The National Consensus Commission (NCC) yesterday sent the final draft of the July National Charter to the political parties that participated in consensus talks.
However, NCC Member Badiul Alam Majumder told Stream later in the day that further sit-downs with political parties would be required to iron out the remaining 9-10 issues on which parties differ.
Zoom In:
The 27-page draft, now awaiting final review, includes the background of the charter, 84 reform proposals that were agreed upon, and 8 commitments for implementation.
But there remain around 10 fundamental issues where a consensus has not been reached. These include:
- Proportional representation (PR) in the upper house of the parliament
- Enshrining the appointment process for the Public Service Commission, the Anti-Corruption Commission, and the Ombudsman in the constitution.
- Issues relating to how the caretaker government will be appointed
- Article 70, which prevents MPs from voting against their political party
The Bigger Picture:
Although the July Charter has dominated the discussion for months, there remain serious worries about how effective it will prove to be.
As of the latest draft, a deadline for implementing the proposed reforms was apparently removed. In the initial draft issued on July 28, the commission had called on the next elected government to complete reforms within two years of assuming office. This, curiously, is now missing.
Clouds also hover around issues on which political parties submitted a note of dissent. If a party comes to power, what happens regarding issues it did not wholly agree with?
"Discussions with legal experts are underway…. The parties will be obliged to follow the interpretations given by the experts," NCC Vice-Chairman Prof Ali Riaz said, offering little insight.
Even the crucial issue of how the charter will be implemented remains unconfirmed, with discussions ongoing with experts to give the charter a legal or constitutional basis. The commission reportedly plans to discuss the implementation method with the parties next week.
The bottom line:
While the July Charter marks a significant step toward national consensus, critical challenges remain. The absence of a clear implementation timeline and legal framework raises concerns about its effectiveness and whether it can be something more than an aspirational framework.
Is there enough incentive for private hospitals to do better?
Law, Justice and Parliamentary Affairs Adviser Asif Nazrul told owners of private hospitals, clinics and diagnostic centres on August 16 to offer better services so Bangladeshis don't feel the need to go abroad for treatment.
"If services are provided here, people will never go abroad. There is no reason to go. If you capture this market, it will be beneficial for you and the country as well."
Zoom In:
- There are around 5,500 private hospitals and clinics in Bangladesh, of which 1,810 are within the Dhaka division, according to the Dhaka Chamber of Commerce and Industry.
- Around 700,000 Bangladeshi citizens travel overseas for medical care each year.
- They spend over $5 billion annually on medical treatment abroad, primarily in India and Thailand, Bangladesh Bank Governor Ahsan H Mansur said in December last year.
- Per-capita health expenditure is $110 in Bangladesh whereas compared to $400 in most South Asian nations.
The bigger picture:
Although private hospitals in Bangladesh remain far from international standards, one of the reasons they continue to flourish is the abject state of public healthcare, which is overcrowded and underfunded.
- The allocation for health as a share of the total budget decreased from 5.33% in FY24 to 5.20% in FY25.
- Expenditure on health as a share of GDP in Bangladesh was the lowest among 45 LDCs in 2021.
- Budget allocation for health has been less than 1 per cent of GDP for the past 20 years, indicating that healthcare has been one of the least prioritised sectors for the government.
- The state of Bangladesh's shortcomings in public health was exposed by a BBS survey published in 2019, which found that the nation had one hospital bed for every 1,196 individuals and one registered physician for every 1,581 individuals.
The bottom line:
The relationship between public and private hospitals in Bangladesh is complex, shaped by necessity rather than collaboration.
Public hospitals, plagued by chronic underfunding, overcrowding, and resource shortages, struggle to meet the healthcare demands of the population.
This weakness allows private hospitals to flourish, offering better services for far more money.
However, not only does this leave low-income patients dependent on an overburdened public system, but their profit-driven model also means they don't feel the need to offer anything beyond the bare minimum.
For the healthcare system to improve, a stronger partnership is needed—one where private hospitals complement public services while the government increases health funding to ensure equitable access for all.
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