THERE is no denying that doctors’ tilt towards urban areas leaves rural people in the lurch. What is alarming is that many doctors still leave workstations in rural areas without notifying the authorities. There are allegations that most of them do not stay at upazila health complexes, ignoring government instructions, which often causes sufferings to people. These allegations have some rationale in that doctors chose to be recruited into the government service being fully aware that after being appointed to their posts, they would be obliged to move to remote places of their posting in rural areas to serve the rural population. A study said that a section of the officials of the health ministry and the health services directorate general and leaders of Swadhinatna Chikitshak Parishad, a pro-Awami League forum of physicians, took bribe from doctors, health officials and employees for appointment, promotion and posting to suitable places. This has resulted in this alarming situation.
When all the divisions lack adequate number of doctors, Dhaka has 3,157 doctors in surplus. This division has 11,963 doctors, more than a half of the total number of doctors, against the sanctioned posts of 8,806 doctors. Against the sanctioned posts, Chittagong division lacks 1,481 doctors, Khulna 1,295, Rangpur 1,270, Rajshahi 1,222, Barisal 961, Mymensingh 675 and Sylhet 640 doctors. According to the Directorate General of Health Services, doctors’ vacancy rate is worse in 21 districts, mostly in the north and in haor and coastal areas. This abysmal state in rural areas should be attributed to the fact that the government has no policy and guideline on how the doctors’ stay in rural and remote areas could be ensured. It would not be an exaggeration to say that the government either lacks urgency or remains reluctant to ensure doctors’ presence in rural areas or it somehow compromises with the errant doctors, and consequent on that, rural people struggle to get access to doctors for treatment and 3,000 doctors are now taking salaries without discharging their duties in government health facilities. Staying away from duty in rural areas by doctors and bribing for appointment and transfer in their jobs in Dhaka and its surrounding areas constitute some insuperable challenges to good governance in health sector.
To reverse this decline in governance, the government needs to address the problems resulting from the immoral practice of taking and giving bribe, which is rampant in the health sector, and pay attention to the promotion of the infrastructural development of rural areas so that doctors can feel quite at home in upazilas. They also must put in place a system of intense monitoring and prosecute those who are involved in these immoral activities and punish them exemplarily to set preventive legal precedents.
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