Hospital for South Chittagong

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 with 1015 people /sq. km. With a current population growth rate of 1.6%, Bangladesh is projected to reach 250 million people by the year 2050. Bangladesh is experiencing significant social and demographic transition with expanding industrialization, rising incomes, globalization, unhealthy environment and lifestyle, and an ageing population. Although 71% of the population resides in rural areas, rapid urbanization (at an estimated rate of 6%) is causing a population growth of 2.5% in urban areas.  These factors have contributed to a rising prevalence in Non-Communicable Diseases (NCDs) in Bangladesh. Inequity in Bangladesh is high: the wealthiest 5% of the population enjoy 30.66% of the national income, while the poorest 5% consume only 0.67%. With a GDP growth rate of 6.3%, the GDP per capita stands at $772.

Over the last ten years, Bangladesh has grown quickly in economy and human development and has significantly reduced the proportion of people living in poverty and the poverty gap ratio, making the country likely to reach its Millennium Development Goals (MDGs) target by 2015. In spite of this success, 47 million people (29% of the population) still live below poverty line, with more at risk of falling back into poverty if struck by unemployment, illness, or natural disasters

Better health for people means empowerment because it also empowers them to participate in economic and public life. Indeed a pro-poor health strategy is central to establishing a harmonious society. Thus, addressing health inequities is a moral imperative, but it is also essential for reasons of global self-interest: a more equitable society is inherently a more stable one.

Currently as a nation, 75% of our health care budget is allocated to the treatment of chronic diseases. That's more than Taka 500 crore a year spent on treating preventable, chronic conditions such as heart disease, diabetes and hypertension.  And the impact of chronic diseases extends beyond these monetary implications: more than half of Bangladeshis suffer from one or more chronic disease every year, making them the leading causes of death and disability.

Chronic diseases affect everyone and the number of people living with a chronic disease is expected to increase over the next decade.   The first steps toward preventing and treating chronic diseases are 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, 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 more community health clinics and improving its quality and scope of services will bring millions of more people for health coverage, it's still a challenge for many to find quality care that could help manage – even prevent – many chronic diseases because once a disease has progressed, a community health centre or a clinic will not be able to manage the patient rather a large hospital which has all the specialty services will have to take care of the patients.  This means community health centre and small clinic are essential component of the health care service delivery model but unless it is linked with the tertiary care hospital the impact of it 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 who are serving low income and medically underserved communities throughout the country through a wide network of clinics and tertiary care hospitals. More needs to be done in the form of Public Private Partnership to ensure health care for every citizen of Bangladesh.

Bangladesh is experiencing significant social and demographic transition with expanding industrialization, rising incomes, globalization, unhealthy environment and lifestyle, and an ageing population. Although 71% of the population resides in rural areas, rapid urbanization (at an estimated rate of 6%) is causing a population growth of 2.5% in urban areas, withDhaka city alone accounting for 40% of the urban population. These factors have contributed to a rising prevalence in Non-Communicable Diseases (NCDs) in Bangladesh.

The ready-made garment sector has been one of the biggest revenue-generators for Bangladesh, bringing in 75% of exports revenue.  Millions of employees depend on the garments industry for a living, the majority being women migrating from the rural areas.  The health problems of these people and their families are similar to those of the rest of Bangladesh.  Even though providing health care to the garments workers is compulsory for the employer, due to various factors the services workers receive are mostly not adequate.  If there are a cluster of factories in an area, government should encourage the stake holders to setup a large hospital in the area to support the clinics within the factories.  Through this partnership and collaborative approach between the clinics and tertiary care hospitals people working in the factories and their relatives living in the surrounding areas will have access to comprehensive health care.  Keeping the workers and their family members healthy is unquestionably good business practice for the employers.

Dhaka is the capital but Chittagong is the life line for Bangladesh because of its port and the industries within but unfortunately unlike Dhaka, Chittagong does not have enough health care facilities to cater to its population.  The situation in South Chittagong is even worse than the Chittagong city. From the South Chittagong it takes a minimum of 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 feeling overwhelmed.  The 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 service for everyone.

As government is setting up Export Processing Zones and Special Economic Zones in different parts of Bangladesh including in Chittagong, it should think about keeping a provision for establishing 500-bed to 1000-bed tertiary care hospitals in the Export Processing Zones and Special Economic Zones which will be accessible to both the people working in those areas and in the surrounding areas.  These hospitals will not only ensure easy access to health service when needed, it will also save time, money and solve overcrowding of the hospitals 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 opportunity for the people. Government of Bangladesh should consider giving financial incentive to the business communities by encouraging them to setup up non-profit yet self-sustaining hospitals in the Export Processing Zones and Special Economic Zones.

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Tanvir Raquib is the Executive Director of Good HEAL Trust.