Experts say that the government's approach to testing and surveillance, including charging patients a fee, is hampering the response. Sophie Cousins reports.
Public health experts in Bangladesh have expressed concern about the government's decision to charge people for COVID-19 tests amid a sharp decline in the number of tests being done. In late June, the government decided to charge 200 taka (£1·80) for testing done at government facilities and 500 taka (£4·50) for samples collected from home to “avoid unnecessary tests”. The private sector charges 3500 taka (£32) per test. Almost one in four Bangladeshis live below the national poverty line.
Since the decision, testing rates have fallen to around 0·8 tests per 1000 people per day, with a low of just 0·06 tests per 1000 people in August. Bangladesh is administering on average between 12 000 and 15 000 tests per day for a population of 168 million, and has recorded almost 275 000 confirmed cases and more than 3600 deaths.
Shamim Talukder, head of Eminence, a Bangladeshi public health research organisation, told The Lancet that the pandemic had exposed the country's ”unethical” health-care system. “From the beginning of the pandemic, the government wanted to control the COVID-19 testing system”, he said. “At the beginning it didn't allow the private sector to do the tests and now they've applied a charge for testing in the public sector, which just means that the poor are excluded.”
Talukder told The Lancet that he had visited multiple graveyards across Dhaka, where graveyard managers had told him the death rate from COVID-19 was ”four times higher” than the recorded figure was. Many people, he said, had died of COVID-19 but had not been tested, or had died before they had received their test results.
Former Director of Bangladesh's Institute of Epidemiology, Disease Control and Research, Mahmudur Rahman, condemned the government's decision. “Charging people for tests is really creating problems; it is creating barriers, especially for the poor”, he said. “During the pandemic, people do not have work, they do not have money, they're at a huge disadvantage...Governments should not charge anyone for testing.”
Other barriers to testing, Rahman said, include the low trust people had in the health-care system. “We've had testing scams here. There is a lack of confidence in the health-care system, so people don't want to get tested because they don't want to get a result they don't trust”, he said. “Another problem is the delay in getting the results—sometimes it takes a week, other times it just doesn't come. If someone needs a result immediately, why bother? They just stay at home instead.”
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