Dhaka Courier

World Health Day: 2019

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Universal health coverage is World Heath Organisation’s number one goal. The Key to achieving it is ensuring that everyone can obtain the care they need, when they need it, right in the heart of the community.

Millions of people still have no access at all to health care. Millions more are forced to choose between health care and other daily expenses such as food, clothing and even a home Progress is being made in countries in all regions of the world.

This is why WHO is focusing on universal health coverage for this year’s World Health Day, on 7 April. Many countries are already making progress towards Universal Health Care. All countries can take actions to move more rapidly towards it, or to maintain the gains they have already made.

Moving towards Universal Health Care requires strengthening health systems in all countries. Robust financing structures are the key to introduce such system.  They exist in many countries such as Britain, Australia and Canada.

 In countries where health services have traditionally been accessible and affordable, governments are finding it increasingly difficult to respond to the ever-growing health needs of the populations and the increasing costs of health services.

When people have to pay most of the cost for health services out of their own pockets, the poor are often unable to obtain many of the services they need, and even the rich may be exposed to financial hardship in the event of severe or long-term illness.

Pooling funds from compulsory funding sources (such as mandatory insurance contributions) can spread the financial risks of illness across a population.

As regards primary health care, it is a whole-of-society approach to health and wellbeing which is centred on the needs and preferences of individuals, families and communities. To make health for all a reality, governments need to invest in quality, accessible primary health care. Health workers need to care and advocate for patients and educate them on how to get and stay healthy. Individuals and communities need to be empowered to take care of their own health.

Gaps in the supply of and demand for health workers are concentrated in low- and lower-middle-income countries. The growing demand for health workers is projected to add an estimated 40 million health sector jobs to the global economy by 2030.

It is reported that the Government of Bangladesh is committed to achieve universal health coverage by strengthening the accessibility of primary health care for the citizens of Bangladesh. As part of the initiative, a ‘National Protocol for Management of Diabetes and Hypertension’ has been developed and is being reportedly rolled out across the country.

Investments are needed from both public and private sectors in health worker education, as well as in the creation and filling of funded positions in the health sector and the health economy.

Preventive care specialist Laura Sander, medical director of the Priority Access Primary Care pilot, explains the program's aims: To keep Medicaid patients out of the Emergency Department (ED) and the hospital by providing very intensive primary care services that are integrated with behavioral health care and social services. Its patients' ED visits and admissions have plummeted, and the program is showing a 2-to-1 return on investment.

Denny Morrison challenges three commonly held but irrational beliefs about behavioral health care: first, that having a mental illness or addiction is a stigma. ("To compare 'having a bad day' to major depression," he says, "is a bit like comparing a paper cut to an amputation.") Second, that the body and mind are two different things. Third, that if you have a diagnosis of mental health or addiction, it's "a living death sentence." Morrison is Chief Clinical Officer for Netsmart, the leading provider of clinical solutions for health and human services organizations nationwide.

He served previously as the CEO of the Center for Behavioral Health (CBH) in Bloomington, Indiana since 1995. CBH was the first behavioral health company to ever win the JCAHO Codman Award for excellence in the use of outcomes measurement to achieve health care quality improvement; the second to win the HIMSS Nicholas E. Davies Award for Excellence in the implementation of Electronic Health Records (EHR); and is still the only organization in the world to have won both awards.

In 2007, CBH was awarded the Negley Chairman's Award for Excellence in Risk Management. Morrison has worked in the behavioral health field since 1969. He holds a doctorate in Counseling Psychology from Ball State University. In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized. (Subject to certain rules and regulations).

It's important to understand the need for preventative care. Unfortunately, our society does not address these issues when they initially appear (likely due to the stigma surrounding them and overall lack of resources for prevention as an approach to treatment as a whole), which leads to the further decline of the individual. All mental health issues are treatable, and like any other illness it is best to diagnose and treat them as early as possible.

It is reported that Zyma Islam in a newspaper writes that children from the slums of Dhaka have an unequal start in life is not a revelation. Sanitation systems are poor or non-existent, poverty affects nutrition levels, and access to advanced health care is limited.

Their living conditions are similar to those in all slums—each of the families is squeezed into tiny windowless rooms of corrugated tin sheets. The bathrooms are open pits leading to the canal. All the households dump trash in the canal because the monthly garbage collection bill is an added burden nobody wants.

That the contamination levels of this large water body has an effect on children's health came to light in a study last year that tested 200 water samples across four slums in the city and found distressing levels of fecal matter. The highest levels of contamination—about 600 fecal coliform bacterial colonies in every 100 ml of water—were found in the water from underground reserve tanks.

Water samples collected from household containers like jugs were also highly contaminated. In comparison, the water supplied by the municipality was tested at source and it had no fecal matter. What that means is that the bacteria enter the water when being transported through underground pipes—pipes that come in close contact with soil that is already contaminated by the canal water, for example. The study was done by BRAC University, Dhaka University, Dushtha Shasthya Kendra and WaterAid Bangladesh among others.

The appalling fact is:  by the time they are two years of age, the children of Mirpur Bauniabandh slum take 10 courses of antibiotics. In the first two years, these children have approximately 10 episodes of illnesses that warrant antibiotic intervention.

An additional fact to be concerned about by health experts is that the children studied in the research were being given stronger antibiotics from the get-go. Experts agree that this contributes to antibiotic resistance in the future. “The infants of Dhaka were more likely to be given highly potent antibiotics like macrolides (generic name being Azithromycin) for diarrhoea, as opposed to anti-protozoal drugs like Flagyl,” according to health experts.

Children from the slums invariably get less of a shot at life than the rest of the kids in the city—they go to worse schools, end up in lower-paying jobs. Must their bodies fail them too because of man-made factors?

The above statistics was found in a World Health Organisation study that compared the conditions of 265 children in Bauniabandh with those living in similar conditions in Pakistan, Tanzania, Brazil, Peru, South Africa, India and Nepal.

So how did Bangladesh compare? The average number of antibiotic courses taken by children across the countries was 4.9, less than half of what the children of Bauniabandh were taking. In fact, Bangladesh comes out second-highest—the children of Naushahro Feroze in Pakistan topped the list by taking 12 courses of antibiotics in their first two years.

“Of course, pharmacists and doctors in Bangladesh prescribe antibiotics indiscriminately, but children in these slums are actually catching more infections,” confirms Dr Tahmeed Ahmed, one of the main authors of this exploratory study and Senior Director of Nutrition and Clinical Services Division at International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).

Finally our Constitution in Article 18 speaks that raising the level of nutrition and improvement of public health are among the state’s primary duties and in particular shall adopt effective measures of consumption of products which are injurious to health.

Barrister Harun ur Rashid, Former Bangladesh Ambassador to the UN, Geneva.

  • World Health Day: 2019
  • Issue 40
  • Barrister Harun ur Rashid
  • Vol 35
  • DhakaCourier

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