Medicine cost eats up two-thirds of the money spent by people from their own pockets for health, pushing those with chronic diseases towards poverty, said speakers at a policy dialogue yesterday.

The out-of-pocket (OOP) payment is about 63 percent of total health expenditure of the country, said Bushra Alam, senior health specialist of the World Bank.

"Because of the burden of OOP,” said noted economist Hossain Zillur Rahman, “about 40 lakh people are pushed into poverty risk every year."

The OOP payment is made directly by a patient to the healthcare provider.

Besides OOP, unplanned urbanisation, lack of inter-linkage between health service facilities, lack of reliable health data and the rise and prevention of non-communicable disease were also discussed by health practitioners, researchers and policy makers at the dialogue.

Organised by Poverty and Participation Research Centre (PPRC) at the capital's LGED Bhaban in Agargaon, the programme “Health challenges of Sustainable Development Goals: Path to Universal Health Coverage in Bangladesh”.

Hossain Zillur, executive chairman of PPRC, said unnecessary prescriptions and superfluous diagnostics are some of the unwelcome consequences of the growing pharmaceutical industry in the country.

"There are 100,000 registered pharmacies in the country, but many pharmacies are run not by pharmacists but by salespersons who have incentive to over-prescribe that drives up the cost," Bushra said.

Aggressive marketing policies of pharmaceutical companies also lead to unnecessary prescriptions by doctors, she said, adding that doctors often prescribe brand drugs instead of the generic ones, which also adds to the cost.

Dr Syed Abdul Hamid, associate professor of Institute of Health Economics, Dhaka University alleged that pharmaceutical companies often present doctors with apartments in posh areas such as Dhanmondi and Banani in return for prescribing their drugs for a certain number of years.

Emphasising the need for government control on drug prices, Dr Zafrullah Chowdhury, founder of Gonoshasthaya Kendra, said the government should form a drug committee with economists, consumers and health practitioners to control the prices of drug.

He suggested the Minister of Health and Family Planning run a prescription audit in the capital to check the tendency of over-prescription by doctors, which would put pressure on doctors to stop the practice.

With regards to quality of drugs and identifying counterfeit ones, she said the drug testing laboratory in the Directorate General of Drug Administration (DGDA) with its modern equipment need to be manned with efficient people.

Dr Md Khairul Islam, country representative of WaterAid Bangladesh expressed concern about air and water pollution caused by unplanned urbanisation, which added to the health risk of the urban population.

Citing a study, Khairul said a correlation between stunting, lower IQ and unsafe water existed among children of the country.

He said inadequate waste management in cities and absence of faecal sludge management in municipalities and rural areas are contaminating surface water and thus posing health risk.

Hossain Zillur said the country has an elaborate health facility infrastructure from community hospitals to tertiary level hospitals such as the Dhaka and Chittagong Medical College Hospitals.

However, instead of working as referral hospitals, these tertiary health facilities are burdened with outdoor patients, he said emphasising the need for ensuring better health services at districts and sub-districts level facilities.

Former Health Secretary AMM Nasiruddin said behavioural change is important to prevent the growing incidence of non-communicable diseases (NCDs) such as diabetes, high blood pressure, heart and kidney diseases and cancer.

"There is a gap in awareness in rural areas about these," he said adding that imams of mosque can be used to encourage people to live healthy life-styles. 

National Professor Brig (retd) Abdul Malik, president of National Heart Foundation, emphasised the need for creating healthcare assistants to look after people disabled from chronic diseases.

He also warned that if prevention control of NCDs were not done now, the incidence of such diseases would become unmanageable in future.

Health Minister Mohammed Nasim said people are destroying their health in the name of modernisation by indulging themselves in unhealthy lifestyles such as eating fast food and avoiding walk.

From this year onward, he said, a health service week would be observed every year from March 17, on occasion of the birth anniversary of Father of the Nation Bangabandhu Sheikh Mujibur Rahman, to raise awareness among people and decide on policy issues.

He added that to stop mushrooming of pharmacies, government would give now pharmacy license in a neighbourhood based on the population of that area.

A book titled “Realising Universal Coverage: Bangladesh: Challenges and Opportunities” edited by Hossain Zillur Rahman and published by PPRC was also launched at the programme.