Study on Health and Drug Policies of Bangladesh to Ensure Health for All

Abstract

Background National Health and Drug policy are the standard guidelines to ensure the healthy life of the citizens of a country. According to World Health Organization, “Health is the physical, social and mental wellbeing and not merely absence of any disease”. Health is one of the basic needs of people in Bangladesh and improvement of nutritional and public health status is a Constitutional commitment of the Government of Bangladesh according to the Constitution, Article 15 and 18, respectively. The present study is focusing on the critical analysis of National Health Policy (NHP), perceptions of the service providers and service receivers regarding NHP, and Primary Health Care (PHC) in Netrokona Sadar Upazila - A Case Study on Expanded Program on Immunization (EPI), National Drug Policy (NDP), availability, affordability and price variation of essential antibiotics in Bangladesh. All issues, in the purview of NHP and NDP, have been analyzed to have an endeavor in contributing to ensure health for all. The objectives of the study were-(i) to check the consciousness of people in health sector about NHP and NDP, analyze the national budget for research and education on health and drugs, contribute on improvement of the NHP and NDP by taking some valuable suggestions from the respondents, find out the drawbacks that are in the policies and find out the strategies to deal with them; (ii) to find the areas of cooperation between Government Organizations (GOs) and Non-Government Organizations (NGOs) in the arena of PHC focusing the EPI and find the weaknesses in providing the PHC services; (iii) to measure prices of essential antibiotics for treating prevalent conditions in Bangladesh, assess the affordability of standard treatment regimens using these medicines, compare the prices of medicines found in the country with international reference prices and compare the prices of medicines of different years with statistical significance testing and (iv) to inform the policy makers to address those issues. Methods The study was conducted as survey as well as case study. Both primary and secondary sources of data were used in the study. NHP, NDP, EPI and availability, affordability and price variation of essential antibiotics of Bangladesh were analyzed. A total of 1100 respondents were selected for the study. The data were collected by random sampling method. Results NHP was consulted with the doctors, health personnel and researchers and important feedbacks were obtained. Majority of the respondents informed that they were acquainted with NHP and put some suggestions regarding the appropriateness of NHP. Role of public servant was addressed by the respondents. Some areas were identified which were not properly addressed in NHP such as management of diseases caused by Zika virus, Nipah virus, Dengue and Chikungunya, non-communicable disease, epidemic disease control. Some suggestions were also given by the respondents. Those were - need revision in NHP; update of NHP at a regular basis; involve civil society, and public representatives; ensure more punishment in case of false drug manufacture. The study showed that most of the service receivers did not know about NHP. It was observed that the percentage of people who knew about NHP was increasing with respect to the educational level. If the people are well informed about NHP, they can get better health service. The respondents put some important comments- the NHP does not ensure enough number of doctors, pharmacists (virtually absent / non-existent), nurses, and other stuffs; some medicine especially antibiotics should be prescribed by the doctors only; the NHP cannot resolve the communication gap between the service providers and the service receivers; does not ensure enough necessary supplies; does not ensure skilled doctors, pharmacists and the health workers in primary and secondary level hospitals; does not utilize the referral system properly etc. In case of service providers, acquaintance with NHP was not satisfactory. In fact, the scenario for service providers was worse than service receivers. In both the cases, it did not cross 50% and most of the service providers were not aware about the policy and as a result, they could not provide better treatment to the patients. It was evident from the study that diseases like child tuberculosis, diphtheria, whooping cough, tetanus, hepatitis B virus, Hib V, polio and measles can be prevented by vaccines through EPI as part of the endeavors of primary health care services of the government. In the journey of primary health care services through EPI, collaboration of GOs and NGOs works effectively to a great extent. The study also found some areas to be improved such as more coordination and endorsement of contributions of the players in the smooth running of the EPI. Maximum respondents (99%) opined that right use of drug practice can prevent abuse of antibiotics. Awareness and training needs were soughed in this respect. It was found that some of the respondents (22%) did not know about essential drug program. It was found that only 26 (5%) respondents out of 500 knew the exact number of essential drugs in Bangladesh. In surveyed pharmacies, the essential medicines were less available in general medicine stores as compared to the Model pharmacies. A comparative study on price variation across years had shown a insignificant increase in price. The median prices of surveyed medicines were obtained, and a gross comparison was done that indicated percent increase or decrease in price. In the studied programs, the median price ratios of surveyed medicines varied from 0.36% - 2.56% and 0.33% - 2.39% in year 2015 and 2019, respectively. While noting the WHO target that consumer should pay no more than four times the IRPs, we observed that medicine prices were lower in Bangladesh compared to IRPs. The study confirmed that the essential antibiotics were affordable in Bangladesh. Conclusion Based on our findings, it can be inferred that the idea of ensuring health for all is not a very difficult task. The major plus point has been the positive gesture of all the related stakeholders of health and medication. Contribution and cooperation of all - politicians, GOs, NGOs, civil society etc. to the NHP and NDP can make them fullest and confident to ensure health for all in Bangladesh.