Decentralization of the health sector will be the first reform and major challenge of the interim government

Professor Dr. KMHS Sirajul Haque is widely known as a cardiology specialist in the country. Throughout his career, he has served as a professor and head of the Cardiology Department at BSMMU. He has also held the position of president in organizations such as the Bangladesh Cardiac Society and the SAARC Cardiac Society. Currently, he is providing services as a consultant in cardiology at City Hospital in Dhaka. Today marks World Heart Day. As the number of heart patients in Bangladesh continues to rise, there is widespread public concern. There are various discussions and criticisms surrounding the healthcare sector and medical services. Dr. Haque has shared his insights on what the treatment and management of heart diseases should entail, as well as the kinds of plans and measures the interim government should take at this moment to address these issues, in an interview with "Views Bangladesh." The interview was conducted by KM Zahid.

Views Bangladesh: Today is World Heart Day. What preparations has Bangladesh made to observe this occasion?

Sirajul Haque: In recent years, we have seen a significant rise in all types of heart diseases in our country. Like many other nations, heart disease has emerged as a leading cause of mortality in Bangladesh. This concern led cardiologists from around the globe to convene in 1999, resulting in the observance of World Heart Day. The primary goal of this initiative is to raise awareness about heart diseases, promote healthier lifestyles, and provide guidance on prevention and management. Since 1999, Bangladesh has participated in this global observance, joining over 90 countries that form the 'World Heart Foundation.' World Heart Day is celebrated on the last Sunday of September each year, coordinated through various cardiac societies and heart foundations worldwide.

Views Bangladesh: What is the theme of this year's World Heart Day? Why was this theme chosen?

Sirajul Haque: Each year, a specific theme is chosen to highlight World Heart Day. For 2024, the theme is 'Cardiovascular Health for All.' This theme emphasizes the importance of accessible heart health services for people from all segments of society. Our goal is to raise awareness about maintaining a healthy heart and to equip individuals with the knowledge they need to take charge of their own health. We advocate for preventive measures, promoting healthy habits such as regular exercise, walking, and avoiding detrimental behaviors like smoking and excessive alcohol consumption. We also emphasize the importance of a balanced diet, advising that daily salt intake should not exceed five grams to help manage hypertension. Furthermore, we encourage manual labor and physical activity to prevent obesity, as well as ensuring adequate sleep—about eight hours a night.

Views Bangladesh: Are there enough doctors and public-private institutions to provide this healthcare in our country?

Sirajul Haque: Heart disease is increasingly affecting people of all ages and socio-economic backgrounds in Bangladesh, leading to a growing number of patients. While we have not reached ideal levels of healthcare access, there are government community clinics, union-level centers, and thana level hospitals in rural areas, along with district hospitals and specialized medical colleges in cities like Dhaka. Each medical college typically has dedicated cardiac units or wards. Rajshahi Medical College, for instance, has developed a solid infrastructure for procedures like angiograms and stent placements, while Chittagong Medical College also provides comprehensive heart treatments. There are specialized institutions in Dhaka, such as the National Heart Institute, which offer a range of services, including heart surgery.

Cardiology care has improved significantly in Bangladesh; previously, many patients had to seek treatment abroad. Now, advanced treatments, including open-heart surgery, are accessible even to remote area patients. However, most of the 26 Open Heart Centers are located in Dhaka, with only a few in Chittagong. This concentration of services raises concerns about accessibility, and it's crucial that we decentralize these facilities to ensure heart care is available at the grassroots level throughout the country.

Views Bangladesh: What is the exact number of heart patients in the country? Why majority of these patients have to come to Dhaka for treatment? What is the solution to this issue?

Sirajul Haque: Recent studies indicate that about 4 to 5 out of every 100 patients experience heart attacks. While I can't provide the exact current figures, it's evident that the prevalence of heart disease is rising, especially among young people. This increase can be attributed to unhealthy lifestyles, such as smoking, drug use, poor diets, depression, and the effects of socio-political unrest. To address this growing issue and improve treatment options, it's essential for individuals to understand their civic rights concerning healthcare. They need to be aware of the medical services available to them locally and seek first aid at accessible facilities. The local health department can guide patients on where to find further treatment.

Overcoming bureaucratic hurdles and enhancing access to medical services are vital steps. While we have a network of sub-centers and community clinics at the union and village levels, many countries do not have these resources. It’s crucial to build trust in local healthcare services, thereby alleviating the burden on facilities in the capital. By empowering individuals to advocate for their rights to healthcare and ensuring better access to services at the grassroots level, we can effectively reduce the number of patients needing to travel to Dhaka for treatment.

Views Bangladesh: According to statistics, 17 per cent of the total deaths in the country from various diseases are due to heart disease. What accounts for this high mortality rate, and what measures can be taken to reduce it?

Sirajul Haque: The high mortality rate from heart disease can be attributed to several factors, primarily the socio-economic conditions in our country. While urban residents may have some financial resources for treatment, many people in rural areas struggle to afford medical expenses. This situation is exacerbated by a lack of awareness and education regarding heart health, as well as poverty. Delays in seeking timely treatment for conditions like strokes and heart attacks further contribute to increased mortality. The key takeaway is that we must focus on prevention rather than just treatment. We advocate for preventive measures as the most effective strategy for tackling heart disease.

Views Bangladesh: What are the main challenges in controlling this disease, and what steps can the government and health department should take?

Sirajul Haque: The first challenge lies in mobilizing patients and the general public to take action. Following that, the government and health department need to step in effectively. In today’s digital age, the government can utilize digital media to raise awareness about prevention and treatment of heart disease, which is a crucial first step. Moreover, using print and electronic media to disseminate health messages can help educate the public. The health department could enhance community engagement through health camps in villages and urban areas. While the government has initiated some of these measures, the impact has not been significant.

Another critical issue is improving access to healthcare. Government hospitals need more doctors to manage outdoor patients effectively, as currently, many doctors are overwhelmed, seeing 100 to 120 patients in just a few hours. These issues have not been resolved. The inability to implement solutions over the years remains the main challenge in controlling this disease. Most doctors and healthcare workers do not wish to stay in rural areas. In addition to the lack of various civic services, there are bureaucratic complexities, along with disparities in salaries and benefits.

Views Bangladesh: What kind of reforms has the interim government implemented in the health sector in the past 51 days? Do you have any suggestions for these reforms?

Sirajul Haque: Following the July uprising, the interim government has expressed a desire to reform the health sector alongside other areas, which I, like many others, welcome. It’s crucial that these reforms come from the top down, with a focus on efficiency—doing more with less. One key aspect is collaboration between public and private sectors. Private healthcare providers should align with government initiatives. For instance, many private hospitals, such as City Hospital, played a vital role in treating the injured during the recent unrest. Their contributions should be recognized, and partnerships should be established for future crises.

Additionally, to make healthcare more accessible, implementing health insurance plans is essential. Increasing the health budget is also critical; only with adequate funding can we aim for a healthy, educated, and equitable society—goals we all share. These reforms should prioritize comprehensive, accessible healthcare for every citizen.

Views Bangladesh: Thank you.

Sirajul Haque: Thank you too.