One of the major drawbacks confronting the country's healthcare services is the failure of the authorities to retain doctors in rural locations. With infrastructure more or less in place, it is the scarcity of medical professionals, especially doctors in the upazila health complexes that makes the delivery of healthcare services to the vast majority of the population less than desirable.
Doctors' preference for major cities, particularly Dhaka, even by dodging government rules to serve at district and upazila health facilities has been a problem for long. In fact, this appears to largely characterise the country's healthcare system for decades. Although successive governments have recognised it as a significant drawback requiring attention, pragmatic steps to address it have been scarce. No doubt, this poses a major challenge for equitable distribution and delivery of healthcare services in the country. More importantly -- and sadly - it makes access to medicare a hopelessly distant dream for the vast majority of the population living in rural areas.
A study conducted in this regard has brought to light some shocking facts on the extremely asymmetrical state of healthcare services in the country. The study shows that a total of 4,749 physicians are currently posted in Dhaka against only 783 sanctioned posts, causing a serious dearth of doctors at district level and below. Currently, Dhaka division has 42.2 per cent surplus doctors or 2,514 more doctors than the sanctioned 5,956 posts, it says. On the other hand, on an average more than 50 per cent posts are presently vacant in Barishal, Rangpur, Khulna, Sylhet, Rajshahi, Chattogram, and Mymensingh divisions.
Doctors' stay in their places of posting in small towns and rural areas is a problem in many developing countries. In Bangladesh, it is in most cases the pressure from powerful quarters including from political high-ups in favour of the incumbent doctors reluctant to go to rural areas that has resulted in the present state of overcrowding in Dhaka and other big cities. At present, the country has only 1.1 doctors per 10, 000 population in rural areas as against 18.2 in urban areas. According to a World Health Organisation (WHO) report, 35 per cent of doctors and 30 per cent of nurses serve 15 per cent of the total population living in four major cities of Bangladesh--- Dhaka, Chottogram, Rajshahi, and Khulna, whereas less than 20 per cent of health workers are available for more than 70 per cent people living in rural areas.
The WHO has recently launched a programme for "Increasing access to health workers in rural and remote areas through improved retention of health workers in rural areas". It has provided guidelines assisting the governments in developing policies associated with improving the quality and duration of training sessions in rural areas. It is the state responsibility to strengthen the infrastructure of healthcare centres by equipping with machinery, drugs and instruments so that doctors get the opportunity to engage themselves more meaningfully.
With considerable development taking place in the districts and upazilas all over the country, unwillingness to stay there for at least a tenure of say, four years makes a shocking case for any professional group, let alone for doctors who are beneficiaries of huge endowments from the state coffer.
Observers, however, point to the lack of career prospect as a genuine issue. In the absence of promotion prospect, an MBBS doctor has virtually no opening in the career ladder unless he/she goes for higher education to obtain a degree or a diploma or at the very least, a specialised training course. This motivates many to seek attachment in hospitals in big cities. Observers opine that if the government makes services of doctors at the outlying health facilities conditional to seeking higher education, absenteeism of doctors in those facilities could be contained to a large extent. This is likely to make a strong case for doctors to serve in those facilities, at least for the period required. However, not everyone can be expected to be eager for higher studies or specialised courses. So, there has to be a system whereby doctors starting their career in rural areas are not left in the lurch without any career prospect. It is thus highly important to look into their career/promotion prospect.
From their perspective, there can be no denying the fact that doctors with MBBS degrees are the most neglected group in the government's employment structure. While government officials from various other cadres posted at the upzila level are open to all kinds of promotion prospects, doctors, often more meritorious, remain stuck with barely any elevation coming their way. This has been the case for long and although there were talks to do something about it, nothing has come up to make their lot better.
The Director General of Health Services (DGHS) should come up with appropriate initiatives that would serve the interest of doctors as well as that of the masses missing out on government's healthcare services.
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