How much opportunity does Bangladesh have in healthcare sector as India limits visas?

Experts say reforms in service quality are crucial to fully seize the opportunity

India’s visa restrictions, imposed in mid-August due to diplomatic tensions following a political transition in Bangladesh, have created a significant opportunity for the country’s healthcare sector, according to industry experts.

However, the extent to which the opportunity can be seized depends on several factors.

Concerns about the quality of healthcare services in the country, which have long been raised by patients and their families, remain a major challenge.

Patients' relatives, healthcare entrepreneurs, and government officials agree that in order to fully capitalise on the situation, several reforms, including improving service quality, must be implemented.

Several patients’ families voiced the need for accurate diagnoses.

They criticised practices like prescribing excessive medication or unnecessary tests.

In addition, they called for changes in the way doctors interact with patients.

Chief Advisor’s Special Assistant Sayedur Rahman told bdnews24.com, "Patients are staying in the country and spending locally. This is a major opportunity."

He pointed out that the interim government is taking steps to enhance the healthcare sector’s capacity.

Sayedur said private institutions have been urged to reduce treatment costs.

Regarding complaints about excessive testing and overprescription, he said: “It's a misconception that doctors in Bangladesh conduct more tests than necessary.”

“However, advanced treatments like cancer care or transplants require extensive testing anywhere in the world.”

Bangladeshis frequently travel to India for treatment of cancer, heart disease, kidney problems, and reproductive health issues.

The exact number of people who travel to India for treatment each year is not available from the relevant government department.

Indian publication The Print, citing the country’s government data, reported that in 2023, India issued nearly 1.6 million visas for Bangladeshis, of which 450,000 were medical visas.

Many others travel on tourist visas to seek medical care, which means the actual number of Bangladeshis seeking treatment in India is likely higher.By August 2024, India had issued 800,000 visas to Bangladeshis across 15 categories, including 200,000 medical visas.

However, following the political unrest, visas are now restricted to medical and emergency cases, with limited appointments available for medical visa applications at five operational centres.

WHY DO PATIENTS GO TO INDIA FOR TREATMENT?

Relatives of several patients said doctors in Bangladesh do not provide sufficient attention to their patients and often fail to listen to their concerns.

In many cases, they are unable to make accurate diagnoses and prescribe unnecessary medications.

As a result, those who can afford it are turning to India for treatment.

Masum Billah Chowdhury, a cloth merchant from Narshingdi’s Madhabdi, has travelled abroad several times for the treatment of his father, father-in-law, and younger brother.

He has visited India the most. Each trip costs him around $2,500 to $3,000.

Masum told bdnews24.com, "There is a difference in the healthcare systems between Bangladesh and abroad.

“If changes were made to the medical system in Bangladesh, people wouldn't have to go abroad for treatment."

He added, "In foreign countries, the diagnosis is better, doctors take the time to listen to patients, and the overall approach is better.

"India not issuing visas is a big opportunity for us. But to make the most of this chance, doctors need to improve their behaviour.

“The practice of accepting incentives from pharmaceutical companies and recommending unnecessary diagnoses must be stopped.”

Nihar Ranjan Dhar, another businessman from Old Dhaka, said: "The negligence of doctors, excessive billing, and unnecessary expenses in Bangladesh often force people to go abroad."

He recalled an incident where his daughter was diagnosed with a heart condition at a large hospital in Dhaka.

"The doctor said she needed surgery immediately, which would cost Tk 600,000 to Tk 700,000. I had a visa, so I quickly took her to India’s Chennai.

“They didn’t perform any surgery; she recovered just with medication.

“Now, tell me, where should I go? If we had proper treatment here, no one would go abroad."

On Dec 21, during a roundtable meeting titled “Overseas Medical Treatment: Way of Outcome” at the Centre on Integrated Rural Development for Asia and the Pacific, or CIRDAP, auditorium in Dhaka, Secretary to Medical Education and Family Welfare Division Sarwar Bari said a large number of people went abroad for treatment due to a lack of trust in local healthcare.

Ahmed Ehsanur Rahman, a researcher from the International Centre for Diarrhoeal Disease Research, Bangladesh, or icddr, b, said over 800,000 people travel to more than 19 countries, including India, Singapore, and Thailand, for treatments such as cancer, kidney disease, heart conditions, and eye ailments.

He added that 51 percent of these people seek treatment in India.

According to his findings, 53 percent of patients who sought treatment abroad did so primarily for diagnosis or check-ups.

A BIG OPPORTUNITY FOR BANGLADESH

India's visa restrictions could potentially lead to a noticeable increase in patients seeking care at private hospitals in Bangladesh, said MA Mubin Khan, president of the Bangladesh Private Medical College Association, or BPMA.

He told bdnews24.com, "India has been a popular healthcare destination for Bangladeshi patients.

“However, due to recent challenges with visas and travel, many are now compelled to seek treatment locally."

Mubin believes the halt on Indian visas could be seen as a turning point for improving the nation's healthcare services, but certain reforms are necessary to capitalise on this opportunity.

He emphasised the need to focus on hiring and training skilled doctors, nurses, and healthcare workers, as well as establishing specialised centres for cancer, heart diseases, and neurosurgery.

Affordable, quality healthcare must also be ensured.

In addition, there is a need for modern hospitals to meet international standards, along with the expansion of existing ones.

Esam Ebne Yusuf Siddique, chief operating officer, or COO, at Square Hospital, highlighted that 95 percent of patients seeking medical treatment abroad have no real necessity to do so.

"Only around 5 percent of cases require treatment abroad due to the unavailability of certain technologies, equipment, or expertise here," he added.

He pointed out that Bangladesh does have advanced healthcare services.

Esam said many people travel to India for basic cardiac surgeries or angiograms that are regularly performed in Bangladesh.

He believes that while Bangladeshi doctors have the ability to treat patients effectively, there is a gap in their counselling skills.

"In India, doctors are trained in counselling. Here, we need to improve in this area.

“Our doctors provide the right treatment, but sometimes fail to communicate it properly."

Bangladesh has made strides in specialised care.

Dhaka is home to the National Institute of Cancer Research and Hospital, with plans under way for regional cancer hospitals.

In addition, the government has established a ‘super-specialised hospital’ at Bangabandhu Sheikh Mujib Medical University to ensure advanced treatment for complex diseases among underprivileged communities.

However, access to treatment for complex diseases like cancer, heart conditions, and kidney ailments remains largely concentrated in Dhaka.

Specialised centres for cancer and cardiac treatment have been established in the private sector, with a few private cancer hospitals already operational.

Ashis Kumar Chakraborty, managing director of Universal Medical College and Hospital, told bdnews24.com: "Every facility available in developed countries is now present in Bangladesh. The pandemic proved that.

“During COVID-19, when no one could travel, all treatments happened here successfully."

He said procedures such as kidney, bone marrow, and liver transplants, along with joint replacements, are now accessible at reasonable costs in Bangladesh.

Dr Asish believes that the root cause of foreign travel for treatment is more of a psychological issue than a lack of medical resources.

To rebuild patients' trust in the local healthcare system, he suggested introducing a referral system.

He said, "This system will prevent anyone from seeing any doctor directly. First, they must consult a general physician, who will assess the patient and advise which specialist they should see.

“Currently, patients often have to wait for days to see some doctors, but this issue will no longer exist under this system."

Labaid Group’s Managing Director AM Shamim shared that their hospital has seen a slight uptick in patient numbers since India’s visa restrictions.

“Even though these patients cannot travel to India, their treatment can still be provided within the country. This could be around 10 to 20 percent.

“Most of those who go to India do so for a second opinion.

“Another group consists of people from the Jashore and Khulna, who bypass Dhaka and cross the border to seek treatment in India."

In Bangladesh, there are 20,000 beds available for tertiary care, and around 20 percent of these remain empty.

Dr Shamim believes that patients who would have gone to India could easily be treated in Bangladesh in the available spaces.

HOW TO CAPITALISE ON OPPORTUNITY

Prof Md Abdul Hamid from the Institute of Health Economics at Dhaka University told bdnews24.com that a lack of trust in Bangladeshi doctors and inadequate infrastructure has driven patients abroad for treatment.

To address this, he emphasised the need for reforms in these areas.

Prof Hamid said, “Patients have high expectations from doctors. They want empathy, time, and attention. Doctors need to carefully listen to patients, and explain prescriptions clearly.

“It’s not just about the doctors; the entire system must become more patient-friendly.”

He also recommended improving the quality of diagnosis, encouraging public-private partnerships in healthcare, ensuring patient safety, and setting up a kidney commission.

“Our diagnostic accuracy is often lacking, which must be improved. We are also short on skilled personnel for treatments like cancer care, but this gap can be filled through short-term training.

“Private hospitals should partner with public ones to enhance services.”

The professor added, “At Dhaka Medical College, some services are unavailable after noon, but patients keep coming.

“The government could set rates, allowing patients to have tests done at private hospitals and bring the results.”

On kidney treatment limitations, he said many people in Bangladesh cannot donate kidneys due to legal constraints, yet they can do so abroad.

He suggested that establishing a National Kidney Commission would address this issue, where donors and recipients could be registered.

“The commission could set a standardised value for kidney donations, ensuring that patients in need can access them in a regulated system,” Hamid said.

INITIATIVES TO IMPROVE SERVICE QUALITY

Director General of the Directorate General of Health Services Md Abu Zafar told bdews24.com that

Bangladesh's healthcare system isn't particularly lagging behind.

However, there are several reasons why people still seek treatment abroad, some of which are "psychological”.

"It's not just India; people are travelling to many countries. They have the right to do so. But the capabilities we have were evident during the coronavirus pandemic.

“At that time, people couldn't go anywhere, not even to India. Our doctors treated patients in the country.”

He added that despite some limitations, Bangladesh’s healthcare sector is ahead of many countries, with private healthcare improving as well.

Zafar said, “It’s not possible to show improvements in just one or two weeks. This will take time. I am trying to promote this message nationally in a positive way.

“I am instructing doctors to be more compassionate towards patients.”

He said the healthcare system in Bangladesh has been severely damaged by long-standing syndicates.

“The health sector has been destroyed, and we are trying to fix it.”

The interim government took charge on Aug 8, 2024, a few days after the fall of the Awami League in the face of a student-led mass uprising.

The Muhammad Yunus-led government formed 11 commissions to reform different sectors of the state.

One of them is the Health Affairs Reform Commission, headed by AK Azad Khan.

Chief Advisor’s Special Assistant Sayedur told bdnews.com that most patients seeking treatment abroad are dealing with heart diseases, cancer, kidney issues, transplants, and infertility.

He highlighted a meeting held on Dec 15 at the Ministry of Health and Family Affairs with representatives from government and private hospitals and specialists, where discussions focused on making treatment for these diseases easily accessible and affordable within the country.

"To enhance the capacity of government and private hospitals, we’ve made it clear that this must not be for profit.

“We’ve also asked to expedite ongoing projects related to these diseases."

Sayedur said the government will grant tax exemptions on the import of medicines and equipment for these diseases, considering the country's financial capacity.

He added, "We are encouraging protocol-based treatments to resolve these issues.

“For instance, cancer treatments worldwide will use the same medicines. There will be no unnecessary prescriptions."

Regarding the issue of counselling patients, Shamim of Labaid group said they have launched a project called "Aastha" to train doctors and healthcare workers.

He highlighted that from January onwards, counselling practice for healthcare workers will begin.

"We are going to implement this system across 40 of our facilities, including hospitals and diagnostic centres.

Shamin added, “Their job will be to explain in detail to patients who come for treatment of major diseases, so they are satisfied and fully understand what has happened to them and what treatment they will undergo.

“They will also clarify what actions need to be taken after treatment and the progress of recovery," he concluded.

[Writing in English by Sheikh Fariha Bristy]