The world is changing ever with major departure from the past. It is becoming richer with massive growth of economy supported by gigantic development of technology bringing about changes in life style. Old society disintegrates to shape cosmopolitan one where you find money, commodity and business as the prime determinants of life. So money is the most important thing which buys everything that you need to lead a decent life. It sounds not much decent as it does not fit well with our values that we have been nourishing for years together. In fact there are many relinquishing ingredients in our society which end up with good results.
But you cannot ignore the role of money in this worthy world. It is not but money that kicks us up to the peak of civilisation. So the concept of money and market as the driver of society may not be looked down. There is no harm if we can buy good commodity with money. It of course needs good market management.
Now if I come to public health care and call you to buy it as a commodity, then perhaps you will not agree with me. Because in Bangladesh, public health care is used to be provided by the government at free of cost. Despite well-known weakness the service is reasonably accepted. But it is also a fact that government buys the service from the provider for its people. So by no means it is free. People rather pay for it indirectly, money again playing its role. But here you cannot choose your care or commodity whatever may be the case.
However, marketing public health care would not be a good idea in this country. But the existing system cannot catch up with the ever increasing demand of the community. So we need to find out an alternative in between. That could be done by empowering people at stake.
In Tuberculosis (TB) control programme, it is moving well in Bangladesh. GO-NGO collaboration and coordination is good in this programme, activities being well distributed amongst them. Government has signed a memorandum of understanding with forty four NGOs through BRAC as lead NGO committing partnership to implementing the programme. Having done that the Government shares its wealth and capacity with them. On the other hand NGOs being flexible and carrying more stakes reach out to the community with ease and integrity. In this way access to care is increasing, most importantly developing ownership of the people. So a sort of empowerment is building up within the community that will ultimately drive the programme.
Important development of this endeavour is patient centered care i.e. care given to the patient at his doorstep. Community health care providers are leveraging service to the patients within their reach through DOT (directly observed treatment) centres, which are more than eight hundred in number in Bangladesh. This sort of service is also under consideration for the management of drug resistant TB, the worst type of its kind. So it is obvious that people’s power is winning over.
That is how empowerment of the people may alternate to marketing health care. Fortunately that is happening in TB control programme making way to success.
The writer is a Former Director, National TB Control Programme.