‘Health audit and health insurance for all’

Staff Correspondent
Thursday, November 2nd, 2017


In 1971, Zafrullah Chowdhury was still to sit his final FRCS exam in the UK, having spent almost six years training in general, orthopedic and vascular surgery with the Royal College of Surgeons, when war broke out at home. He promptly left to come back home and fight, firstly as a guerilla, and then eventually as one of the founders, with Dr M.A. Mobin, of the Bangladesh Field Hospital – a make-shift 480-bed hospital he ran with four other doctors and a large number of women volunteers who had no previous medical training.


That would have been enough to seal anyone’s legend, given its unlikelihood in the circumstances, but Zafrullah Chowdhury’s contribution to his nation in the post-independence era has remained vital, be it as a public health activist of global renown (winner of the Magsaysay Award in 1985 as the chief architect of Bangladesh’s first National Drug Policy) through his work with Ganoshasthyo Kendra, or as one of the country’s most prominent voices of conscience. In this interview with Dhaka Courier’s Wafiur Rahman, he emphasises the importance of proper education for building quality manpower and promotion of entrepreneurship with healthy growth of workers for the sake of all industries in Bangladesh.


Why did you establish Ganoshasthyo? What inspired you to venture into this initiative?


The Liberation War led to certain innovation as necessity does. I and another doctor named Mobin formed Bangladesh Field Hospital in Agartola, India, to serve the freedom fighters. But we had no nurse. We then trained Bangladeshi girls with simple training, demystifying the conventional, complicated thinking in medical profession. It was a 480-bed hospital, part of which was shifted to Comilla immediately after the country had been freed.


We applied for registration of Bangladesh Hospital in 1972 but bureaucracy declined. I was even advised to go back of London. Eventually I had meeting with Sheikh Mujibur Rahman (then Prime Minister) who approved my alternative proposal for naming the hospital as Ganoshasthyo Kendra. We helped rural women to conduct operations in 1974, an achievement which was published in a renowned international medical journal. Ganoshasthyo also contributed to World Health Organisation’s declaration of ‘health for all’ in 1978, and we had held people’s health assembly in 2000 gathering representatives from 94 countries. Currently, we are providing healthcare facilities to 1.5 million people, mostly rural masses.


What kind leaders and entrepreneurs in different sectors does Bangladesh need to build and promote for future? How will the next generation bring a personality revolution of the nation?


I always foresee tremendous prospects of Bangladesh. We are a young nation — homogenous, almost unilingual, and tolerant. But hostile politics, dynastic in nature, has grabbed the entire society, making democracy hostage. I am still optimistic because poor women and young entrepreneurs have built an industry of more than a dozen billion dollars. I would suggest the businesspeople to focus on business, without directly engaging them in politics. For promotion of leadership, I demand that election to student union at education institutions should be held immediately and regularly. We need debates on development and healthy growth of our children at educational institutions so that they can think about and lead the country.


How do you feel seeing governance and regulation patterns in the country? Where is the ray of hope for us?


Unfortunately, we see a lot of anarchism in different sectors. It is not that anarchy is there only in Ashulia or Gazipur industrial belt. Millions of unsettled cases that burdened the law courts is part and parcel of anarchy in governance. However, I see the ray of hope in the people’s power and I strongly recommend devolution of power to allow growth of people. Bangladesh must decentralise power. A politician can be approached any time for help but a bureaucrat at the centre of power cannot even be reached. So, elected leaders at the grassroots level can solve the people’s problems, We must also pay attention to agriculture and to secure water supply through common rivers, we must make permanent settlement with India.


Do you think it is time for the business community to emerge as a distinct pressure group with ethical business practices?


Our business community has failed to emerge as a genuine pressure group as yet. There is no alternative to doing ethical business in asserting their position in society. For example, big sized garment factories are already paying monthly salary of over Tk 8,000, which is much higher than the minimum wage fixed at Tk 5,300. But buyers from neighbouring countries allure small players to set up factors at low cost, encouraging unhealthy competition. I think growth of industry depends on workers’ growth with proper pay, skills and working condition.


How do you evaluate the country’s public and private healthcare services? How should we make a balance between profit and public welfare?


Bangladesh has reasonably good physical infrastructure for healthcare services. I would suggest use of public-private partnership mechanism for utilising those facilities to reach healthcare services to the doorstep. For example, Apollo Hospital could be encouraged to go Gaibandha, not merely making business in Dhaka.


Unfortunately, both public and private sector are cheating with and exploiting the people in the name of healthcare. Absenteeism in hospital is a big shame. Doctors in public sector should in no way be allowed to practice at private clinics. Our public healthcare system is nonfunctional and the private sector is exploitative. We need health audit.


You have earned reputation (after initial criticism) for the drug policy in the 1980s that contributed to the growth pharmaceuticals industry? What is its current state in view of potential?


While formulating the drug policy, we tried to demystify the conventional notions. Complicated handwriting by physicians does not make any good sense and instead prescriptions must be written clearly. Doctors were not conversant of health economy and production costs of medicines. So, we decided to make medicines affordable to the people and remove all harmful medicines from the market. Around 1,700 items were banned under the drug policy. We felt the necessity of growth of business but ensuring public welfare. We had faced a lot of resistance from vested quarters. As a result of that drug policy, pharmaceuticals industry witnessed a fantastic growth. Today, local industry meets 95% of demand of medicines whereas 84% of the medicines available in the country at that time were imported.


What is your thinking about health insurance of the people in general after you proposed such insurance for industrial workers?


No doubt the people need health insurance, but a typical capitalist model of insurance. Our health insurance should cover entire healthcare services for diseases ranging from fever to dysentery, from injury to cardiac arrest. We at Ganoshasthyo have been experimenting the concept since the 1970s and developed a model for industrial workers. An amount of Tk 2,000 a year can provide healthcare coverage to a garment worker in Ashulia and if additional Tk 500 is added, the coverage can be expanded to her/his full family.


What would you recommend for producing more technical people and professionals in a populated country like Bangladesh?


Had I been in power, I would have made every focus on education, which is the most important for us as a nation. We must ensure education for addressing disparity and we must not allow education to be weapon to widen disparity. The reason why many girls go to Madrasha education is food and lodging provided under that system. Unless we provide proper education t the entire generation, they would be essentially misguided. We must build quality human resources through quality education. In order to cash in on the demographic dividend, we should provide technical education and language learning. We would need to produce many physiotherapists for sending abroad with jobs. We must produce a lot of quality teachers having command over mathematics, science and English language and send them to villages.

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