Doctors’ tilt to urban areas leaves rural people in lurch

Manzur H Maswood | Updated at 07:20pm on September 06, 2018

Dhaka division has 3,157 surplus doctors against sanctioned posts, 21 districts in northern, coastal, haor regions face shortage of doctors

Tejgaon Thana Health Complex, with its 27 physicians, in the capital’s Tejgaon Industrial Area treats only 15 to 150 patients a day, most of the time having nothing to do.
The hospital has no inpatient services and the patients visit the outdoor and emergency departments only for minor ailments.
During a visit last week, New Age found seven doctors gossiping at the outpatient department, with no patient visiting the hospital in about two hours.
‘We sit idle…we have no work to do but to wait for a patient to come,’ said orthopaedic consultant Shahriar Rahman.
He said that a medical officer’s post fell vacant in August only to be filled not later than by September at the hospital and that not all the doctors were regular at the facility.
The Thana Health Officer was not found at the hospital.
But this is not what one will find at a Thana Health Complex in a rural area, where patients face an acute shortage of physicians.
According to National Health Bulletin 2017, published in January this year, there are about 25,000 posts for doctors in the public health services.
Of them, 21,000 were filled, with about 17 per cent posts remaining vacant.
But when all the divisions lack adequate number of doctors, Dhaka division has 3,157 doctors in surplus. Dhaka division has 11,963, more than 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 division 1,295, Rangpur 1,270, Rajshahi 1,222, Barisal 961, Mymensingh 675 and Sylhet division lacks 640 doctors.
Doctors having political influence manage deputation in Dhaka and other urban areas, officials have said, preferring anonymity.
According to the Directorate General of Health Services, doctors’ vacancy rate is worse in 21 districts, mostly in the northern regions and in haor and coastal regions.
The districts with the doctors’ vacancy rate over 50 to 80 per cent are Panchagarh, Thakurgaon, Lalmonirhat, Kurigram, Naogaon, Gaibandha, Sherpur, Netrakona, Sunamganj, Pabna, Gopalganj, Meherpur, Satkhira, Narail, Khulna, Bagerhat, Pirojpur, Jhalokathi, Borguna, Patuakhali and Bhola.
But many upazila-level hospitals in these districts, especially those in the district headquarters, that have better communications and urban or semi-urban setup have a higher presence of doctors, with vacancy rate in between 1 per cent and 20 per cent, the DGHS data show.
Though 70 per cent of the people live in rural areas, the presence of qualified doctors is ‘overwhelmingly urban biased in Bangladesh’, according to the World Health Organisation.
‘On the other hand, unqualified, quacks and semi-qualified allopathic practitioners such as village doctors and Community Health Workers are mainly concentrated in rural areas,’ it comments in the Bangladesh Health Review, published in 2015.
‘The overwhelming urban bias of the distribution of qualified professionals remains a persistent phenomenon,’ it adds.
Health minister Mohammad Nasim said last week at a function in the capital that many doctors were unwilling to serve government hospitals in the countryside.
He said, ‘Around 3,000 doctors are now drawing salaries regularly without working…they are not found at any government offices.’
The minister said the government would recruit 7,000 more doctors only for rural areas by November and their posting would not be changed in three years under any circumstances.
But the minister said that earlier he had appointed 6,000 doctors on condition that they would have to be posted to rural health setups for at least two years.
‘But many of them did not complete two-year tenure and managed to be transferred,’ he said.
DGHS, however, could not provide the details of the doctors taking salaries without working.
Officials of admin and finance divisions of DGHS traded blame over the matter.
ABM Muzharul Islam, DGHS director for admin responsible for posting and transfer of doctors, told New Age that it was not for them but for the director for finance to give names or positions of the doctors.
Khawaja Abdul Gafur, DGHS director for finance, talking to New Age, referred back to the director for admin.
DGHS additional director general Nasima Sultana declined to comment on the statement of the minister that 3,000 doctors were drawing salaries without working.
‘I don’t know who the doctors are and how he (minister) came up with the findings,’ she told New Age.
The qualified doctors concentrating in urban areas are evading treatment of people in the countryside, health rights campaigners have alleged.
They point out that the health services are seriously lacking in human resource management, which deprived the rural people of health facilities.
‘Rural people are struggling to get access to doctors because of the health services’ inefficient human resource management,’ observed Bangladesh Health Rights Movement chairman Rashid-e-Mahbub.
He said the government had no policy and no guideline on how the doctors’ stay in the rural areas could be ensured.
‘Qualified doctors concentrating in urban areas is evading treatment of people in the countryside but the government is not serious about that’, he said, adding, ‘an unholy nexus between politically influential doctors and corrupt officials was taking opportunity of government’s indifference’, he said.
Former WHO South Asia regional adviser Muzaherul Huq said that the government must strengthen the health facilities in the rural areas for ensuring universal health coverage.
‘But the government either lacks urgency or remains reluctant to ensure doctors’ presence in the rural areas or it somehow compromised with the errant doctors,’ he said.
Bangladesh Medical Association secretary general Ehteshamul Huq Chowdhury said that the health ministry and the DGHS must take action against the errant doctors.
‘It’s the duty of the ministry and the DGHS to ensure the accountability of the doctors for their job,’ he told New Age.