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Rural health care in the spotlight

Patients receiving intravenous fluid at the ICDDR,B hospital in Dhaka.
(Shamsuddin Ahmed/IRIN)

Rural Bangladesh is facing something of a healthcare crisis: State-run facilities there are facing acute shortages of doctors, nurses and technicians, and many people resort to traditional healers as a result.



There is a huge disparity between the number of healthcare personnel in urban and rural areas, according to the government’s Directorate General of Health Services (DGHS).



In some cases in Dhaka, health professionals outnumber patients: In the gynaecology and obstetrics department at Bangabandhu Sheikh Mujib Medical University (BSMMU), the prime medical institute of Dhaka, 106 physicians are on duty for a department which has the capacity to house 80 patients.



But the exact opposite is the case in almost all rural areas - home to over 85 percent of the population. Here, there are large numbers of medical vacancies: Of the 90,000 public healthcare personnel positions in the country, 18,000 are currently vacant, including the posts of about 5,500 doctors, according to the Health Ministry.



Bangladesh has about 48,000 registered doctors to serve its 145 million people, according to the DGHS.



UHCs



Primary health care in the public sector is organised around the Upazilla Health Complexes (UHCs) at sub-district level; they work as healthcare hubs. UHCs have both in- and out-patient services and care facilities. Most commonly, they have in-patient care support with 31 beds; some UHCs have 50 beds.



In Dakop UHC in Khulna District, there are supposed to be 29 doctors, but in reality only four are ever on duty. According to the sub-district health and family planning officer, S.M. Akbar Hossain, the centre treats over 100 patients a day.



Dakop UHC has had a vacancy for a dental surgeon for years. It has an ECG (electrocardiogram) machine which does not work because there is no one to fix and maintain it. The only emergency power backup system is a generator, which is never used for lack of fuel. This is scenario is typical in many sub-district healthcare centres (UHCs).



Absenteeism



Absenteeism plagues rural healthcare centres. At UHCs, 40 percent of doctors are regularly absent. At the smaller Union Health and Family Welfare Centres (UHFWCs), the sole doctor is absent 74 percent of the time, according to a World Bank report.



“I go to my workplace twice a week. I have to attend to my [private] patients here in Dhaka,” a doctor officially supposed to be working in Mymensingh, 75km from Dhaka, told IRIN on condition of anonymity.



He told IRIN his private practice in Dhaka took up most of his time.



“The standard of living at the place where I am posted is a joke. Commuting every day is also out of the question. There are other physicians at the centre. So the patients are not neglected,” he said.



Stranded on the `chars’



The problem is not confined to the lack of personnel and equipment. People living in remote areas with poor transport links have a lower chance of surviving if they get seriously ill.



The shifting river islands, locally known as ‘chars’, are the hardest places to get government doctors to go. Most do not have a qualified physician or health centres.



“A few days ago, my six-year-old daughter was struck down with very high fever. By the time I had hired a trawler and taken my daughter to the doctor, she had passed away. Had there been a doctor in the `char’ region this outcome could have been avoided,” lamented Kamal Malut of Shariyatpur District.



Mollar Char, Fulchhari Arendabari, Fulchhari Sadar and Fazlupur are four local government units in erosion prone Gaibandha District on the banks of the Brahmaputra river. All are `chars’ and have a combined population of over 100,000 people. None have any pharmacies or health centres.



The only UHFWC was in Mollar Char, which collapsed into the river a few years ago.



“Many patients die before medicines can be brought in from the towns. Local health workers only provide immunisation,” Abu Bakar, a resident of Fulchhari sub-district in the northern district of Rangpur, told IRIN.



Informal sector



According to Bangladesh Health Watch (BHW), a civil society network which monitors the health situation in Bangladesh, over 80 percent of the population turn to non-state providers of health care as a first port of call when they fall ill.



These healthcare providers include traditional healers, traditional birth attendants, village doctors, drug stores and NGO trained community health workers, according to BHW.



Given the difficulties `char’ residents have in reaching a UHC, it is not surprising that many residents opt to use the services of traditional herbal healers, faith healers and tribal magicians.



In response, the government has launched massive medical services awareness campaigns, one of which was a healthcare week starting on World Health Day, 7 April.



ao/cb


This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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