"When written in Chinese, the word 'crisis' is composed of two characters: one represents danger, and the other represents opportunity." I had no doubt that the Chinese were people with an abundance of wisdom stemming from, and culled out of, the tradition of more than 5,000 years of civilised existence, but it is only a wise leader who can internalise such profound thoughts, as did John F Kennedy whose exact words I have quoted above. He also added, "In a crisis, be aware of the danger—but recognise the opportunity." Should all leaders worth the name not do so as well? It would be well to remember that a crisis reveals the true character and quality of a country's leaders, the business community and the affluent section of society.
Apart from the death and destruction, a crisis leaves many lessons in its wake. The good points must be built upon further, without indulging in celebratory beating of one's chest or coming out with outlandish and puerile statements—such as that the number of deaths would have been triple were it not for the actions taken, or that we have combatted the Covid-19 pandemic more efficiently than many other countries in the world, etc.
What is important, alongside strengthening the positives, is to address the weaknesses revealed without wasting time on discovering exculpatory circumstances. And that is possible only by looking dispassionately and objectively at what went wrong and why. Rectification is possible if the administration is quick to take action to plug the holes in terms of the infrastructure, policies, and the process of taking decisions or formulating policies. The idea is to be prepared for an eventuality. Although there would be many unpredictable contingencies, a good plan must foresee as many as those and formulate as many alternatives as possible, so as not to be caught off guard. The effort should not be merely to manage things but to do the right things, and do so on time.
A case in point is the way we have, over the last two decades, developed our capability to tackle natural disasters like cyclone and flood, which are rather more predictable. But as far as this pandemic is concerned, we were caught completely off guard. And although the mission to combat Covid-19 remains unfinished, it is time for a mid-course assessment, or a post-mortem on our actions taken so far. Here is my tuppenny worth of suggestions.
The first is to take a hard look at our health sector.
What Covid-19 has done is to expose, very blatantly, our frail and poor healthcare system. It is in a shambles. The 2.3 percent of GDP expenditure on health is inadequate if the state really wants to provide even basic healthcare support to the vast majority of the 17 crore people who fall in the category of indigents. True, the government has invested considerably in providing the basic facilities by establishing an extensive network of health services. The number of public hospitals has gone up considerably, but are they fully staffed and equipped? What good is a hospital if the ICU does not have a centralised oxygen supply system? Except for Dhaka, very few divisional headquarters—not to speak of district headquarters—have specialised services and few of those hospitals have ICU facilities, if at all, not to speak of the upazilas. More than 50 percent of ICU beds are in the capital. This is another example of everything becoming Dhaka-centric. And only when the health ministry scampered to induct thousands of nurses and junior doctors after we were hit with the full blast of the pandemic, did we come to know about the state of manpower in our private hospitals.
Private hospitals have mushroomed in Bangladesh but they are highly commercial. Healthcare service, for them, is an appendix; churning out money is the prime motive. In any case, most of those in the high-end category of hospitals cost much more than some hospitals abroad, and the quality of their service does not quite measure up to the standard of service of hospitals in the neighbouring countries. In any case, a majority of the private hospitals in Bangladesh are beyond the reach of those in the middle rung of the economic ladder. Moreover, the pandemic has helped many of those producing or dealing in medicines and equipment like oxygen cylinders to reap whirlwind profit, which is quite unfortunate.
The second issue is the way we have attempted to tackle the pandemic from the very seminal stages of its onslaught. It could be said that the appraisal of the likely impact of the pandemic, particularly on public health, was faulty as much as our confidence in developing herd immunity—and belief in Nature taking care of it—was in abundance. The euphoria was stoked all the more by a few "experts" who cited the example of SARS. And as the situation developed, it appeared that the administration was playing it by ear. Some of its decisions seemed to be off-the-cuff reactions, and many of them were not even implemented fully. Even "the best laid schemes o' mice an' men" may go haywire, and so did ours in the very first weeks of the pandemic stamping its footprint in the country.
The government hospitals designated to treat Covid-19 patients were not adequately set up, despite the PM's directives. The number of testing booths remains pathetically inadequate. And that justifies the demand for making quick testing kits available on a large scale. It is hard to reason the delay in passing verdict on the fast testing kit one way or the other. It has been more than a month since the ones produced by Gonoshasthaya Kendra were handed over to BSMMU.
In the midst of the pandemic, general treatment in the hospitals seems to have stopped. More than a hundred people have reportedly died due to hospitals turning away general patients, including pregnant women. Many hospitals did not, and still do not, have any facility for Covid-19 treatment. It is an emergency without the government declaring so. Under this circumstance, the government can press in any facility to address the emergency. Couldn't a certain percentage of hospital beds in all the private hospitals be requisitioned for Covid-19 patients? Government instructions to private hospitals were left at the discretion of their authorities: a few complied, but most did not do so fully.
It seems that only one hospital in the country, CMH Dhaka, is equipped adequately to treat Covid-19 patients. For all VIP patients, the road leads to CMH only. The demand for its services is noticeable. While it makes me proud that this one treatment facility of ours has garnered confidence in the people, I wonder why such confidence has not been created by other hospitals. When senior government functionaries reportedly choose CMH over other government hospitals for Covid-19 treatment, what confidence will others have in them? Why is that so? The answer is bitter: the military utilised the funds diligently, honestly and wisely, and in a planned manner. The military health service is led by a band of highly efficient and dedicated officers and staff who are, as it is, under tremendous strain even in normal times.
In view of the prevailing state of the health sector, it deserves much more than what it has got in the past. We understand that there will be an increase of 7.25 percent in the health budget for next year. Given that our per capita expenditure on health is the lowest in South Asia, the proposed increase is not enough. If the annual outlay on development in the health sector has not been fully utilised, it is the system that must be corrected, and removing systemic flaws should start with discarding the ones in the leadership of the sector. Right to health is implicit in a citizen's right to life.
One wonders whether anyone is watching the graphs. If so, how is it that the so-called lockdown—if it was a lockdown at all—was lifted at a time when both the numbers of identified cases and deaths spiked exponentially? And now, we have selective lockdown. Couldn't the reverse—selective reopening—be done? Merely declaring a "general holiday", as the administration had done, leaves too much to people's discretion, and given our economic condition, with the informal economy being hit the hardest, the poorest section of society had no other alternative but to scrounge around for a living.
The long and short of it is that the health sector should receive much more than what it has been receiving in the past, and it should be led by dynamic people. A permanent national taskforce or committee on epidemics, as we have for natural disasters, should be set up. The shortcomings in all public hospitals should be eliminated in light of the Covid-19 experience and their facilities should be brought up to par. Blatant commercialisation of the private health service should be stopped. A strict mechanism to enforce orders and instructions should be put in place before issuing directives. For a country like ours, this is a tall order, but that has to be done, gradually of course, if we want to be better prepared to face such an eventuality in the future.
Brig Gen Shahedul Anam Khan, ndc, psc (Retd), is a former Associate Editor of The Daily Star.