Healthcare in rural areas in disarray, needs urgent care

Healthcare service in rural areas is in dire straits despite having all the facilities and huge government expenditure for a sizeable manpower deployment at union level, as the medical centres virtually remain dysfunctional.   
Reasons are many, but experts attribute the failure basically to weak local government.
They say it is an implicit decision of the successive political governments that they will never make the local government system strong which could have improved the present poor healthcare situation at roots level.
Under the present system of government health-service delivery at union level, at least 18 to 20 healthcare providers are deployed to serve a union having a population of 25,000.
The healthcare facilities include one Union Sub-Centre under the directorate- general of health services (DGHS) where there is a post of an MBBS doctor, one pharmacist, one medical assistant and one peon to provide outdoor services. There are at least 1,272 such union health centres across the country. But the government has created one post of MBBS doctor for those unions where there is no UHC among the total 4500 unions.
The second facility for a union is Health and Family Welfare Centre under family planning directorate. Such a centre is manned by one medical assistant, one pharmacist, one family-welfare visitor, one midwife and one guard to dispense outdoor services.
Also there are community clinics (CCs) at village level for 6,000 persons each with three healthcare providers.
CCs are the clinics at the grassroots level, including the remotest and hard-to-reach areas. It is basically meant for health education (on health, nutrition & FP), health promotion and treatment for minor ailments, first aid, and identification of emergency and complicated cases to establish an effective referral linkage with the higher facilities i.e. UHFWC & UHC for better management, as mentioned in the official statement of the government.
Besides, there are field workers called health assistant and family-welfare assistant under the supervision of assistant health inspector and family-planning inspector to visit the houses of the rural areas. Altogether the number of field- level workers is at least eight.
Despite having those healthcare providers at roots level, there is much hue and cry in the country that rural people are deprived of health services.
During a recent visit to Tuker Bazar Union Parishad in Sylhet district, this reporter found one UHC (Union Health Centre) there to provide services for 56,000 people. Chairman of the union Shahid Ahammed informed that the government has given permission to set up three CCs in his union after much lobbying from the UP.
He said, "The doctor is irregular, for which village people do not find anyone to write prescription during their health problems. Also there is inadequate supply of medicines compared to the population and lack of awareness among the people about the services."
Public Health expert Dr Abdus Sabur told the FE that the government has deployed an adequate number of healthcare providers who draw salaries without performing their duties properly.
Contrary to Shahid chairman, Dr Sabur said, "Rural people are very much aware of the fact that the UHCs remain locked for years and the doctors and paramedics are not there."
Dr Sabur thinks the situation could have been better had the UPs been stronger and given executive power to make the officials and staffs accountable.
UP standing committee on education, health and family planning and the UP chairman could introduce the citizens to the service providers and recommend increasing service-based delivery in the area, experts observe.
Former adviser of a caretaker government and expert on local government and health sector Hossain Zillur Rahman said UPs cannot play any direct role over the UHC as it is completely a concern of the DGHS.
"But it can play role in community clinics as there is a committee which is established by involving local communities."
Transparency International Bangladesh (TIB) executive director Iftekharuzzaman said local representatives are the closest medium to reach root- level people and they can ensure the basic requirements like education and health for people.
"Their main role is to monitor the service-delivery performance of the government healthcare facilities and report it to the proper authority to improve their performance in case of any kind of faults."
Mr Iftekhar, however, cautioned this role of the local representatives should be beyond any political influence and in greater interest of the people.

msshova@gmail.com