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the Private healthcare sector regulation in Bangladesh
- 1. 1 The State, Regulation and the Private Health Care Sector in Bangladesh Redwan-ur Rahman Doctoral Candidate School of Public Health La Trobe University
- 2. 2 The Private Sector Growth • Dimension of the private health care sector growth in Bangladesh • Role of the State • Economic Factors • Social Factors • Problems in the Public Sector • Role of International Donor Agencies
- 3. 3 0 100 200 300 400 500 600 700 800 900 1978 1983 1988 1993 1998 2003 Private Hospitals Public Hospitals Trends of Public and Private Hospital Growth in Bangladesh 1978 to 2003
- 4. 4 Problems of the Private sector • Higher Cost • Lack of Necessary Manpower • Provide Unnecessary services • Lack of Standard and Quality of Care • Exploitation of Patients • Lack of Accountability, Poor Management
- 5. 5 Main features of Regulation • Promulgation of regulation 1982 • Licence from DGHS • Conditions for licence • Manpower • Space • Hygienic environment
- 6. 6 Continue… • Operation theatre • Life saving medicine • Instruments • List of Charges • Inspection • Penalty
- 7. 7 Organizational Chart of Implementing Agencies MOHFW DGHS Director Hospital Deputy Director-Hospital Assistant Director (Medical Board & Private Practice) Medical Officer
- 8. 8 Analyzing of State Capacity • Incomprehensive law • Lack of Revised Law • Incapable and incompetent State Capacity • Shortages of Manpower, Finance, Logistics
- 9. 9 Human Resource Development • Training, recruitment, utilization • Retention of managerial, professional, and technical talent that contribute to task performance at the organizational level
- 10. 10 Institutional relationship between Actors and their activities
- 11. 11 Regulatory Capacity • Legislative • Resources • Technical Capacity • Administrative Capacity • Stewardship • Governing Capacity
- 12. 12 Continue • Bargaining Capacity • Political Will • Self-Regulation • Complaint Mechanism
- 13. 13 Coordination and Conflicts • Interactions of various organizations • Relations among MOHFW , DGHS, BMDC, Nursing Directorate , Nursing Council, private providers, & BMA- DAB & Shadinata Doctor’s Council • Level of co-ordination & facilitation
- 14. 14 Organizational Structure of DGHS & Director (H) • Organizational structure, process, resources, management style • Inflow of communication within Ministry and Directorate level • Conflict between civil administration and specialist (professional) administration
- 15. •Administrative responsibility •Administrative pressure from the Directorate and from the Ministry •Pressure from peer groups e.g. BMA •Political parties •Owner groups •Social interaction- friendships, relatives •Mastani(Extortion) •Corruption •Regulators’ rent-seeking behaviour •Corruption Regulator •Consumer and health rights groups •Civil society •
- 16. 16 State capacity • Since 1997 ….. • Political capacity • Governing capacity • Institutional capacity • Technical capacity • Financial capacity • Limited capacity of the state
- 17. 17 Effects of Regulatory Practice • Limited regulation • Poor enforcement of regulation Poor regulatory practices
- 18. 18 Impact of regulatory practices • Quality • Cost • Access • Distribution • Equity
- 19. 19 Recommendations • Formulation of new comprehensive and transparent law • State’s more active role • Reorganization of Directorate • Promote professional and business ethics • Introduction of consumer participation in professional council • Empower consumer organizations and establishing courts • Make the complaint mechanisms easy • Encourage continuing education