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OP-ED: Health before wealth

  • Published at 11:02 am May 26th, 2020
New Zealand Prime Minister Jacinda Ardern
A leader worth following / Reuters

Empowering our public health sector is the most effective way of fighting against the coronavirus

These are extraordinarily challenging times for humanity, especially for the leaders of men. Of course, with the exception of the leaders who have championed the genuine concerns of the flocks they lead with their honest compassion and pragmatism.  

I may mention the names of a few: Angela Merkel the German Chancellor serving her nation for the last 15 years so successfully and viewed by many commentators globally as the leader of the Free World; Katrín Jakobsdóttir, the prime minister of Iceland; Moon Jae-in, president of South Korea since May 2017; Tsai Ing-wen, president of Taiwan, and also the Republic of China and our own honourable prime minister.  

What Ardern did right

Among these exceptional leaders, Jacinda Ardern, the prime minister of New Zealand, the ambrosial voice of the millions oppressed worldwide, delivered her first budget in 2018. Delivering a budget which was much restrained and fiscally cautious, she stated in her budget speech that, in the years to come, she wanted her child to look back in the history books and judge her and her government favourably.  

She continued saying that their position politically was unambiguous: They were in government for the young generation and for the future of the country, the abode of their young ones. In her budget, there was a substantial increase in health spending for she wanted every New Zealander to be happy, safe, and healthy.  

To achieve her goals, she believed in the need to support strong, safe communities, and a robust and efficient health service, proposing a major overhaul of New Zealand’s healthcare system, rebuilding hospitals, boosting funding of services, making sure those working on the frontlines were getting proper support, a free, nationwide, frontline mental health service, cancer action plan with new cancer treatment equipment and new cancer drugs, fixing or rebuilding rundown hospitals and major investment in medical and nursing education.  

Despite a fiscally cautious budget, she had increased previous year’s health funding by almost 20%. 

Then, towards the end of 2019, our known world was mangled by a deadly virus regarded as an invisible killer, with no way to know when it strikes and when the pernicious pathogen reveals its presence, and no available treatment to combat the catastrophic devastation executed by this unique bio-entity.  

With the Covid-19 pandemic, HPM Ardern has done remarkably well as a result of an aggressive approach which has enabled New Zealand to end the transmission of SARS-CoV-2. New Zealand recorded its first day of no new cases of Covid-19 early, in the week beginning May 4.  

The Lancet on May 9 reported that New Zealand had recorded fewer than 1,500 confirmed cases of Covid-19 and 20 deaths. On March 23, a month after the country had recorded its first case, the premier committed New Zealand to an elimination strategy.  

A few days later, she announced a strict national lockdown when it only had 102 cases and zero deaths. Her swift decision-making won widespread international praise, including a copious one from the WHO.  

Leaders like Jacinda Ardern, in contrast to many others, believe that, absolute capitalism, like any other absolutism, without the benefit of social justice and fairness, is detrimental to the community they have been voted to serve.  

In any case, whatever the fiscal policy of a country is, a plan and its successful implementation is the main weapon against a biological enemy like the SARS-CoV-2. The plan in a situation where the pathological agent is deadly and vicious, with much about it unknown, would have to be spearheaded by a comprehensive risk management strategy to be established by the public health care system supported by the national leadership at the very beginning of the crisis.  

Investing in public health

In this case, the window of opportunity that had been delivered on Bangladesh’s door steps, much before the crisis presented to the shores of our country, was the time-lag between the height of infection in Wuhan and start of Covid-19 in Bangladesh.  

The risk management process requires risk assessment and subsequent minimization of the risk through resources available to the entire health care system, with an emphasis on public health care. The strength of the virus to do harm and the quality of the public health care determine the extent to which harm is caused to the population.  

We are never going to be absolutely risk-free with the SARS-CoV-2 virus hanging around. The aim is to reduce the risk and the reduction of risk against coronavirus 19 would depend on effective steps taken such as that of social distancing, social etiquettes, the provision of protective equipment, intensive care facilities and, most importantly, the availability of tests and the subsequent tracing of contacts, among others. 

I have been emphasizing on the need for proper investment in Bangladesh’s public health care, including major funding for medical education, for a while now. The public is obviously concerned and, at some stage, may feel keen to hold to account the policy makers, particularly the officials who should have been better equipped to lead the fight against Covid-19. 

I readily and very emphatically quote Margaret Chan, the past director general of WHO, who firmly believed in our success story, and time and again iterated how Bangladesh had shattered the long-held assumption of experts that countries must first reduce poverty before better health can follow.  

She was glad to see international political and socio-economic specialists to be proven wrong by how Bangladesh had managed to reverse the order, freeing the populations first from the misery caused by ill health, followed by the economic miracle which subsequently followed the good health of the population.  

Bangladesh has witnessed significant gains in the primary health care sector, achieving the Millennium Developmental Goals on time, thanks to the commendable leadership of our honourable prime minister. Freeing the population from the malediction of poor health heralded the envious economic growth observed during her second and subsequent terms in office.  

Unfortunately, the people entrusted appear to have failed miserably to uphold the shining precedence that she had set in motion. They seem to have presided over the subtle but steady and disastrous free fall of the superb gains in health indicators achieved by our HPM, described by Hans Rosling, professor of international health at Karolinska Institute, as the Bangladesh miracle -- minimum investment in health with maximum benefit harvested. 

The worst aberration committed by those responsible was their inability to timely appreciate and improve the quality of our health professionals through further training and education. This needed to happen simultaneously with the increased demand for the skill, knowledge, and attributes of our doctors.  

Post-graduate education and training should have been incorporated as a statutory requirement for allowing doctors to independently practice, be it privately or in the public sector, as is the norm in any developed country. After five years’ uninterrupted training for eligibility to general practice in the community following graduation (MBBS), the medical education authority in close collaboration with the Bangladesh Medical and Dental Council and other stakeholders would introduce similar but longer training programs for doctors intending to pursue careers in hospital practice.  

An eye opener

The coronavirus pandemic has been an eye opener for our society. Without the benefit of proper structured curriculum based post-graduate training empowering the medical graduates of our country, quality management of people suffering from medical conditions such as the coronavirus is not practicable and definitely fraught with repeated incidents of medical malpractice, avoidable deaths, and financial ruins.  

If we look at the leading causes of death in Bangladesh as reported by the WHO, it is clear that it is virtually impossible for us to tackle complex cardiovascular, neoplastic (cancer) diseases, endocrine ailments like diabetes, injuries due to road traffic accidents, serious infections leading to organ and multi-organ failure, and others with the knowledge, skill, and qualities imparted by the education and training in the graduation program in a medical college.  

Defined post-graduate training for every medical graduate in Bangladesh is imperative for the health sector to acquire the required knowledge, skill, and attributes. 

Dr Raqibul Mohammad Anwar is a Colonel, Royal Army Medical Corps, UK Armed Forces, and Specialist Surgeon & Global Health Policy and Planning Expert.