Deep-rooted issues hamper Bangladesh’s recovery

Even as the number of COVID-19 cases continues to rise, healthcare workers in Bangladesh struggle to get their hands on good quality personal protection gears. The tendency to cover up irregularities and mismanagement has led to a prevailing culture of corruption.

SALEEM SAMAD

Recently, Bangladesh crossed the grim milestone of 1,62,000 confirmed coronavirus cases. With a population of 160 million, the developing economy has been grappling with formidable challenges that have only been exacerbated by the outbreak of COVID-19.

Transparency International Bangladesh (TIB), a civil society organisation dedicated to fighting against corruption, has squarely blamed the government’s poor coordination for the current crisis.

The rot within

Data shows that 26 percent of the frontline healthcare workers in Bangladesh, including doctors, nurses, and hospital staff, did not receive personal protection gears, even as the number of COVID-19 cases has been on the rise. Also, the protection materials supplied to government hospitals were deemed to be of inferior quality.

At least six doctors who brought up the issue via Facebook posts were suspended or transferred to non-COVID hospitals as punishment for speaking out. Eventually, at the intervention of Prime Minister Sheikh Hasina, the Anti-Corruption Bureau and anti-crime forces were shaken from their siesta. They raided dozens of places – including government warehouses – to find fake protective materials and stolen medical products.

“If the government wants to tackle this crisis, the right to get and publish accurate information must not be diminished,” said Dr. Iftekharuzzaman, executive director of TIB. The tendency to cover up irregularities and mismanagement through restrictions on disclosure of information encourages corruption.

Stitch in time

In the wake of the coronavirus outbreak, TIB analysed seven indicators of governance, including rule of law, responsiveness, capacity and effectiveness, coordination and participation, accountability, transparency, and control of corruption. “The government failed to make adequate preparations even after getting three months’ time,” noted Dr. Iftekharuzzaman.

“The impacts of the COVID-19 pandemic have been largely ignored in the budget allocation for the health sector,” remarked Dr. Fahmida Khatun, executive director of the think tank Centre for Policy Dialogue (CPD). “The outbreak is a lesson for us, which has made it clear how much strength we have to tackle the crisis,” she said.

The Daily Star, an independent newspaper, in an editorial recently wrote: From the onset of the pandemic, citizens have been confused and frustrated about the government’s lack of vision and direction in addressing the health and socio-economic implications of COVID-19 holistically. The newspaper came heavily on the government’s casual handling of the risk of spread at the initial stages, declaring general holidays and non-binding lockdown.

The arbitrary policy decision at every stage, the editorial observed, have left ordinary citizens as well as experts in bewilderment as to what the government is thinking and what it wants to achieve in the near and far future.

Prof Abul Kalam Azad, Director General of Directorate General of Health Services (DGHS) drew flak from ruling party leaders when he recently said, “COVID-19 situation in Bangladesh will not go away in two or three months, rather it is likely to stay for two to three years.”

First published in the Health Analytics. 10 July 2020

Saleem Samad, is an independent journalist, and health fact-checker, recipient of Ashoka Fellowship and Hellman-Hammett Award. He could be reached at ; Twitter @saleemsamad

Pandemic has exposed deep-seated weaknesses in Bangladesh

Photo: Reuters

SALEEM SAMAD

A senior staff member along with many others of a grocery chain outlet in Dhaka were hailed as “corona warriors” by a leading English newspaper. The daily did not hesitate to describe that “our humanity, empathy, and responsibility is being tested by the coronavirus pandemic.”

Shila Aktar, a customer relationship officer at a grocery outlet had a fever, but other signs of coronavirus were absent. With fever, she went from one government hospital to another -- over four consecutive days.

She tried day and night to access the dedicated helpline. Also, she desperately tried online registration with no luck.

On the third day, she had an outrageous experience at a government-dedicated Mughda Hospital for Covid-19 patients. The Ansar Battalion sold Tk20 tickets at the exorbitant price of Tk2,000 to 3,000 in connivance with the hospital staff.

Hearing her ordeal, a journalist wrote an angry post on Facebook. Promptly, the lawmaker Saber Hossain Chowdhury responded pro-actively. The following day, the guards were removed and an additional booth to collect 150 additional samples a day was opened adjacent to the hospital.

On the fifth day, despite feeling weak, she stood in a queue from 6am in a make-shift booth in Bashabo, in the city. Finally, her sample was taken.

The issue did not end there. Now the waiting period began to get her virus test report. After four days she received a heartbreaking message online and also phone SMS that she was positive. 

“Dear Shila Aktar, your test for coronavirus is positive. Please stay at home. Be positive.”

The test for the coronavirus is a nightmare for millions in the country. Well, the government and private resources have been inadequate, coupled with widespread corruption in medical supplies and a lack of transparency in health care management.

As the crisis in Wuhan enlarged last winter, the “learned” heath minister Zahid Malek assured the nation that the country is fully prepared to overcome the pandemic.

When the virus finally struck on March 7, there were only a few ventilators in the country. The country had few virus testing labs, and no dedicated hospitals for infected patients when the first virus was detected in early March.

Despite media warnings, based on input from infectious disease experts, the airport authorities and immigration departments were lax in checking the entry of thousands of people, and also didn’t follow the quarantine protocols.

Well, the government never used the word “lockdown” or “curfew” and the police and civil administration all over the country failed to keep the people at home, maintain social distancing, wear masks, or practise basic hygiene.

The worst-case scenario was that the doctors, nurses, and health care staff often did not have enough PPE, including gloves and masks and safety materials.

Some state hospital senior doctors who have taken to social media to criticize the poor quality of medical supplies were punished. Even those who complained of poor living facilities in designated hotels were also punished.

Caught in a catch-22 situation, between lives and livelihoods, after 66 days, the government partially opened offices, factories (including export industries), shops, public transport, domestic flights, and restaurants. Several media reports say all the establishments flouted health guidelines with impunity.

Prime Minister Sheikh Hasina has been rated among the top 10 women leaders for the commendable job in coronavirus management by the prestigious Forbes magazine. She recently wrote in the British newspaper, The Guardian, that Bangladesh is unlikely to be the only country struggling with health, economic, and climate emergencies this year.

Most governments have proved dangerously unprepared for the crisis, which has exposed deep-seated weaknesses in public-health and social-security systems in rich and poor countries alike.

First published in the Dhaka Tribune, 16 June 2020

Saleem Samad is an independent journalist, media rights defender, recipient of Ashoka Fellowship and Hellman-Hammett Award. He could be reached at saleemsamad@hotmail.com. Twitter @saleemsamad

Healthcare, humanity, and hospitals

Testing for coronavirus has been a nightmare for millions in Bangladesh, coupled with widespread corruption in medical supplies and poor transparency in healthcare management

SALEEM SAMAD

A senior staff of a grocery chain outlet in capital Dhaka, along with many others, was hailed as “Corona Warriors” by the Business Standard published from Bangladesh. The paper was emphatic in celebrating the role of these “heroes” at a time when “our humanity, empathy, and responsibility is being tested by the coronavirus pandemic.”

Testing for coronavirus has been a nightmare for millions in the country. The government and private resources are inadequate, coupled with widespread corruption in medical supplies and poor transparency in healthcare management.

Desperate times

Shila Aktar, a Customer Relationship Supervisor at Agora grocery outlet, had fever and weakness, but other signs of coronavirus were absent. She went from one government hospital to another. On the fifth day, she decided to stand in a queue at another make-shift booth in the city. Finally, her sample was taken.

Shila had desperately tried all helplines – announced as public health messages on public and private televisions, FM radios, newspapers, SMS, as well as embedded ringtones on mobile phones. At last, she took to Facebook to share the suffering of hundreds of people who had to wait in long queues for several hours at the state hospitals to get themselves tested.

She recounted her terrible experience at the government-dedicated Mughda Hospital for COVID-19 patients, not far from her home. The Ansar Battalion guards sold Taka (BDT) 20 tickets at an exorbitant price of Taka 2,000 to 3,000 in connivance with hospital staff union leaders. Her angry Facebook post brought the matter to the attention of a local lawmaker, Saber Hossain Chowdhury. The following day, para-police guards were removed and additional booths were opened adjacent to the hospital to collect further 150 samples a day.

Then began the waiting period to get her virus test report. After four days, she received a heartbreaking message online and also via phone SMS: “Dear Shila Aktar, your test of coronavirus is positive. Please stay at home. Be positive.”

Shila was unknowingly wandering for more than nine days infected by the contagious virus.

Leadership lessons

Bangladesh Prime Minister Sheikh Hasina has been rated among the top 10 women leaders for their commendable responsibility in coronavirus management by the prestigious Forbes magazine. Despite working with goddess Durga’s ten hands, she was in a dilemma as to what should be her nation’s priority: lives or livelihood?

As the crisis in Wuhan grew, the ‘learned’ heath minister Zahid Malek assured the nation that the country is fully prepared for any eventualities to overcome the pandemic. Thousands of panicked migrants returned home from epicentres; they were checked with ancient thermal scanners and hand-held thermometers, which broke down in weeks.

Despite media warnings, based on inputs from infectious disease experts, the airport authorities and immigration department were lax in checking the entry of thousands of people, who didn’t follow the quarantine procedures.

When Bangladesh’s first virus infection was detected on 7th March, there were only a few ventilators, a couple of virus testing labs, and no dedicated hospitals for infected patients. While the government never officially announced a ‘lockdown’ or ‘curfew’, the police and civil administration in the country failed to keep the people safe at home or ensure that they maintained social distancing, wore masks, and practised hygiene.

The most worrisome part was that the doctors, nurses, and healthcare staff did not have enough Personal Protective Equipment (PPE) kits. The suppliers had no fear of delivering low-quality and even fake materials. Scores of doctors and nurses were infected and were either placed in-home quarantine, isolation centres, or hospitals. Nearly half a dozen doctors succumbed to the deadly virus.

Some state hospital senior doctors who took to social media to criticise the poor quality of medical supplies were punished. Even those who complained of poor living facilities in designated quarantine hotels were punished.

When Cyclone Amphan from the Indian Ocean struck southwest of Bangladesh in May, people were afraid to move to the shelters as they were not built with social distancing in mind.

Caught in a catch-22 situation, between lives and livelihoods, the government has partially opened offices, factories (including export industries), shops, public transport, domestic flights, and restaurants. For now, the fate of parks, cinema halls, convention centres, religious and cultural festivals is on hold.

Regular products that were once sold on the streets have vanished. Now we have hawkers selling hand gloves, sanitizers, face shields, PPE gowns, and goggles to eager customers, who are unaware of the quality of these products.

First published in the Health Analysis Asia, 12 June 2020

Saleem Samad is an independent journalist, health fact-checker in Bangladesh. Recipient of Ashoka Fellowship and Hellman-Hammett Award. He could be reached at saleemsamad@hotmail.com; Twitter: @saleemsamad

Cybercrime laws continue to silence journalists, writers and whistleblowers in Bangladesh

SALEEM SAMAD

The global outburst after a series of arrests, detentions, harassments, and intimidation of journalists and whistleblowers in Bangladesh amid lockdown in response to the coronavirus pandemic has shaken the myth of transparency and accountability of the Covid-19 healthcare management and food aid to disadvantaged people.

The outburst of civil society and rights group after 11 persons, including journalists, writers, cartoonists, bloggers, and micro-bloggers on social media were arrested and booked under the controversial Digital Security Act, allegedly for “spreading rumours and misinformation on Facebook.”

Among the dozen accused under cybercrime laws, the arrests of writer Mushtaq Ahmed, cartoonist Ahammed Kabir Kishore, social justice activist Didarul Islam Bhuiyan, and stockbroker Minhaz Mannan Emon have sparked protests by the civil society and media too.

An aide-memoire, that Minhaz Mannan’s brother is Xulhas Mannan, who was brutally hacked to death in April 2016 for publication of a gay rights magazine Roopbaan.

The four whistleblowers were slapped with cybercrime laws Section 21, Section 25(1) (b), Section 31, and Section 35 for “knowingly posting rumours against the father of the nation, the liberation war, and the coronavirus pandemic to negatively affect the nation’s image,” and to “cause the law and order situation to deteriorate,” which their colleagues and relatives denied.

Regrettably, the cybercrime laws were never applied for the disreputable sermons of the “waz-mongers” on social media for spreading rumours regarding the coronavirus pandemic.

The “waz-mongers” often dare to vilify the Liberation War, state constitution, national flag, national anthem, women’s empowerment, women’s leadership, secularism, Ekushey February, Pahela Baishakh, and whatnot.

Possibly, I have not missed hearing any of the Muslim zealots been booked under the Digital Security Act? The controversial law is deliberately misapplied to silence the journalists, writers, and whistleblowers.

The digital security laws, instead of checking for cyber crimes, hackers, mongers, fake news, and sexual harassment on social media, the laws were discriminately applied only against journalists and whistleblowers.

In a flashback of my ordeal in November 2002 during the repressive regime of Khaleda Zia, I was arrested and tortured in police custody. British TV Channel 4 hired me as fixer for a documentary on the widespread persecution of Hindus post-elections on October 1, 2001.

I was arrested along with two British and Italian TV crew, war-crimes historian Prof Muntassir Mamoon, and writer and documentary filmmaker Shahriar Kabir. We were charged under sedition laws and accused of defilement of the image of Bangladesh.

Fortunately, the superior court had rescued us from being awarded the death penalty.

It was understood how much the High Court judges were angry with the regime. How much the mainstream media in Bangladesh was frustrated with Khaleda’s administration for hobnobbing with the anti-liberation nexus.

The Bangladesh Federal Union of Journalists criticized the detention of several journalists under the controversial Digital Security Act. Since 2018, 180 journalists have been intimidated by the cybercrime law, which challenges the justice system, the statement read.

Finally, the Sampadak Parishad (Editors’ Council) has once again reiterated its demand to repeal the notorious Digital Security Act.

If the state allows the police and civil administration to discipline the media, they will surely shrink the space for freedom of expression, which will undermine the tenets of democracy and the elected government too.

First published in the Dhaka Tribune, 12 May 2020

Saleem Samad is an independent journalist, media rights defender, recipient of Ashoka Fellow, and Hellman-Hammett Award. Twitter: @saleemsamad; he could be reached at saleemsamad@hotmail.com

Dr Amartya Sen: What's happening in Bangladesh?

AMARTYA SEN

Self-assured commentators who saw Bangladesh as a “basket case” not many years ago could not have expected that the country would jump out of the basket and start sprinting ahead even as expressions of sympathy and pity were pouring in. This informative Lancet Series on Bangladesh helps to explain what happened—and why. It is important to understand how a country that was extremely poor a few decades ago, and is still very poor, can make such remarkable accomplishments particularly in the field of health, but also in social transformation in general.

The lessons are important for Bangladesh's own future, and for what The Lancet Bangladesh Team describe as the construction of “a second generation of health systems”. But the messages from Bangladesh's experience are also of great relevance for many other countries in the world that suffer from debilitating poverty. It might not be good manners for Bangladesh to start lecturing the world on what to do, so soon after jumping out of the basket to which it had been relegated, but the country's experience has important lessons for other developing countries across the globe.

These lucid and helpful papers discuss the main avenues of change on which Bangladesh has travelled. I will not summarise the findings: this has been nicely done in the introductory paper by Mushtaque Chowdhury and colleagues. Instead I will concentrate on a small number of striking features of the strategy followed by Bangladesh in moving rapidly towards health transition.

One direction of change is the emphasis that the country has placed on reducing gender inequality in some crucially important respects. The impetus for the change was linked in many different ways with the politics of liberation that made the issue of freedom, including the liberation of women, a part of the progressive agenda of what people wanted and were ready to fight for. There are inescapably complex issues to be addressed in order to explain more fully how exactly that happened. It can be argued that there were historical elements in the culture of Bengal, and particularly in the emergence of radical movements in various forms in that province throughout the first half of the 20th century, that leant them to include a serious concern for gender equity. But it was the nature of the struggle for independence of Bangladesh, particularly in focusing on the contrast with West Pakistan, that made it possible to make an effective political translation towards empowering women.

The causation of this move towards gender equity cannot but remain somewhat speculative, but its consequences are clear enough. Schools focused particularly on expanding the education of girls: Bangladesh is one of the few countries in the world where the number of girls in school now exceeds the number of boys. Public services, including school teaching, health care, and family planning, employ a much higher proportion of women workers than is the case in most developing economies, including in Bangladesh's neighbouring countries. Women have also entered the economic workforce in plentiful numbers, led by such industries as garment making that provided easy entry to female labourers, even though the neglect of safety at work has been a huge blot in the record of that industry, a serious deficiency that is only belatedly being addressed, and perhaps not yet strongly enough.

Women have also received special attention from Bangladesh's powerful non-governmental organisations (NGOs)—from large initiatives like BRAC and Grameen Bank to smaller organisations—and the mobilisation of the active agency of women has been a distinctive feature of the vision that has moved Bangladesh forward. And there has been a general determination in post-independence Bangladesh to target the elimination of female disadvantage in different fields of action, including maternal and child survival.

The removal of female disadvantage and the use of female agency have raised Bangladesh's record of achievement even on its own, but it is in fact the case that women's agency has also contributed greatly to the advancement of the lives and freedoms of all—men, women, and children. The unlocking of the power of women's active role in the society and in the economy has been an extremely productive move for Bangladesh and contrasts with what has happened in much of India. Bangladesh's powerful achievement in making much greater use of women's agency is a remarkable affirmation of the importance of what Mary Wollstonecraft called, in 1792, “the vindication of the rights of woman”. Indeed it turns out that the removal of the social shackles that restrain women has a crucial part to play in the progress of all people—of both sexes and of all ages.

A second striking feature of the Bangladesh story is the general acceptance of a multiplicity of instruments in the public and private sectors for rapid social advancement. Just as state initiatives have been seriously undertaken, NGOs and private enterprises have been forcefully supplementing the efforts of the public sector. As Syed Masud Ahmed and colleagues argue, the use of pluralism has allowed Bangladesh to get off to a quick start bringing the country a little closer to a health transition.

This is not to deny that the mixture of instruments that characterise Bangladesh's path of development will demand critical examination over time, since substantial overall advancement can coexist with persistent inefficiency and inequalities in the sharing of the benefits of health transition. These evaluative issues remain open to scrutiny and critical examination, but what has to be immediately—and firmly—recognised is that Bangladesh has been, in its own way, going ahead rapidly, rather than remaining paralysed by the slowness that is often entailed by the pursuit of “purity” in more ideologically oriented initiatives which favour either exclusive reliance on private enterprise or exclusive use of state-based programmes. The pragmatism that Bangladesh came to accept through a complex political and social process has yielded noticeable success, which has impressed—and to a considerable extent surprised—the world.

A third feature, closely related to the second, is the intelligent use of community-based approaches in the delivery of health services and medical care. As Shams El Arifeen and his coauthors outline, the mobilisation of community-based participation has many advantages, not only for the fostering of social cooperation, but also for extending the reach of the health initiatives and their impact. The innovations in health-service delivery from which Bangladeshis have benefited have been possible partly because of these participatory features in the process of social change. The importance of innovations is also discussed in the context of equity in the paper by Alayne Adams and colleagues.

A fourth feature, which demands particular attention in Bangladesh, is the country's improved ability to face natural disasters, such as storms, cyclones, floods, and droughts. These natural calamities have acted as a persistent drag on the country's progress. As the contributions by the Richard Cash and colleagues highlight, the deep vulnerability of the disaster-prone country to unruly forces of nature, which needed to be subdued, has indeed been, to a considerable extent, reduced. The elimination of these problems would, however, demand much more security-oriented progress in future years, especially if the threats for climate change become stronger.

I have pointed to a few of the special features in Bangladesh's progress towards a health transition, and many other features have been explored in this valuable Lancet Series. One very important aspect of this compendium of investigations is the continued focus on a call to action that nicely supplements the appreciation of what has been accomplished. Bangladesh has still a long way to go. This Lancet Series shows how Bangladesh has firmly placed itself on the way to that long journey (and has made an excellent beginning), but also points to further problems that have to be tackled as the journey proceeds. The key to Bangladesh's laudable success has been the avoidance of the twin dangers of inertia and smugness. The future will demand more from these virtues.

I declare that I have no conflicts of interest.

First published in The Lancet journal, 21 November 2013

Prof Amartya Sen, a Nobel laureate and professor of economics, Harvard University, Littauer Center, Cambridge, MA 02138, USA