Healthcare reels from shortage of nurses, midwives

Bangladesh’s health sector is grappling with a severe shortage of health workers, particularly nurses and allied professionals, alongside stark urban-rural disparities in workforce distribution, threatening equitable access to healthcare, according to a government-funded study.

The country has only 12.78 doctors, nurses and midwives per 10,000 people, compared with the World Health Organisation-recommended 44.5 doctors, said the study conducted by the University of Dhaka’s Department of Population Sciences over the past year with funding from the National Institute of Population Research and Training (NIPORT).

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The researchers interviewed 1,756 health professionals -- including doctors, nurse, medical technologists and pharmacists -- and analysed the government’s recent health workforce data, including the HRH Data Sheet 2023.

While the number of doctors meets the WHO benchmark, the country continues to face an acute shortage of nurses and midwives, leaving the doctor-nurse-midwife ratio at 1:0.75:0.74 -- far below the recommended 1:3:5.

It highlighted severe urban-rural maldistribution, with almost 75 percent of doctors and nurses serving in urban areas, though 62 percent of the population lives in rural areas.

More than half of the doctors, pharmacists and medical technologists expressed interest in working abroad, while 45.9 percent of the nurses showed similar aspirations.

However, actual migration remains limited. Only 7.1 percent of those interested had applied for overseas jobs, reflecting a major gap between aspiration and preparedness.

The report identified visa and work permit difficulties, certificate equivalence issues, lack of guidance and high licensing exam costs as the main barriers.

To address the crisis, the study recommended prioritising recruitment and training of nurses and midwives, ensuring equitable rural deployment of health workers, aligning workforce production with actual service demands and a government-supported mechanism to find jobs abroad.

While presenting the findings of the study titled “Potential of Health Workforce for Harnessing Demographic Dividend in Bangladesh: Opportunities, Challenges and Policy Implications”, Aminul Haque, who led the research, said Bangladesh had 123,853 registered MBBS doctors and 85,971 registered nurses as of 2023.

The country has already met the WHO minimum benchmark for doctors, which recommends at least 0.50 doctors per 1,000 population. Based on that standard, Bangladesh needed around 88,909 doctors in 2026, which is below its current stock.

However, the WHO benchmark remains lower than the average demand in South and Southeast Asia, Haque said.

Bangladesh continues to face a severe shortage of nurses and midwives, with the projected 2026 supply expected to meet only 43 percent of the required demand.

Private sector dominates when it comes to producing graduates, with private institutions accounting for 6,828 of the 11,328 MBBS seats and 33,840 of the 41,750 nursing seats.

Although there are 0.73 registered doctors per 100 population, only 0.18 doctors per 1000 population are working under Directorate General of Health Services (DGHS), said Haque, also a professor at DU’s Department of Population Sciences.

DGHS, the Directorate General of Family Planning and the Directorate General of Nursing and Midwifery have 71,765 posts vacant, which is 28.6 percent of the seats.

Referring to the study, MA Muhith, state minister for the health ministry, said the situation in rural areas is much worse than the national average in terms of the availability of doctors.

But, the absence of nurses and midwives is severe, even though the issue is not discussed much, he said, adding that the number should be increased by three to five times.

The findings of another study, conducted by the Dhaka Ahsania Mission and funded by the NIPORT, on health workers’ preparedness for the effective management of pandemic diseases were also presented at the programme.