Governance Challenges in Health Sector and the way out

Abstract

Despite some successes, hindrances to good governance prevail in health sector. According to TI-Bangladesh's National Household Survey (2012), 40.2% of the recipients of health services from public institutions became victims of irregularities and corruption while receiving services. According to this survey, the estimated amount of bribes at the national level in this sector amounted to Tk 703 million. News reports on irregularities such as absenteeism of doctors, low-quality services, irregularities in getting hospital beds and medicines, active presence of middlemen luring patients to private health facilities, and financial corruption of health professionals and hospital staff are regularly published in the print media. The main objective of the study is to identify the challenges of good governance in the health sector an to propose specific recommendations based on the findings.

Methodology

This is a qualitative study which collected data by conducting in-depth key informant interviews (KII) and group discussions. Key informants included service providers and managers/ high officials of public and private healthcare institutions, members of professional bodies, media personnel, and health sector experts. Quantitative data from secondary sources was also analysed. Secondary sources include surveys such as the National Household Survey (2012),
2 Citizen Report Cards on 28 institutions, other studies on health, proceedings of a Consultation Meeting on Health organized by TIB (held in Dhaka in July 2013), relevant policies, laws and rules, national budgets, official documents, and web-based and media reports. The research findings were shared with high officials of the Ministry of Health and Family Planning on 28 August 2014, and the report was updated on the basis of their comments. It is important to note that the research findings are not equally applicable to all institutions, doctors, nurses, officers/ employees. However, it provides an indication of the challenges of governance existing in the health sector.

Findings

1. Despite significant efforts and laudable achievements of the government in the development of health sector, even more could have been achieved if there were less limitations, irregularities and less corruption in this sector.
2. Planning in regard to human resource management, control and supervision, and ensuring transparency and accountability is lacking long-term orientation.
3. The monitoring and supervision system for public and private healthcare institutions is too weak.
4. An institutionalization of corruption in this sector particularly with regard to the administration and service provision could be observed.

Recommendations

1. The share of the national budget that is allocated to the health sector should be increased.
2. Influence of the health professional bodies in line with political considerations in recruitment, promotion, transfer of doctors should be prohibited.
3. Monitoring and supervision should be strengthened to ensure the presence of health assistants at community clinics and to stop the theft of government medicines.
4. To ensure the presence of doctors in duty locations, they should be granted decent residence facilities and special hardship allowance should be introduced for the doctors who are posted in remote areas and for working on holidays.