Doctors deserve props to serve rural areas

Recently the ministry of health (MoH) suspended seven doctors for failing to remain in their workplaces in rural  health sub-centres and health complexes in Shibpur and Palash upazilas (sub-districts) of Narsingdi district. Based on complaints, the minister concerned issued suspension orders and recommended punitive actions against the physicians. Three other doctors of Mymensingh were suspended for absence from duty.
The suspension reflects the present government's awareness of the great need to provide adequate medicare to the rural populace. The health complexes, having fairly good infrastructure, near homes of villagers, stand as lifeless medicare centres having no doctors or trained health assistants. Sometimes health assistants, in absence of doctors, prescribe common drugs to treat chronic diseases of the poor villagers. Use of such medicines without knowing fully the nature of the ailments usually complicates the diseases.   
According to a World Bank (WB) study, at union health centres 40 per cent of doctors remain regularly absent. The smaller union health and family welfare centres, where there is only one doctor, suffer his/her absence for 74 per cent of the time. Such doctors are to be found at their work places allegedly only on the day they collect their salaries and most of them prefer to stay in cities for a very large part of their tenure of rural assignment.
Health services in Bangladesh are provided at three levels: primary health care - from the upazila level down to the community level, secondary level - district level hospitals and healthcare and tertiary level - hospitals attached to the universities and medical colleges and also those attached to specialised health institutes. Primary health-care services are provided at the three levels for three different types of facilities: community clinics each for a population of six thousand at the community level, union health and family welfare centres (UHFWC) each for a population of about 30,000 at the union level, and each upazila health complex (UHC) for a population of about 3,00,000 at the sub-district level. At the district level, secondary level district hospitals, with 150-250 beds, provide secondary health-care services. Hospitals attached to public medical colleges and specialised institutions provide tertiary or specialised health services in urban areas.
The number of qualified doctors including dentists stands at about 66 thousand. This means the ratio is 0.44 per thousand population that is far below WHO standard of 2.3 per thousand population. We find a reverse trend in nurse-doctor ratio. At present, there are 30,680 nurses in the country. The number of medical technologists is also scanty. For a total population of over 150 million, there exist less than a hundred thousand medical technologists.
The nation spends a substantial amount of public money on grooming a doctor at government medical colleges. After graduating, s/he has the onerous and patriotic duty to serve the people whose money made the medical study easier and cheaper. The government should also introduce incentives for doctors posted in rural areas so that they do not abstain themselves from work. In fact, the government cannot provide healthcare services in rural areas if doctors do not go there and thus render the healthcare infrastructure utterly useless. It is sad that government officials of all departments stay at their rural workplaces. Why then will a physician be persistently absent from work? This question has to be answered by the doctors themselves.
There are instances that despite punitive measures having been taken against errant doctors, they continue to forego their duties, remaining absent from their posts and getting or managing transfer orders as early as a day after being posted to a station.
Some parliamentarians' suggestions that doctors be required to obtain recommendations from local MPs before being transferred are not quite the solution either. The concerned ministry itself should have a system by which it can ensure the presence and performance of its members and officers.
There are countries with some of the world's best healthcare systems, such as Cuba, making it mandatory for doctors to serve in rural areas for a stipulated time, such as for two years, after graduating from their respective countries' public medical schools or colleges. Considering the subsidised medical education in public institutions in Bangladesh, not to mention the shortage of doctors and lack of proper medical facilities in rural areas, it will be better to implement such rules in the country.
Doctors need incentives to serve the rural areas. The sad reality is that it takes many years for upazila-level health and family welfare officials to get promoted. They are to travel by motor bikes, while the upazila executive officers are entitled to jeeps or cars. Besides, thousands of posts have remained vacant for years. Some 21,000 posts of hospital staff and 10,000 posts of doctors are currently vacant.
The Health Minister has acknowledged the problems doctors face in rural areas, and pledged incentives for better services. Time will tell when the minister's assurances would be implemented.
Even the authorities concerned have failed to fully equip the medical centres or hospitals with medicines and equipment. According to a survey, more than half of the medical equipment in public hospitals remains dysfunctional, unused or underused. It was reported that 11 per cent equipment are damaged and 11 per cent functional but unutilised in 50 public healthcare facilities in Dhaka, Khulna and Sylhet divisions. Only 49 per cent of the medical equipment in such hospitals is being properly used, revealed the survey titled 'Medical Equipment Survey 2012'.
Patients are often referred to private hospitals for medical tests, which increases healthcare expenditure and also takes health services beyond the reach of many.  
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