Professional Documents
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Healthcare Laws in Bangladesh Final
Healthcare Laws in Bangladesh Final
Introduction:
Every year, we, in Bangladesh, observe World Health Day. On the
day, esteemed dailies publish special supplements with messages of
the Head of State, Head of Government, Health Minister/Advisor
and other executives with articles and news. All is well for the Day,
but not for rest of the year.
Around the World Health Day, interested quarters hold seminars in
national level and attract print and electronic media. In the year
2008, was of no exception. At least three seminars were organised,
one by the Transparency International Bangladesh [TIB], the second
one was by the National Committee of Health Rights Andolon and
the third one was by Bangladesh Private Clinic Diagnostic Owners
Association. I had the opportunity of attending them all. In all of
them, most of the discussions concentrated on Health Care Rights,
National Health Policy, Drugs Policy, Government and Private
Health Care Services and facilities, and Health Budgets and
allocation of funds, Contributions of NGOs and their lack of
accountability, and over-all governance of the Government and
Private Health Care institutions. In the year 2009, similar seminars
with similar agenda were held.
The discussants of the above seminars were Health Care
professionals, economists, NGO executives, media personalities,
representatives of the international health organisations and
interested individuals. Noticeably, there was no participant
representing the Homeopathic and Ayurvedic practitioners. There
was no discussion about failure of the governments came into power
to implement the constitutional obligation upon the state to secure
the health of the people, even after 37 years of our independence.
Sadly, 150 million general members of the public along side with the
technocrats, bureaucrats, civil society and professionals; no one can
deny the fact that we drink formalin milk; eat bird flu chickens,
poisonous fish, forced ripen fruits, adulterated food; suffer from
Political Parties Ignore Healthcare Issues, The Daily Star, Tuesday, December 23,
2008, p3
Research Methodology:
1. Relevant Literature Survey;
2. Group Discussion with the Doctors specialising in
Healthcare Administration;
3. Research Papers;
4. Internet Data Search : domestic and international etc.
Literature Survey:
Healthcare Statistical Data:
Bangladesh is an over-populated with highest population density of
881/sq km and a least developed country (LDC) in the world.
Seventy seven percent people live in rural areas. Sixty per cent of the
population live below poverty level. Maternity and child healthcare
service is inadequate. Infant and maternal mortality rate is still very
high. Protein deficiency and chronic malnutrition are widespread. 2
Selected Health Infrastructure information:
UHFWC
31-50 Bed UHC
District Level Hospitals
Government Medical College Hospitals
Postgraduate Hospitals
Specialist Hospitals
Doctor to population ratio
Nurse to population ratio
Total Hospital beds
Number of Nursing Institutes
No. of Registered Nurses
services) 3
3375
397
80
13
6
25
1:4719
1:8226
40,773
(over 290000 in GOB)
38
22,000 (14,686 Govt.
5.2/1000 population
1.48 percent
3.92/1000 population
62/1000 live births
83/1000 live births
2.9
53.8%
68 (m) and 69 (f)
52%
31.2% 4
Ibid.
The Health Policy confirms that every Citizen has the basic right to
adequate health care, the State and the government are
constitutionally obliged to ensure health care for its citizens. In deed,
the goal of the National Health Policy (NHP) is to make necessary
medical utilities reach people of all strata as per Article 15(A), and
develop the health and nutrition status of the people as per Article
18(A) of the Bangladesh Constitution7.
Health Policy is required to be re-drafted to be more compatible to
the demands and expectations of the Heath service users the
patients and service providers of all different areas. The preparation
committee may consist of Doctors, Health Care Managers,
Economists, Lawyers, Stakeholders, Service users and relevant
experts and consultants along side with the government
administrative servants.
Health experts and rights activists at a seminar rejected the National
Health Policy 2008, saying that it has ignored several fundamental
issues and that such a policy should be formulated by an elected
government, not the caretaker government no health rights
activists were involved in the policy-making process although the
policy calls for health rights of all, it gives priority to private
healthcare service the role of NGOs in the health sector be made
specific the policy has given priority to medical technology,
whereas prevention of diseases and primary healthcare service
should be given priority the policy does not have vision
statement. 8
Legal Analysis:
Constitutional Rights to Healthcare:
Article 32 of the Constitution of the Peoples Republic of
Bangladesh states that no person shall be deprived of life or personal
7
Dr Belal Husain Joy, Right to Life and Food Adulteration, New Nation, September
12, 2005
10
Law of Contract, 1872
The provisions contained under the Contract Act are wide enough to
cover even a breach or non-fulfilment of a contractual obligation
resulting into mental disorder or loss to the patient. However, it is
difficult to prove the allegations under this Act The compensation
or damages being granted by them is very high and stand at a
different footing.11
Penal Code, 1860:
Provisions for imprisonment and fine are available in penal code, 12
and these provisions are equally applicable to both the doctors and
the patients (complainant). If a doctor or a nurse can be punished or
fined for his/her negligence, a complainant shall not be spared if his
complaint is found to be frivolous or vexatious. Such provisions are
intended to check harassing complaints or actions initiated with
oblique motives to achieve unlawful gains or unearned incomes.
Sections 269 and 270 covers punishments for negligent act and
malignant act likely to spread infection of disease dangerous to life
respectively; Causing death by negligence is a criminal offence and
it is punishable under s.304A 13; causing miscarriage without
womens consent under s.313; death caused by act done with intent
to cause miscarriage if act done without womans consent under
s.314; an act done with intent to prevent child being born alive or to
cause it to die after birth under s.315, and other relevant sections like
Ss.316-318. In addition, acts not intended to cause death, done by
consent in good faith for persons benefit under s.88 can also be an
essential provision for medical wrong cases.
There is a fear in the minds of doctors/medical professionals that,
they may be harassed by police or by the law courts particularly in
medico-legal cases. This inhibits them in the handling of such cases.
11
Prof. SK Verma, Legal Framework for Health Care in India, 2002, p158
Penal Code, 1860
13
Dr Belal Husain Joy, Law Management Skills, 2005, p226
12
Prof. SK Verma, Legal Framework for Health Care in India, 2002, p165
Code of Criminal Procedure 1898
16
Dr Belal Husain Joy, Constitutional History of Bangladesh, 2008, p462-463
17
The Limitation Act, 1908
18
Dr Belal Husain Joy, Law Management Skills, 2005, p239
15
act but provisions are available and enforced under different acts as
discussed above.
Consumer Rights Protection Ordinance, 2007:
Medical negligence with special reference to the newly passed
Consumer Rights Protection Ordinance 2007,23 like every other
statutory has the same sanctity of protection and enforcement of
rights. But it must not be abused or used as a tool to blackmail ones
opponents for mercenary gains.
Consumerism is still a new concept in Bangladesh. Consumer rights
are integral part of Human Rights. It is important to clear who is a
consumer by law? A Consumer is a person who is not directly
involved in a trade, but receives goods and services from a person
who is occupied in the business. 24 Consumer right is the right to
satisfy basic needs. It describes the legal foundations for consumer
protection in Bangladesh. Consumer Rights are required to measure
the protection of consumers from products, processes and services
which are hazardous to their health 25 In Bangladesh such rights and
relevant legislations are scattered, hence, the consumers themselves
cannot initiate any legal action against wrong-doers.
In India, Consumer Protection Act 1986, modified in 1992, 26 under
which consumer courts were established all over the country to try
cases instituted by the consumers for violation of their rights
instances are there that physicians had to compensate the patients for
medical negligence and wrong treatment. In Malaysia, Sri Lanka and
even in Nepal consumer protection laws are in prevalence and
implemented for the protection of consumer rights There are
some conventional laws in existence in the country, but these laws
23
Grameen teams up with GE Healthcare, The Daily Star, Business Report, Tuesday,
December 23, 2008,
professional bodies. At the same time, almost all out-dated laws are
also urgently in need of up-dating to handle present day problems,
challenges to give effective remedies to the citizens.
Apart from the above, politicians in position and in opposition must
increase their awareness and be dutiful as per their own manifesto or
agenda and play appropriate role to allocate adequate funds and to
give best possible health care service to the people of all levels and
locations.
All doctors, dentists, nurses, technicians and other corporate and
administrative personnel must respect and abide by their individual
Codes of Conduct. For doctors and dentists, there is a specific
Professional Ethics and Code of Medical Conduct designed,
developed and supposed to be implemented by the Bangladesh
Medical and Dental Council,29 but never heard of any disciplinary
action taken in its tribunal against any of its members. Appropriate
measures are needed to be taken to reduce number of complaints and
litigations against the medical and dental professionals.
Government should up-date its good offices of the public health with
appropriate health strategy, development units (like planning,
information, epidemiology, evaluation), technical support, consumer
protection, health insurance and administrative units.
Bangladesh must set its targets and indicators in relation to health
care under the goals like poverty, hunger, education, gender, child
health, maternal health, HIV/AIDS, Malaria/TB/Heart Disease,
sustainable development, safe drinking water and sanitation etc.,
which could be compatible to the Millennium Developments.
Bangladesh must have its own modernisation program for the
application of appropriate knowledge, technology and management
which constantly evolve by new innovations to achieve the national
29
30