DCs’ proposals expose health sector ills

Barguna, a southern coastal district with a population of about 10 lakh, turned into a dengue hotspot last year, recording 15 deaths and 9,534 cases -- the highest for any single district except those at divisional headquarters.

The district has come under the spotlight again this year amid a measles outbreak, as Barguna Sadar upazila recorded the highest infection rate until March.

But, none of the public hospitals, including the 250-bed General Hospital, in the district has intensive care units (ICU). Critically ill patients are referred to hospitals in Barishal and Dhaka, with many dying in transit, while others cannot afford ambulance transport.

The district has the necessary structure for setting up ICUs but not the equipment and necessary manpower, said Barguna Civil Surgeon Muhammad Abul Fatha.

Besides, two-third of the posts for health workers at all six upazila health complexes in the district have remained vacant for long, compounding the situation.

Against the backdrop, Barguna Deputy Commissioner has proposed establishing an ICU at the general hospital, along with ensuring adequate manpower and medicine supply at medical facilities.

The is one of the proposals put forward by DCs to the cabinet division ahead of the Deputy Commissioners’ Conference scheduled for May 3-6.

The cabinet division has received more than 80 health-related proposals from deputy commissioners and divisional commissioners across the country, The Daily Star has learnt from people informed about the proposals.

These proposals highlight the chronic problems of the country’s healthcare system, particularly in rural areas, where hospitals exist but lack doctors or nurses, and where equipment is available, there are no trained personnel to operate it.

Even where facilities are in place, essential medicines and ambulances are lacking, leaving people unable to access the healthcare services they need.

The proposals include expanding hospital capacity, providing manpower, introducing water ambulances and supplying medical equipment in rural areas where shortages of the essential resources are hindering access to basic healthcare.

Take the case of the Tangail Medical College Hospital, a 500-bed facility that started operation in 2022. The facility has a 10-Bed ICU wing but was never functional due to the absence of a central oxygen supply system.

The hospital was supplied with a catheterisation lab but it cannot be used for treating heart patients because of a shortage of trained personnel, said its director Abdul Kuddus.

The warranty period for the machine has expired without being used once, he said, adding that some parts of the machine are not functioning now.

Typically, a 500-bed hospital requires more than 750 manpower, but 200 people are now working at Tangail Medical College Hospital against 322 sanctioned posts.

Patients face further hardship as the hospital does not have any ambulances, forcing them to rely on private services.

Against this backdrop, the Tangail DC has proposed installing a central oxygen supply system, deploying required manpower and providing at least two ambulances so the hospital can deliver essential services.

In another proposal, the Tangail DC sought manpower support for the 250-bed General Hospital, where 44 doctors are currently working against 178 posts. Besides, only 13 sanitation workers are employed.

Barishal DC sought water ambulances, along with drivers and fuel for three upazilas that are surrounded by rivers: Muladi, Hijla and Mehendiganj.

Pirojpur DC also proposed introducing a water ambulance for Nesarabad, Nazirpur, Bhandaria and Mathbaria upazilas.

Madan Upazila Health Complex in Netrokona District was upgraded to a 50-bed hospital from a 31-bed facility over a decade ago. However, no new building was constructed, leaving the authorities to operate the hospital in a congested old structure, said Netrokona Civil Surgeon Golam Mawla.

The Netrokona deputy commissioner has proposed rehabilitation of the hospital building, deployment of necessary manpower and procurement of at least two ambulances for each upazila health complex.

The government built a 20-bed Trauma Centre near Bahubal Upazila Health Complex, located approximately 200 metres from the Dhaka–Sylhet highway in 2023, but the specialised facility remained unused for three years due to a lack of manpower.

No post for manpower for the hospital has been created even though they have sent letters to the higher-ups on several occasions, said Abdullahel Maruf Faruque, Bahubal upazila health and family planning officer.

Besides, there is no budget allocation for the hospital, so the facility remained unused, he said yesterday.

In this situation, the Habiganj deputy commissioner has proposed taking steps to recruit the necessary manpower to make the hospital functional.

Thakurgaon deputy commissioner has proposed the establishment of a 100-bed specialised children’s hospital in the district.

The 250-bed Thakurgaon District General Hospital currently has a 40-bed paediatric ward, but on average, 180–200 child patients are admitted every day, he said.

The Magura DC has proposed formulating a policy to set and standardise medical test fees at diagnostic centres across all districts of the country.

The Rangamati DC has proposed formulating a coordinated deployment policy to ensure healthcare services for the people of the three hill districts.

Most upazila health complexes in the Chittagong Hill Tracts (Rangamati, Khagrachhari and Bandarban) are located in remote areas.

As a result, it is difficult to post doctors, nurses and midwives there, and even when they are posted, they do not tend to stay for long, he added.

Non-utilisation of many existing healthcare facilities and equipment is a very common phenomenon in the health sector, said Prof Shafiun Nahin Shimul, director of the Institute of Health Economics at the University of Dhaka.

“It is causing a double loss.”

On one hand, the money spent on building facilities or procuring equipment remains idle; on the other, people are not receiving services, he said.

“This is a management problem,” he said, adding that the government should revise its management approach.

For example, it can sign contracts with third parties to operate these facilities, given the overall manpower shortage in the sector.

Asked about the reasons, he said many facilities are built and equipment procured based on political considerations and the financial interests of vested groups rather than need-based allocation.

“This malpractice must be stopped, and the government must ensure need-based allocation when building facilities or purchasing equipment,” he added.

Abu Hussain Md Moinul Ahsan, director (hospitals) at the Directorate General of Health Services (DGHS), said the main issue behind the ICU crisis is the shortage of skilled manpower.

“We are working on how this can be mitigated. We have discussed providing short-term training to health workers to activate existing ICUs,” he told The Daily Star on Monday.

Asked about non-functional medical facilities, he said many were built without proper planning, particularly 21 trauma centres. “We are now working on how to make those facilities functional.”