After the fall of the Awami League government on August 5 with Sheikh Hasina fleeing, the Indian government restricted the issuance of visas for Bangladeshis. Recently, the burning of the Bangladesh flag at the Assistant High Commission in Agartala, India, led to a new deterioration in relations between the two countries. At one stage, the country officially stopped the activities of the visa center. Although medical visas are available on a limited scale, they are few and far between.
It has been learned that currently, after much effort and lobbying, a limited number of visas are being obtained through the Indian High Commission and visa processing agencies of various organizations. Some get them after various efforts, but most do not. As a result, patients have to rely on domestic treatment for the time being. Due to visa complications, the number of patients going to India has dropped by about 50 percent in the last six months compared to the first six months of the year.
Those concerned say that it is difficult to get treatment in the country's government hospitals, while doctors consider patients who come to private hospitals for treatment instead of receiving minimum services as 'customers'. Doctors and staff try to strategically allocate patients to private hospitals to earn extra money. In addition, there are complaints of unnecessary tests, faulty results, and not listening to patients due to the greed of the commission. Many people have lost faith in the country's medical system for these reasons.
However, expert doctors say that it is time to change this situation. Although previous governments have improved the medical infrastructure, they have failed to ensure the necessary facilities, starting from doctors, in hospitals compared to the people of the country. The governments' goal was to manage the situation rather than provide quality treatment. The private medical sector has also failed to inspire hope. Although several private institutions have been established, the desired medical services are not available there either.
It has been learned from officials of the Ministry of Health and Family Welfare that a Health Reform Commission has been formed to radically change the country's health system by reducing foreign dependence. In the meantime, the government's policymakers are continuing discussions with stakeholders at the government and private levels as well as with ambassadors of various countries, including Singapore. They are meeting with countries whose health systems have advanced technology and facilities than Bangladesh's. If necessary, the government wants to reach the first stage of improving the country's medical system by transferring technology from those countries. However, they said that political commitment is necessary for this.
Patients going to India have decreased by half in five months:
According to the Tour Operators Association of Bangladesh, the main destination of Bangladeshi tourists is India, which is about 41 percent, of which 80 percent is for medical treatment. A large part of these passengers go by road and train. In this case, the most goes through Benapole port in Jessore. Last year, 956,000 Bangladeshis went to India on this route. Of these, more than 750,000 are for medical treatment.
Benapole Immigration data says that 776,404 Bangladeshis have gone to India till December 20 this year. This is 180,000 less than last year. Of these, 461,000 Bangladeshis went to India in the six months from January to June, but in the subsequent six months, this number is around 300,000.
Benapole Immigration Checkpost Police Officer-in-Charge (OC) Ibrahim Ahmed told Amar Desh, ‘Since August 5, the number of passengers has basically decreased. The visas of most of the businessmen have expired. The number of patients is also much less now.’
On the other hand, according to Akhaura Land Port, 150,000 Bangladeshis went to India using this route in 2023, but this year the number is around 100,000. Especially in the last six months, the number of passengers has decreased significantly. While 67,000 went from January to June, it was around 40,000 in the next five months.
Passengers have also decreased by air. Although it was not possible to know the exact amount of decrease. However, according to a report by The Economic Times, the passenger traffic on flights to India has decreased by about 50 percent.
80 percent of those going to India are patients:
Most of those from Bangladesh who are going abroad for medical treatment are from neighboring India. However, there is no accurate statistics on how many patients go abroad for medical treatment every year, both government and private. Before the fall of the Sheikh Hasina government on August 5, several thousand applications were submitted to the Indian Visa Center in Dhaka every day. 80 percent of the thousands of people standing in line since dawn are candidates for medical visas. Currently, these are almost closed.
The 15 Indian Visa Application Centers in Bangladesh are operated by the State Bank of India. According to the center and bank information, Indian missions in Bangladesh issued 1.38 million visas in 2017, 1.46 million visas in 2018, and about 1.6 million visas in 2019. At least three-quarters of these visas were issued to patients and their helpers for medical treatment, confirmed High Commission sources.
Meanwhile, it is learned that the Indian government has largely stopped issuing visas after August 5. Thai hospitals are taking advantage of this. Representatives of some of the country's hospitals in Dhaka said that in normal times, at least 3,000 patients would visit Bumrungrad Hospital every month, which is now double the number. More than times. In addition, the number of Bangladeshi patients has also increased in Bangkok and Vejthani hospitals. Every year, about 1.25 million Bangladeshis go to the country for treatment. Especially, a large part of those injured in the July Revolution are receiving treatment in various hospitals in Thailand.
Reasons for going:
Md. Belal Hossain (67) of Gurdaspur Upazila of Natore, who has been suffering from liver cirrhosis for about three years. Despite efforts at many government and private institutions including Bangabandhu Sheikh Mujib Medical University (BSMMU), he could not get a liver transplant. If he wanted to survive, he had no option but to get a liver transplant. But Belal was spending his days in a hurry due to the lack of a donor. Last March, his son Zakir Hasan donated his liver to his father at a hospital in Chennai, India.
Zakir told Amar Desh, 'There are so many big hospitals in the country, but they do not have the capacity to transplant liver. We tried everywhere. But we had to go abroad without finding a way. Which cost 85 lakh taka. But if there was capacity in the country, it could have been done here.’
He said, ‘In addition to capacity, there is a considerable shortage in the services of our doctors and nurses. Even buying healthcare with money, one has to suffer and be harassed. There is a great lack of sincerity here. As a result, people are somehow forced to go abroad.’
Dr. Syed Abdul Hamid, a professor at the Institute of Health Economics, University of Dhaka, told Amar Desh, ‘The main problem is in our system. The patient does not have the information about where to get treatment for a disease. In the developed world, when he gets sick, the first center he goes to is the one that tells him where to go in the next step. But in Bangladesh, the patient initially goes to a doctor, then to an MBBS doctor. There, he goes to the district headquarters hospital and medical center in various ways. There, he falls into the clutches of brokers and is unable to go to a good doctor. This is destroying both his money and his body. After such suffering, the patient goes abroad in despair.’
He said, ‘Doctors in government hospitals cannot give enough time to the pressure of patients, while in private hospitals they do not show sincerity on their own. At the same time, there is a big problem in diagnosing diseases here. No one can say where 100% quality diagnosis is done. Due to these problems, it has reached the people that good treatment is not available in Bangladesh. And the brokers of other countries in Bangladesh are taking advantage of this and are dividing the patients.’
Abdul Hamid said, ‘We could also do a beautiful medical tourism. There are many private hospitals, they could do it if they wanted. But for this, only sincerity is needed. If you go for treatment abroad, there is a system of accommodation and food in the hospital building. But hospitals like Square and United do not have such a system. As a result, if someone from one part of the country goes to Dhaka for treatment, the patient’s relatives do not know where they will stay. However, medical tourism does not mean only treatment. Our highest quality private hospitals can announce that they will provide 100% quality treatment and other services to patients who have been treated abroad and are trying to go for it. Special packages can be announced for them. Where there will be treatment and entertainment facilities with special security, time and sincerity. If this is done, patients heading abroad will take treatment. Once that is provided, the interest in going abroad will decrease.’
5 billion dollars spent annually on treatment abroad:
How much will it cost for such a large number of people to go abroad for treatment? Bangladesh Bank Governor Ahsan H. Mansur has given an estimate. At an event in Dhaka on December 15, he said, ‘Bangladeshis spend more than five billion dollars annually on treatment abroad.’
Ahsan H. Mansur said, ‘A large portion of patients going abroad go to India and Thailand. Because the healthcare systems of these countries are better than Bangladesh. However, a large portion of this expenditure is sent informally, which creates considerable pressure on the country’s balance of payments or foreign transactions. This trend of people going abroad for better treatment is making clear the limitations of the country's medical system and the lack of specialized treatment.
In such a situation, the demand for ensuring better treatment in the country is becoming stronger. Although there is a lot of infrastructure in government hospitals during the last decade and a half when the Awami League was in power, there has not been much increase in doctors, nurses, technologists, technology and other facilities, research to improve the quality of the medical system.
Initiatives taken, challenges continue:
The matter is further clarified in the comments of Special Assistant Professor Dr. Md. Sayedur Rahman of the Health Services Department of the Ministry of Health. He told Amar Desh, 'First of all, patients who do not have treatment for diseases or do not have such facilities are going abroad. Especially cancer, infertility, liver, kidney transplant and some heart disease patients. Some of these diseases do not have technology to treat, while others lack capacity. Besides, the big problem is the crisis of trust. These have been identified. However, these improvements cannot be achieved in a short time.’
Sayedur Rahman said, ‘The interim government has already taken steps to reduce foreign dependency. However, everything will not happen overnight. Even if we can bring equipment, we will need that kind of skilled manpower. A national initiative is urgently needed to lift it. We will help in places where there are crises, shortages and problems. However, it is difficult to make everything 100 percent. It will take at least one to one and a half years to introduce improved services in places where there is infrastructure.’
In response to the question of how much change is possible without political commitment, the special assistant said, ‘It is not possible without continuity. However, we want to start. In the meantime, a meeting has been held with all the policymakers from the government and the private sector. This In this regard, we are talking to the relevant parties of countries where technology can be transferred. Discussions are underway with countries with advanced health systems.’
Solution through public-private partnership:
BSMMU Vice-Chancellor Professor Dr. Mohammad Shahinul Alam has mentioned that patients going abroad is a symptom of the disease of the health sector. He told Amar Desh, ‘The main problem is the serious crisis of health workers including doctors, nurses, technologists. These manpower is at a level below the critical level in about 50 countries of the world, Bangladesh is one of them. It is not possible to provide medical services to 170 million people even with all the government and private doctors. The allocation is also very low. Besides, there are irregularities and corruption everywhere. In addition, promotions are not being made according to skills. The biggest problem is the lack of political commitment. If the next government does not continue the initiatives taken by the interim government to reduce foreign orientation, the situation will remain the same.’
He said, ‘The problem is that if hospitals are built through public-private partnership, great benefits will be obtained. In different countries of the world, wealthy people have built hospitals like Tata Memorial and CMC Vellore. Through the donations of many people, the highest quality treatment is available at low cost in these.’
Professor Shahinul said, ‘It is also very important to be able to utilize manpower. If this hierarchy can be brought into the referral system, taking community clinics and union health centers as basic, upazila hospitals as primary treatment, district hospitals as specialized treatment centers, medical college hospitals as academic research, more benefits can be obtained with less manpower. As a result, the tendency to go abroad after receiving the right treatment at the right time will decrease.’
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