What holds again the referral well being system in Bangladesh?

Within the UK, one can’t go to a specialist physician straight on one’s personal. A basic practitioner will determine if seeing a specialist is clinically vital for a affected person. A specialist will solely see a affected person with a referral letter from his or her basic practitioner.

Not simply in authorities hospitals, a non-public specialist can even ask you for a referral out of your basic practitioner.

However, in Bangladesh, specialists are beneficiant sufficient in seeing as many sufferers as they will, and sufferers are free to self-refer to any specialist they like.

Folks with signs of easy illnesses, which may simply be handled on the main degree, are likely to see specialists, creating an enormous rush at medical faculty hospitals and personal chambers of senior physicians within the cities.

This overflow of sufferers, largely unreferred, results in inferior high quality of companies, inflicting sufferers’ dissatisfaction and depriving critically unwell sufferers of due consideration and care.

A examine this 12 months exhibits {that a} referral system can filter 65% of sufferers at main and secondary healthcare services at upazila and district ranges, thus lessening pressures on tertiary services like medical faculty hospitals.

A referral system can create an efficient linkage amongst three tiers of healthcare companies, serving to them to unfold proper from group clinics at union ranges to medical universities in Dhaka.

Within the absence of a referral system, the price burden on sufferers is growing on the one hand and the creation of expert physicians is being disrupted on the opposite, observes Dr Syed Abdul Hamid, professor on the Institute of Well being Economics at Dhaka College.

“Normally, it takes two to 3 months to get a specialist physician’s appointment in our nation. Once more, even when an appointment is obtained, the physician can’t give sufficient time as a result of they see 50-60 sufferers in his chamber on any given day. Consequently, most individuals are discovered dissatisfied after they go away the physician’s room,” he tells The Enterprise Commonplace.

Had there been a referral system, a affected person couldn’t have reached a senior physician with out seeing a junior physician first, Dr Syed Abdul Hamid notes.

“Then the stress on senior medical doctors could be diminished and so they may commit extra time to crucial sufferers.

“Apart from, as sufferers don’t need to go to junior medical doctors, they can not deal with an ample variety of sufferers. That is why their capability just isn’t growing. Even when these medical doctors change into professors, their abilities will stay the identical,” he says.

He emphasises the necessity for presidency efforts to enhance affected person satisfaction and improve the talents of junior medical doctors.

Healthcare professionals, officers and specialists are nicely conscious of the advantages of the referral system in healthcare, and it has been talked about for many years, with healthcare practitioners citing the UK’s referral system again within the Nineteen Nineties in the best way they’re stressing the identical in the present day.

However it couldn’t be put into apply successfully but. Some initiatives fell aside midway via.


Professor Liaquat Ali, a biomedical scientist and educationist, says within the developed world there are three ranges of care – main, secondary and tertiary care.

“A affected person goes to secondary or tertiary care solely when referred from the first care. However, in our nation, it’s the reverse. It’s because there isn’t a coverage within the rural areas and no infrastructure within the cities.”

Professor Liaquat says the agricultural areas of the nation have adequate infrastructure wanted for a practical referral system.

“In rural areas, there are group clinics, upazila well being complexes and district hospitals. Initiatives and rules are wanted to make them operational.

“However the vital infrastructure has not been constructed within the cities the place about 40% of the nation’s complete inhabitants dwell. Right here tertiary degree hospitals have been established instantly with out main and secondary well being complexes being arrange, and other people flock to medical faculty hospitals even in circumstances of minor illnesses,” he tells TBS.

He provides that there’s an infrastructure named “City Main Healthcare Centre”, however it isn’t below the purview of the Ministry of Well being however below the Native Authorities Ministry, which is normally depending on donors.

“These services don’t have well being infrastructure in the true sense of the matter. Additionally, there isn’t a infrastructure for linkages with secondary and tertiary degree hospitals that lay the groundwork for the referral system,” says Professor Liaquat Ali.

A examine, “Bangladesh well being sector: current challenges and future pointers”, was carried out via coverage dialogue with 60 people, amongst whom have been eminent medical doctors, politicians, and journalists, from 11 March to 2 July 2021 with a view to determine and clear up current issues within the nation’s well being sector. Former well being minister Dr AFM Ruhul Haque, in collaboration with the non-government organisation Eminence Associates for Social Improvement, carried out the examine.

In accordance with the examine report printed on 20 March this 12 months, 33.3% of eminent residents really feel that it’s attainable to make sure high quality and accountability in well being companies if a referral system is launched comprehensively via a digital system.

How one can, then, make it occur in Bangladesh?

In 2016, the well being directorate took an initiative to introduce a structured referral system in Rangpur and Nilphamari for medical companies, however it’s but to see the sunshine of day.

Professor Liaquat Ali thinks to introduce the referral system, “we have to construct infrastructure or recruit basic physicians the place such services, similar to group clinics, exist already.”

The well being ministry must create a brand new chain for city well being, which is now the weakest level of the well being sector, he says. 

Within the absence of the referral system, complaints run rife that medical doctors don’t give sufficient time to sufferers, he notes.

Professor Liaquat factors out that there are numerous tertiary and specialised hospitals, together with ward-based group clinics, union sub-centres, upazila well being complexes, district hospitals, and medical faculty hospitals throughout the nation, however when individuals really feel unwell in distant areas, they arrive on to Dhaka for therapy as a substitute of going to those well being centres.

Professor Dr Samiul Islam Sadi, director (administration) of the DGHS, who took the initiative to launch the referral system in 2016, tells TBS that the newest expertise of Covid-time well being emergency has made the referral system extra related.

He remembers the feasibility examine he did in Rangpur again in 2016 via assessing the wants of grassroots individuals as additionally the supply of specialized sources and services.

Folks in close by districts rely on district hospitals and public medical faculty hospitals for main illnesses that require specialists’ supervision, he says.

“However these well being services are already overloaded. If we begin referring sufferers earlier than enhancing services and making extra specialists obtainable, then individuals must queue once more for serials open air and lose curiosity within the system,” Professor Sadi says.

He stresses the urgency of making a referral desk and getting ready a listing of specialists.

Why did the initiative not make additional headway?

Prof Sadi avoids a direct reply to the query however says it’s the proper time now to take the method ahead. Well being infrastructures have seen additional enhancements in recent times and now all upazilas have pathological testing services and 10-bed hospitals, with just a few even aware of 250-bed services, with vital tools and employees.

“Our well being companies have seen a lot enlargement. Now service high quality wants to enhance. We should be directed to healthcare as practised worldwide. The system will inform which affected person wants what sort of specialist therapy,” he says.

No new legislation is required for the introduction of a referral system within the well being companies, he notes, including that the system exists in official paperwork and may be put into apply straight away.

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