Private Healthcare: Governance Challenges and Way Out
About the chapter:
Transparency International Bangladesh (TI-B) is an independent, non-government, non-partisan and non-profit organization with a vision of a Bangladesh in which government, politics, businesses, civil society and the daily lives of its citizens are free from corruption.
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Theory of Change
Policy & Insititutional ChangeImproved enforcement of policies Better Institutional Processes
The main objective of this research is to identify the challenges of governance in private healthcare programs and to recommend ways to overcome them. The specific objectives of this research are to:
1. Review the existing legal and institutional framework governing private healthcare institutions.
2. Identify the nature of irregularities and corruption in private healthcare institutions; and
3. Identify the reasons behind the existing irregularities and corruption.
According to the National Household Survey (2015) by Transparency International Bangladesh (TI-B), a large proportion of households (63.3%) receives healthcare services from private institutions alongside the public ones. According to the Health Bulletin 2015 of the Directorate General of Health Services (DGHS), a substantial number of Bangladeshi physicians (60.3%) are associated with private healthcare activities. Over the last four decades, the number of registered private healthcare institutions experienced astounding growth – from 33 in 1982 to 15,698 in 2017 (DGHS, 2017). This sector has been assigned importance in various government plans and policies. The Seventh Five Year Plan (FY 2016 - FY 2020) emphasized on building a strong and effective regulatory framework, formulating government rules and regulations, ensuring provision of information to the healthcare receivers on the quality of healthcare service providers, and developing robust and responsible professional organizations for the development of private health sector. It has been mentioned in the National Health Policy (2011) that private institutions would be encouraged to play supplementary roles, necessary rules and regulations for them would be formulated and applied to maintain the quality of healthcare services, and steps would be taken to maintain the cost of tests and other expenditure within a tolerable limit.
This is a qualitative research where data collection and analysis were made following qualitative research methodology. Primary data were collected from three sources :
1) From key informant interviews (total of 706) from management and owners of private healthcare institutions, service providers, service recipients, regulatory and supervisory authorities and other stakeholders
2) From focus group discussions (total participants 310 in 27 discussions with 14 male and 13 female groups)
3) From direct observations.
Data was collected countrywide from 116 registered private healthcare institutions (66 hospitals and clinics, 50 diagnosis centres). Institutions were selected from every divisional city, eight district towns under each division, and eight upazilas under each selected districts (total 24). Considering the size of the population and number of the institutions, 26 were selected from Dhaka City and 90 from other areas of the country.
Opinions of the healthcare service recipients at local levels were taken into consideration while selecting these institutions. Laws and rules related to private healthcare, government documents, research and news reports in mass media and information from websites were used as sources of secondary data. The research was carried out from January 2017 to December 2017.
- The tendency of commercialization in private healthcare in Bangladesh is quite evident. This is characterized by too much profit-oriented and commission-based care, where quantity has taken priority over ensuring the quality of service delivery.
- The government is not paying much attention to this sector. This is reflected in the lacking emphasis on the sector in policy and planning, not updating relevant laws, not developing regulatory structure, poor monitoring and supervision, and poor coordination amongst stakeholders.
- The sector has become out of control on the one hand, while some individuals are extracting disproportionate private gain from the patients. Poor efficiency and the recurrence of irregularities are evident, especially at the upazila and district levels.
- The general care receivers have become hostages to the system and victims to enormous financial and physical loss, and access to quality healthcare is not ensured well.
- An independent commission should be formed to regulate the private healthcare institutions.
- The revised law has to be finalized and adopted to regulate private healthcare sector.
- Institutional capacity (both at central and field levels) should be developed to strengthen the regulatory and monitoring of private healthcare institutions.
- The relevant associations should play a pivotal role in maintaining quality assurance in the private healthcare institutions.