NCD corners have been established at 300 Upazila health complexes, which are mostly “ill-equipped” and go against integrated service delivery approach.

At secondary level, services are provided as part of general services and there is less focus on preventive aspects, it said. At tertiary level, speicalised institutes provide specialised services without any collaboration network downwards.

NGOs and private sector mostly focus their works at urban level, according to it.

Analysing the impacts of chronic illness to ‘catastrophic’ spending and impoverishment, the report showed that chronic illness can cause large out-of-pocket payments, more than double, relative to other types of diseases.

The proportion of catastrophic spending for chronic diseases is highest among those from lowest quintiles at 14 percent, compared with 6.6 percent among the richest.

Cancer forces the highest average out-of-pocket payment followed by epilepsy, diabetes, high blood pressure and arthritis.

MP Razzaq suggested PPP model for capacity-building efforts for NCD prevention and management as short-term measures.

He said he would try to incorporate issues pointed out in the report into the new national youth policies for better prevention of the diseases.

Prof Azad pointed out risk factors such as fast food and tobacco consumption. He insisted advertisement controls of fast food targeting school children, which, he said, has not been done.

He also stressed on smoking control. “Why haven’t we been able to ban tobacco cultivation?” he asked.

Zafrullah blamed expensive treatment at the private facilities on a lack of public oversight.

Citing examples of his own organisation, he said it is possible to offer cheaper services to the people.

“Eye lens cost only Tk 300 at my organisation. But people have to pay between Tk 8,000 and Tk 20,000 in the market for buy them,” he said.

The Rockefeller Foundation has funded the Health Watch Report which is being published since 2006.