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THE health and family welfare ministry has released the draft of a new national health policy on its website for public opinion. First of all, the ministry deserves praise for recognising the need for public opinion on matters that will directly affect the people of the country.
   The health policy highlights the present state of health in a country, the poor quality of health care, the inefficiency of health care givers and the prevalent poor access to quality health delivery to women, children and the poor. It also mentions the inadequacy of the national annual budget that has been allocated to Health and other related issues. These issues are not new. The general public, the media and talk shows have been airing such grievances for the last twenty years.
   The policy has been divided into ‘aims’, ‘policies’ and ‘recommendations’. However, it must be noted that what is written in the policy as ‘objectives’ is a repetition of the various policies mentioned in the text. There is no mention of a practical work plan as to how to implement the policies. On the whole, the policy is confusing and not easily understandable.
   On paper it is evident that the healthcare system in Bangladesh reaches the rural level and is one of the best systems in South Asia. Government documents show that from the capital Dhaka to district, upazila and union levels, there is a healthcare system in place. However, in reality, one is usually unable to locate any health care worker at the union-level health care centres. The upazila-level health centres are suffering from lack of sufficient medicine, medical equipment and specialists. Not only that, doctors remain absent on a regular basis. There are also complaints that there is not even medicine or equipment to treat common illnesses. On the other hand, it is also true that the government hospitals in Dhaka are so overcrowded that proper service and care is next to impossible.
   There have been numerous complaints regarding the business-oriented private medical facilities too. Some of these include: astronomical fees; giving unnecessary medical tests; and prescribing medications that either the patient does not need or may be harmful to him/her. It may be noted here that approximately 80 per cent of the people of Bangladesh seek the services of such private medical facilities, many of whom have to suffer through unwanted tests and taking unnecessary medication – usually bought from laboratory or the pharmacy attached to the facility.
   What, then, does the present health policy of 2009 need? First of all, it needs to spell out its aims and objectives clearly and place concrete, do-able methods of implementing its objectives in a comprehensive work plan. Some areas of the policy, which need revising, are given in the following paragraphs:
   The policy mentions changing and revising the teaching curriculum in order to improve the ability of health workers and develop their skills. Every one in the country is aware of the lack of skilled doctors, nurses and medical technicians at all levels of the healthcare delivery system. Skilled health workers are a basic necessity in any heath complex. Educated and skilled heath workers would not only be a great asset to our country, but also abroad. For example, in the developed world, there is a void in the area of nursing and related heath service delivery areas. Skilled heath technicians from Bangladesh would be able to fill this void and not only develop their own expertise and experience, but also improve the family economy. The government needs to put in place some implementation plans in the area of how it plans to go about changing/revising the curriculum to bring about improvements in the skills of healthcare providers.
   The draft policy mentions that the government will take steps to ensure transparency in health costs. The draft also mentions that the health budget is insufficient. It is true that health delivery, especially in areas of specialised treatment and tertiary care, is expensive. This justifies the demand to increase the national budget not only in the health sector, but also in education. People in Bangladesh spend a lot of money, seeking treatment abroad and in the private hospitals. Common sense tells us that if we could combine the large amounts of money spent on private treatment with the government run healthcare system, then we could probably establish a sustainable and profitable health service. It must be mentioned here that there is a lack of proper administration and hardly any supervision in the grassroots health facilities, which also causes mismanagement in costs and spending. Therefore, increasing the budget allocation in the area of health and education does not necessarily mean an automatic improvement in the health delivery services unless we establish a workable, accountable administrative setup.
   According to the draft policy, there will be measures to be taken to review the activities of relevant administrative bodies in order to bring about and ensure accountability and sustainability in the healthcare system. The present administrative setup in the health sector is centralised. Immediate steps need to be taken to decentralise it and ensure transparency and accountability. To bring about such a change requires a political will. The only solution to the weak and incompetent administrative setup that we have in the health sector today is a progressive and decentralised system. This will also ensure accountability at the field level.
   Another aim of the draft health policy is to regulate the establishment and activities of the private health delivery systems, and shut down those that provide substandard health care. Approximately 80 per cent of the population of the country are dependent on the private sector. However, in that sector, too, there is no clear and unified policy or guidelines or regulatory framework. This results in corruption and lack of accountability. There is an urgent need to draft a regulatory framework, applicable to all private health delivery services. In this regard, the draft health policy needs to review the relevant laws and take steps to tackle the existing private health care delivery
   systems.
   Strengthening the medical and dental council in order to assess the quality and professional capacity of all health service providers is another objective of the draft national health policy. Generally, it can be said that the council not only provides licenses to medical practitioners, but also acts as an ombudsman for maintaining quality and decorum in the health delivery system. If any citizen feels that he or she has been affected by the actions or inactions of a licensed medical practitioner, he or she can bring the matter to the medical and dental council. Unfortunately, it has been a very, very long time since the council played the part of an ombudsman and compensated anyone for any medical malpractice. Furthermore, people are unaware of the fact that they can complain to the council. The draft national health policy needs to mention the ways in which it will strengthen the role of the medical and dental council in order to ensure accountability of the practitioners.
   The draft policy recognises the need to bring private and government sectors into a partnership for effective health delivery. To do this, it proposes the creation of a guideline. In the last two or three years, we have been hearing talks of a public-private partnership in the health sector and, if this becomes a reality, it will make great contributions to the health delivery system in the country. There are a few healthcare facilities that are already being run jointly by the government and private entities. These health centres should be examined closely and their successes replicated all over the country. Such partnership will not only help the government financially, but will also make the system more transparent and accountable.
   The NGO sector is another concern of the national health policy. The draft states that measures will be taken to assess the activities of non-government organisations that are working in the health sector in light of accountability and efficiency. Bangladesh has several hundred large and small non-governmental organisations many of which work solely in the area of health. It seems several of such NGOs that are being funded by the World Bank, World Health Organisation and bilateral donors such as the UK Department for International Development, the United States Agency for International Development and the Canadian International Development Agency have become immune to the country’s actual plights in the area of health, following the dictates of the donors only so that they can receive more funds. Due to the inefficiency of the government machinery, such NGOs take advantage of the situation and are involved in unsustainable, donor-driven projects, which cannot be assessed. As a result, a huge amount of funds are being misused, adding to the already corrupt atmosphere that engulfs not only the health sector, but almost all development sectors of the country. In the last few years, there has been no sustainable development in the health sector, despite the enormous amount of donor funds coming into the country in the name of better health. Large amounts of money are spent by NGOs in hiring consultants, whose reports and ‘advise’ have sometimes even caused problems and confusions in the health administration system.
   It is hoped that the government will amend the draft of the National Health Policy 2009 and make the objectives simple to understand. Instead of a repetition of what the government hopes to achieve, there should be practical solutions to the problems highlighted. There needs to be included a realistic policy action plan.
   It is also hoped that the national experts who are already working in the field of healthcare system will assist the government in this regard. The government must invite such persons to come up with practical solutions to the problems plaguing the health sector and for implementing them. The work plan must be flexible to fit in with changing times and situations. The present government must stop playing with people’s health and give the country an affordable and sustainable health delivery system through a practical and workable policy supported by an implementation plan.
   Professor Mahmuder Rahman is professor of medicine at National Medical College and Hospital, and also coordinator of Dhaka Community Hospital

THE crushing defeat in the national elections for the ruling conservative Liberal Democratic Party in the hands of the Democratic Party of Japan, analysts predict, will mark the dawn of a truly two-party system after half a century of almost unbroken LDP rule. The only stint of the LDP in the opposition was back in 1993-94, when a coalition of eight smaller parties took charge, and lasted for about ten months. In the August 30 elections, voters overwhelmingly cast their ballots in favour of a left-of-centre opposition camp that has promised to rebuilt the economy and breathe a new life into the country after 54 years of virtual one-party rule.
   The Democratic Party of Japan won 308 seats of the 480-member lower house of the parliament, ousting the Liberal Democrats, who had governed Japan for about ten months in 1993-94 since 1955 when the party came into being. The vote was seen as a barometer of frustrations over Japan’s worst economic slump after World War II, and a loss of confidence in the ruling Liberal Democrats’ ability to tackle tough problems such as the rising national debt and rapidly aging population.
   The loss by the Liberal Democrats would open a way for the Democratic Party of Japan, headed by Yukio Hatoyama, to oust the prime minister, Taro Aso, and establish a new cabinet, possibly, within a few weeks. It would begin debates in the parliament, which had remained suspended since the democrats and their allies took over the less powerful upper house in 2007. Last week, the government reported that the unemployment rate for July hit 5.7 per cent – the highest in Japan’s post-World War II era, while deflation had intensified and families had cut spending because they were insecure about the future. ‘The ruling party has betrayed the people over the past four years, driving the economy to the edge of a cliff, building up more than 6 trillion yen in public debt, wasting money, ruining our social security net and widening the gap between the rich and the poor,‘ said the Democratic Party, adding with emphasis, ‘We will change Japan.’
   When the DPJ is poised to take over probably in about two weeks, observers are saying it is unlikely to quickly or radically shift the foreign policy, despite the campaign season rhetoric opting for a pragmatic approach. The democrats have also said they will make Tokyo’s diplomacy less US-centric. But Hatoyama, who has a doctorate in engineering from the Stanford University, insists they will not bring any dramatic change in Japan’s foreign policy. ‘My sense of the DPJ is that it has wanted a little distance between Tokyo and Washington,’ says Hatoyama. Despite trade disputes and frictions about the US bases on its soil, Japan largely emulated the US free model as it rose from the ashes of war to become Asia’s top economy. Koizumi even sent non-combat troops during the war in Iraq. The DPJ has also said it will not renew the naval mission that has supported the US-led war in Afghanistan when its current mandate expires in the next year. Leaders of the Asian countries have welcomed the historic shift in power after Japan’s general elections and sought closer ties with Tokyo, with only North Korea sounding a note of dissent.
   ‘If Japan wants to secure international trust, it must squarely break with its crooked past,’ the ruling Communist Party newspaper Rogdong Sinmun of North Korea commented. Historians say more than 200,000 women mostly from Korea and China were forced to work as sex slaves for Japanese troops when Japan imposed brutal colonial rule over Korea in 1910-45. But, Seoul voiced hopes of further improvement in relations between the President of South Korea, Lee Myung-Bak, and Hatoyama, congratulating Hatoyama.
   The democrats are proposing toll-free highways, free high schools, income-support for farmers, monthly allowances for job seekers in training, a higher minimum wage and tax cuts. The estimated bill is likely to come to 16.8 trillion yen, if fully implemented beginning in the fiscal year 2013, with its support ratings sagging to a dismal 20 per cent. Hatoyama has repeatedly laid stress on his party’s role to lead Japan’s rise from the ashes of the World War II to one of the world biggest economic powers. He also underscored the need for being well-equipped to get the country out of its current morass. But the current state of the economy has been a major liability for his party.
   Support for the LDP, which has ruled for ten to eleven months since its founding in 1955, has been on a downtrend for years, but charismatic leader Junichiro Koizumi managed to lead the party to a huge election win in 2005, with promises of market-friendly reforms. Those reforms came under fire even within the LDP, for worsening social and income gaps, and were further attacked after the global financial crisis tipped Japan into recession. ‘We are not saying that the free market principles are all bad, but the current economic situation is one where there need to be corrections in areas where reform went too far,’ Hatoyama said.
   A series of scandals, policy flops and a perceived inability to address deep-rooted problems such as creaking pensions and health systems eroded the LDP mandate. Voters having taken a gamble on change will want to see the proof quickly that the democrats can do a better job. ‘It’s going to be crucial how they spend the first year in office, so in that sense they have to get focused very quickly to get things accomplished,’ said Sophia University professor Koichi Nagano. ‘Otherwise, the goodwill may dissipate very quickly and they may face a hostile upper house within a year.’ Hatoyama will want to have his cabinet up and running in time to attend a UN General Assembly meeting and a G20 leaders’ summit in Pittsburgh in September. The democrats want to forge a diplomatic stance more independent of the United States, raising fears about possible friction in the alliance.
   The Japanese parliament, which is known as Diet, has two chambers. The House of Representatives, having 480 members who are elected for a four-year term, comprises 300 members in single-seat constituencies and 180 members by proportional representation in 11 block districts. In this system, each voter votes twice, once for a candidate in the local constituency, and once for a party. The House of Councillors has 242 members elected for a six-year term, 146 members in multi seat constituencies and 96 by proportional representation on the national level. Half of the councillors come up for election every three years.
   For many years, Japan had been a one-party dominant state, with the Liberal Democratic Party as the leading party until 1993. They lost office and then soon regained power. The 2009 elections handed the first non-LDP victory to the Democratic Party of Japan. Due to the majoritarian parallel voting system, it is unlikely that Japan will develop a multi-party system, but there is speculation that after 2009 Japan will develop a two-party system.
   LDP secretary general, Hiroyuki Hosoda said on Sunday just after the elections that he and two other top officials had planned to submit their resignations to the prime minister Taro Aso, who serves as the president of the party. A top official of LDP said other officials had planned to step down from their posts over its apparent crushing defeat in the parliamentary elections. It’s a great learning for the political leaders of Bangladesh. Since they proved less important for the party and for the nation, they need to resign. This culture is yet to appear in our country.
   Md Masum Billah is senior manager of BRAC Education Programme, PACE

Women education

Islam has encouraged education and training to women folk. A good mother obviously means an educated one. So it needs no telling the importance of women education.
   We live in a competitive materialistic age. Today life has also become harder than before and the struggle for existence is grim and only the fittest will survive. Moreover, a country cannot prosper if its women are kept ignorant. Women education is, therefore, a must for any nation from every point of view.
   Habibur Rashid Ismail
   Chittagong

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