Health Minister\\\'s \\\'carrot and stick\\\' policy

In many small towns and villages across the country, the public sector health facilities, including hospitals, have the latest equipment but not sufficient number of doctors to treat patients or personnel to operate the medical gadgets.
But in Dhaka, there is no dearth of doctors or medical technicians in government hospitals, specialized or otherwise. Everyone from a specialist doctor down to a peon is interested to stay in the capital. And the battle is quite intense to have a berth in any government health facility in Dhaka or undo any move to transfer from the capital to other places.
When the majority doctors are not willing to go even to headquarters of major districts, one can well imagine their reaction to any move to put them in hospitals or health centres at the upazila level.  
And who does know the situation better than the health minister who has to meet everyday a good number of visitors lobbying in favour of doctors either willing to come to Dhaka or unwilling to go out of it? The lobbyists often include leaders of the pro-ruling party doctors' associations or forums.
In fact, the health ministry and the directorate of health are finding it hard to keep doctors working in government health facilities in rural areas. All the pleadings have failed to encourage the doctors to stay in rural areas and serve the people there. In most cases, the doctors skip their stay in rural areas and spend time in Dhaka.
When all other government officials are staying at the upazila headquarters, it is the doctors who are found to be reluctant to do so. But the situation should have been different when the government is spending a substantial amount of money annually on the salary and allowances of doctors, officials and other employees of the public sector hospitals across the country. It is taxpayers' money and the rural people have a large share in it.
The finance minister in the budget for the fiscal 2014-15 has proposed revenue expenditures worth Tk. 5.08 billion, Tk. 4.0 billion and Tk. 8.82 billion respectively for government medical college hospitals, district hospitals and upazila health centres. A large part of the proposed allocations would be spent on salaries and allowances of doctors, nurses and other employees of these hospitals and other health facilities.  
Apparently, with a view to reversing the current trend, the incumbent health minister has decided to adopt the 'carrot and stick' policy.
Last Monday, in a statement delivered under the rule 300 of the Rules of Procedures of the Parliament, Health Minister Mohammad Nasim announced that a doctor would get a 'good' posting if he or she worked at the upazila level government health facilities for three consecutive years.
While offering the bait, the health minister also issued a note of warning that no amount of lobbying would work to avoid posting and transfer to upazila health complexes and doctors would get due punishment if they indulged in irregularities. He informed the House that during last five months, 81 doctors faced departmental cases, 11 removed and 14 reprimanded.
However, Mr. Nasim pointed out a few difficulties that the doctors serving the government hospitals usually face.  He said the doctors are required to work on the weekends and attend many patients everyday.  
It will not be out of place to mention here that it is the junior government doctors, not the mid level or senior doctors, are sent to rural areas. The facilities available with the upazila health complexes do not require the presence of mid level or senior doctors. Under such circumstances, the junior doctors feel that they are being discriminated because of their age and insufficient experience.
Moreover, the doctors while working at the upazila level government health facilities in most cases are exposed to many difficulties, including the lack of accommodation, transport and recreational facilities. Their compensation packages do not include any incentive to compensate for the difficulties and deprivation.  
The government might consider granting a handsome amount of 'outstation' allowance per month to the doctors posted at the public rural health facilities.
The government spends a lot of money on the operation and development of its health facilities in rural areas. The additional amount to be spent on the proposed allowance would not be any big deal. But it could help the government to ensure better return on its investment in rural health facilities and offer improved services to the rural population.
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