DOCTORS are, as an International Centre for Diarrhoeal Diseases Research, Bangladesh says, highly urban-centric while majority of the population live in rural areas. The study, made public on Saturday, says that the inequitable distribution of physicians is troubling the health services delivery. The study has also found a high concentration of doctors in urban areas, especially in Dhaka division, having 42.2 per cent surplus doctors, or 2,514 more doctors on the 5,956 sanctioned positions. Grade IX doctors, appointed through the civil service recruitment, account for 67 per cent of the health workforce. But against 17,700 sanctioned positions in the grade, 18.3 per cent remain vacant across the country and about 7,134 doctors have been made officers on special duty. The Directorate General of Health Services says that ‘lobbying from political quarters’ is a key reason for doctor’s posting to urban areas.
The study has found doctors pursuing post-graduate education to be reluctant at returning to rural areas after their study. Because of this, although Dhaka division has more doctors than the sanctioned positions, in Barishal division, 63 per cent of the positions are vacant, in Rangpur 59 per cent, in Khulna 56 per cent, in Sylhet 51 per cent, in Rajshahi 47 per cent, in Chattogram 43 per cent and in Mymensingh 40.8 per cent. This abysmal state is attributed to the government’s having no policy and guideline on how doctors’ stay in rural and remote areas could be ensured. A nexus between politically influential doctors and corrupt officials take this opportunity against the backdrop of government indifference. The government seems to be lacking the urgency to ensure doctors’ presence in rural areas or it somehow compromises with errant doctors and consequent on that, rural people struggle to get access to doctors and many doctors draw their salary without discharging their duties in public health facilities. Staying away from duty in rural areas by doctors and bribing for appointment and transfer to Dhaka and its surrounding areas constitute some insuperable challenges to good governance in the health sector.
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 to reverse this decline in governance. The government also must put in place a system of intense monitoring and prosecute people involved in immoral activities and punish them exemplarily to set preventive legal precedents.
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