Dr Md Ashraf
Ours is a densely-populated country with resource constraints. Here millions of families have no access to basic healthcare and thousands of doctors and nurses are neither employed in the public sector for health services nor given any policy support for self-employment in the community. The society is bearing the cost of producing these health professionals but it is failing to use their services in return. We cannot afford the loss of health resources including manpower either in the public or in the private sector. We need to address efficiency and equity issues in health care. But the level of competence and integrity of individual health professionals are not beyond question and the whole profession's efficiency in meeting the gradually increasing healthcare needs of the community should be proved. Medical professionalism developed in our health sector is failing to address the problem of equity in healthcare delivery. It is observed that efforts of our health system to give care to a poor person or a remote community are bearing no fruit.
New way to combat changing health needs: how to dream: Besides diseases and disasters, environmental crises (e.g. pollution, adulteration, loss of biodiversity, global warming and climate change) and psychosocial problems (e.g. poverty, injustice, inequality, gender discrimination, violence, corruption, crime, terrorism, social unrest, political instability) have profound impact on our health/wellbeing. The latter two-environmental crises and psychosocial problems-result from irrational human behaviour. Therefore it is obvious that diseases, disasters and deranged human behaviour are the root causes of loss of health. So reduction of the burden of disease and control of irrational human behaviour are essential for enjoying the highest attainable health/wellbeing in a defined community.
This changing health needs are demanding new methods to intervene in health problems. The way to combat the root causes of loss of health is the Bio-Medical-Social Action, where the principle is building capacity of both biological and psychosocial existence of human life and the strategy is endowing families with bio-psycho-social functional integrity. The faculty of medicine has to face the challenge of addressing the root causes of loss of health/wellbeing by organising integrated health care and medical social work in the community.
Healthcare for tomorrow: how to visualize: The highest good for the least number and hope for the best treatment regardless of cost make little sense. Efforts to revive life are eventually futile. Human life is a product of gene and environment. The rational way to save our community and the humanity is the Bio-Medical-Social Action that supports the humans to cope with the environment and maintain a state of equilibrium. This creates an opportunity for an individual to enjoy the best health. Loss of health is a social problem. Care demands information on an individual as well as a family and a community. Resource allocation in the health sector has to consider issues of efficiency and equity. Market provision and government intervention both have efficiency and equity failures in health care. In order to address these issues (i) Medical faculty should establish the philosophy of 'people-centred health system' and 'ethical provision of health care' by bringing necessary changes in medical education, training, practice, research and faculty development process, (ii) Health administration should support introduction of 'community-based unitary family health service approach' in healthcare structure by reviewing basic healthcare science development policy, and (iii) State law should support public private partnership for developing 'ethical provision of health care' that will pave the way to a build 'people-centred health system' by ensuring community participation. Ethical provision of heathcare is the one which encourages equal access to service according to need, minimises resource loss, maximises social benefit, ensures rational use of medical information and appreciates health sector reform initiatives. People-centred health system supports development of ethical provision of healthcare in the community and unifies the events of health manpower development process by tuning education with training, training with practice, practice with research and research with faculty development.
Way forward: how to proceed: We, the health professionals, are to think deeply about the ethical dimension and the medicine in consideration of human rights. We are to go beyond the usual individualistic perspective of healthcare and widen the scope to include environmental and psycho-social issues. We need to achieve a consensus on redefining medicine and updating educational contents in order to address broader and complex health problems of the community. Our people are waiting for the day when veteran politicians, pioneer health administrators and rational health professionals would raise their voice and influence the government for reviewing policy-plan-law to upgrade medical faculty which promotes ethical provision of healthcare that paves the way to build a people-centred health system. Let us strive for excellence and realise that we have in our hands the most valued things people have: life and health, and our duties are to do the best for them by fighting disease, disaster and deranged human behaviour.
The writer is former consultant, Health & Population Sector Program, Bangladesh, DFID, British Council, Dhaka.