SHEIKH Hasina鈥檚 resignation and fleeing to India on August 15 marked the end of her 15-year autocratic rule and the beginning of a new era in politics. Over these years of authoritarian and oppressive rule, Bangladesh has experienced significant issues, including an extreme violation of rights and a systematic destruction of public institutions. Indeed, the health sector is no exception which has been challenged with incapable leadership and weak coordination, widespread corruption and mismanagement and an extreme form of politicisation at all levels, including undue political interference.
The factors have contributed to the fragmentation and disruption in services delivery and widespread medical negligence at all levels, including in public and private facilities. It further led to increased disparities in healthcare access and quality, particularly affecting the poor and other marginalised people. Many families and individuals face financial hardship because of unnecessarily high healthcare costs, leading to catastrophic expenditures.
As a result, Bangladesh has increasingly become incapable of managing its basic health sector challenges. The chronic challenges that the country has experienced for decades include a limited access to health care, inadequate infrastructure, the shortage of skilled healthcare professionals, high out-of-pocket expenses, an inequitable distribution of resources, a high burden of infectious diseases and fragmented/fragile health information systems.
These health system challenges are compounded by skyrocketing increase in accidental injuries which are now estimated to account for a higher number of deaths than infectious diseases. According to limited information that is publicly available, accidental injuries account for around 12 per cent of all death and by 2030, this acute condition will become a top leading cause of death in Bangladesh.
A well-functioning emergency medical services system will play a crucial role in preventing death from accidental injuries by providing immediate medical care and transport to injured patients. In addition, the integration of an emergency medical services system in health systems will reduce the risk of further injury or complications during transport, ensure a timely arrival of patients in hospital for proper treatment, promote the provision of life-saving interventions by trained paramedics and emergency medical technicians, strengthen coordination with hospitals for emergency preparedness and response and, on the top of everything, it will create public awareness of accident prevention and safety measures.
By strengthening the emergency medical services system, Bangladesh will be able to reduce the impact of accidental injuries and save lives, including thousands of students and other young people who were brutally injured by Hasina鈥檚 unruly law enforcement agency personnel during atrocities between July 15 and August 5. A well-functioning emergency medical services system could have prevented many death and permanent disabilities that were attributed to this massacre.
The introduction and integration of a well-designed emergency medical services system in Bangladesh will require an immediate high-level policy attention. This involves the development of specific legal framework, the implementation of policy reforms, the adaptation of immediate measures to increase investment and collaboration among stakeholders both in the public and the private sector.
Hasina and her regimen鈥檚 departure on August 5 has re-opened opportunities to identify and implement a range of legal and policy actions that will equip the health sector to face the health-related challenges of the day and decades to come.
The number of patients visiting emergency departments worldwide is increasing. In the United States, the number of emergency department visits was 353 per 1,000 people in 1997, but it was 411 per 1000 people in 2020, reaching 131 million a year, more than double the rate of population growth. In Korea, the number of emergency patients, which was 2.4 million in 2002, increased steeply from 1,0 million in 2018.
In Bangladesh, it is difficult to identify the exact emergency patient demand because of severe data gaps. Most patients who go to hospital are also triaged and then divided into outpatient department, inpatient department, emergency department and intensive care units.
In Bangladesh, the emergency medical services system, including its referral and transport systems, has yet to be recognised as a vital component of the healthcare system. The country does not have any emergency medical service like 911 in the United States and Canada.
The number 鈥�911鈥� is the universal emergency number for everyone in the United States. However, before 1968, there had been no standard emergency number. So how did 911 become one of the most recognisable numbers in the United States? In 1967, the Federal Communications Commission met the听 AT&T to establish such an emergency number. They wanted a number that was short and easy to remember. More important, they needed a unique number and as 911 had never been designated for an office code, area code or service code, that was the number they chose.
Soon after, the US Congress agreed to support 911 as the emergency number standard for the nation and passed legislation making 911 the exclusive number for any emergency calling service. A central office was set up by the Bell System to develop the infrastructure for the system.
On February 16, 1968, Alabama senator Rankin Fite made the first 911 call in the United States in Haleyville, Alabama. In 1973, the White House鈥檚 Office of Telecommunication issued a national statement supporting the use of 911 and pushed for the establishment of a federal information centre to assist government agencies in implementing the system.
By 1979, about 26 per cent of the United States population had 911 service and nine states passed legislation for a statewide 911 system. Through the latter part of the 1970s, 911 service grew at a rate of 70 new local systems per year. Approximately 50 per cent of the US population had 911 service by 1987. In 1999, about 93 per cent of the US population was covered by 911 service. Canada听adopted听911听in 1972 and the first city to implement the system was London, Ontario, in 1974.
Building on this unique example, Bangladesh needs to kick-start a similar approach to institutionalise the emergency medical services system within the country system. To enhance the emergency medical services system in Bangladesh, it is essential to identify resources, understand the actual demand and develop a comprehensive improvement plan for each component of the emergency medical services system. With a heightened level of political will and ambition to implement reforms in the health sector, the post-Hasina era in Bangladesh presents a significant opportunity to establish a comprehensive emergency medical services system, which will be a crucial milestone in achieving universal health coverage in Bangladesh.
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Dr Ziauddin Hyder, a former director research at BRAC, is adjunct professor of the University of Toronto and University of the Philippines.
