New health policy: handiwork of the bureaucrats?
ABM Moniruddin | Friday, 29 August 2008
THE Ministry Of Health and Family Welfare of Bangladesh is going to force the dream of New Health Policy promulgating it through a presidential ordinance that was formulated mostly by the bureaucrats, without understanding the realistic demands of our rural and urban health sectors and based on false statistics.
The Ministry Of Health and Family Welfare has published the draft of New Health Policy on its website a few days back drawing attention of and inviting opinion from people by Aug 24, 2008, giving only about one week time to the people. It is a very short time for passing opinion by the people. It is to be stated that less than 0.33 per cent people of our country have access to the Internet to get a draft copy. Thus it is a ridiculous act by the ministry asking people to submit their opinion within such short time
Bureaucrats sitting in the air-conditioned room of the Ministry of Health and Family Welfare are not at all aware of our health problems in the rural and urban areas. It is only the health workers including doctors, paramedics, paraprofessionals and the field workers, who are capable of defining our health and its problems in relation to our needs. The New Health Policy formulated by the bureaucrats would never be people-oriented, but remain problematic and thus would never be successful in meeting our health demands. Say, a bureaucrat (having no academic background on health) of '81 BCS cadre, now working at the Ministry of Health and Family Welfare has only bureaucratic experience in the health ministry of only several months (because he was transferred to this ministry a few months back from other ministry having experience not related to health). Such bureaucrats are empowered to formulate the health policy. On the contrary, a doctor (having an exact academic background on health) of '81 BCS cadre still works at the upazila level, who has already acquired sufficient experience on our health needs and priorities. But he is not called to contribute to formulating the health policy. Thus skilled health manpower of all levels is being neglected while formulating the New Health Policy of the bureaucrats. Thus the New Health Policy would be by the bureaucrats, of the bureaucrats and for the bureaucrats. It would be of no use for the people, or the health professionals, or the paraprofessionals.
As regards the budgetary allocation for our health sector, the budgets for family planning activities are wrongly added to the health budget. As a result, the total amount is being declared as the health budget every year. It is to be understood that the family planning issues and problems crawl from our national, social, familial and personal domain and are never directly linked with our health demands. Family Planning items like condoms, contraceptive pills and injectables, spermicidal foams, intrauterine devices, etc., are not primarily intended as health promoters. So those should never be considered as items of health sector. Thus, budgets for family planning activities must be subtracted to find out the real health budget. A real health budget thus would be around only 3.0 (three) per cent of the total national budget. However, most of this amount is being spent for giving salary and allowances to the bureaucrats, officers and other employees, leaving only a very negligible amount for establishing new hospitals and purchasing medicines and machinery for curative and preventive measures, etc. Though food items have direct implication for health problems, no nation in the world adds budgets for food, agriculture or social welfare to the health budget. Likewise, with emphasis, budget for family planning activities must be segregated clearly from health budget. If the budgetary allocation for health reaches the level of international standard in the course of time, our health service would also be up to the mark, i.e., international standard.
The Ministry of Health and Family Welfare of Bangladesh claims that the country has a doctor-population ratio of 1:3169 (as declared by the health adviser on 06-04-2007 at the conference hall of that ministry), considering all the doctors (42,881) registered so far with the BM&DC. However, there is a gross error in the report of working Physicians (Government and Private) available for the care and treatment of ailing patients. Because, many of the doctors registered so far with the BM&DC have already expired and many of the doctors registered so far with the Bangladesh Medical & Dental Council (BM&DC) have left Bangladesh for working abroad (most of whom will not return as they have taken the citizenship of foreign countries), and many of the doctors registered so far with the BM & DC are no longer involved in care and treatment, i.e., they are involved either in business or some other profession, or retired (quite old, disabled and not involved in care and treatment of the people). When all these factors are rightly considered, the number of working and living Physicians (Government and Private) available for care and treatment of ailing patients in our country at present would be less than 20,000. Thus there seems to be a gross error in the report of working physicians available for care and treatment of people of Bangladesh. This error needs to be corrected. Otherwise all health plans and policies based on false statistics would fail to achieve the goal. The Ministry of Health & Family Welfare in collaboration with the Directorate General of Health Services and the BM&DC should first enlist the registered doctors who are living and working in Bangladesh. The BM & DC should enlist the registered doctors who have already expired. The BM & DC along with the Ministry of Health & Family Welfare should also enlist the registered doctors who are no longer involved in care and treatment of ailing patients. About one third of government doctors are working as health administrators, who are in no way involved directly in caring and treating patients. They should also be enlisted. The Ministry of Health & Family Welfare in collaboration with the Directorate General of Health Services and the BM&DC should also enlist the registered doctors who left the country for job as well as for job plus citizenship abroad. The Ministry of Health & Family Welfare cannot avoid its pivotal role in correcting all these existing discrepancies in health statistics.
It has been learnt that at present there are 6,220 posts of graduate MBBS doctors, while 2229 posts of qualified diploma nurses are lying vacant in the governmental sector. In addition, a huge number of positions numbering 30,367 are lying vacant throughout the country. These vacancies are substantially increasing in number day by day. It is the prime responsibility of the Ministry of Health & Family Welfare of Bangladesh to take necessary steps to employ manpower against these vacant posts. But it is very sad to state that the Ministry is quite careless about, and indifferent towards, performing its sacred duty. Rather, the said ministry is engaged in promulgating a 'New Health Policy' based on very weak foundation and erroneous health statistics.
No doctor in the world is able to work all the 24 hours in a day, the 168 hours in a week, all the 720 hours a month sand all the 8,736 hours in a year without any rest. But many of the government doctors in our country are being forced to work 24 hours in a day, all the 168 hours a week, 720 hours a month and 8,736 hours a year without any rest. Even they are not entitled to enjoy weekly, national and religious holidays. There is none in the government to see and remove all these inhuman system in the health sector.
The government doctors are being deprived of promotion, time scale, selection grade scale, regularization of their appointment at entry and higher levels in due time. Depriving the working doctors of their rights, it is absolutely impossible to implement the dream of any health policy.
It is to be recollected that our population is increasing by 2.5 million each year and the number of graduate, qualified doctors and paraprofessionals are not increasing proportionately. The government has not taken adequate steps to raise the number of graduate, qualified doctors and paraprofessionals in our country. It is a huge obstacle to the expansion of our health service in the government and the private sectors.
No government hospital in our country is provided with adequate number of doctors and paramedics to meet the demands of that hospital to run it smoothly. Internee doctors in the Medical College Hospitals are being made to work as senior government doctors, thereby seriously deteriorating the standard and level of treatment. Honorary doctors working in the government hospitals are not given any honorarium. For all practical purposes, these honorary doctors should be paid by the government. Their service and labour should not in any way be devaluated. Each upazila hospital caters to three hundred thousand people within its catchment area, but surprisingly the government has not created emergency department with the posts of Emergency Medical Officers there. Though more than 15,000 doctors are unemployed in the country, without appointing doctors to the 11,000 community clinics, the Ministry of Health & Family Welfare is handing over these clinics to the non-government organisation (NGO) businessmen to win the heart of NGO personalities now working as advisers and special assistants of the government.
Needless to say, the manpower and the logistic supports in all the government hospitals are very weak and poor. All these discrepancies at all levels of government hospitals are created and maintained by the bureaucrats of the Ministry of Health & Family Welfare. The so-called New Health Policy of the bureaucrats wouldn't solve these problems.
Can we expect this caretaker government (CTG) to extend its honest hand to solve these problems in the health sector for the greater interest of our beloved country and the countrymen?
The writer can be reached at
e-mail: monirudd@bangla.net
The Ministry Of Health and Family Welfare has published the draft of New Health Policy on its website a few days back drawing attention of and inviting opinion from people by Aug 24, 2008, giving only about one week time to the people. It is a very short time for passing opinion by the people. It is to be stated that less than 0.33 per cent people of our country have access to the Internet to get a draft copy. Thus it is a ridiculous act by the ministry asking people to submit their opinion within such short time
Bureaucrats sitting in the air-conditioned room of the Ministry of Health and Family Welfare are not at all aware of our health problems in the rural and urban areas. It is only the health workers including doctors, paramedics, paraprofessionals and the field workers, who are capable of defining our health and its problems in relation to our needs. The New Health Policy formulated by the bureaucrats would never be people-oriented, but remain problematic and thus would never be successful in meeting our health demands. Say, a bureaucrat (having no academic background on health) of '81 BCS cadre, now working at the Ministry of Health and Family Welfare has only bureaucratic experience in the health ministry of only several months (because he was transferred to this ministry a few months back from other ministry having experience not related to health). Such bureaucrats are empowered to formulate the health policy. On the contrary, a doctor (having an exact academic background on health) of '81 BCS cadre still works at the upazila level, who has already acquired sufficient experience on our health needs and priorities. But he is not called to contribute to formulating the health policy. Thus skilled health manpower of all levels is being neglected while formulating the New Health Policy of the bureaucrats. Thus the New Health Policy would be by the bureaucrats, of the bureaucrats and for the bureaucrats. It would be of no use for the people, or the health professionals, or the paraprofessionals.
As regards the budgetary allocation for our health sector, the budgets for family planning activities are wrongly added to the health budget. As a result, the total amount is being declared as the health budget every year. It is to be understood that the family planning issues and problems crawl from our national, social, familial and personal domain and are never directly linked with our health demands. Family Planning items like condoms, contraceptive pills and injectables, spermicidal foams, intrauterine devices, etc., are not primarily intended as health promoters. So those should never be considered as items of health sector. Thus, budgets for family planning activities must be subtracted to find out the real health budget. A real health budget thus would be around only 3.0 (three) per cent of the total national budget. However, most of this amount is being spent for giving salary and allowances to the bureaucrats, officers and other employees, leaving only a very negligible amount for establishing new hospitals and purchasing medicines and machinery for curative and preventive measures, etc. Though food items have direct implication for health problems, no nation in the world adds budgets for food, agriculture or social welfare to the health budget. Likewise, with emphasis, budget for family planning activities must be segregated clearly from health budget. If the budgetary allocation for health reaches the level of international standard in the course of time, our health service would also be up to the mark, i.e., international standard.
The Ministry of Health and Family Welfare of Bangladesh claims that the country has a doctor-population ratio of 1:3169 (as declared by the health adviser on 06-04-2007 at the conference hall of that ministry), considering all the doctors (42,881) registered so far with the BM&DC. However, there is a gross error in the report of working Physicians (Government and Private) available for the care and treatment of ailing patients. Because, many of the doctors registered so far with the BM&DC have already expired and many of the doctors registered so far with the Bangladesh Medical & Dental Council (BM&DC) have left Bangladesh for working abroad (most of whom will not return as they have taken the citizenship of foreign countries), and many of the doctors registered so far with the BM & DC are no longer involved in care and treatment, i.e., they are involved either in business or some other profession, or retired (quite old, disabled and not involved in care and treatment of the people). When all these factors are rightly considered, the number of working and living Physicians (Government and Private) available for care and treatment of ailing patients in our country at present would be less than 20,000. Thus there seems to be a gross error in the report of working physicians available for care and treatment of people of Bangladesh. This error needs to be corrected. Otherwise all health plans and policies based on false statistics would fail to achieve the goal. The Ministry of Health & Family Welfare in collaboration with the Directorate General of Health Services and the BM&DC should first enlist the registered doctors who are living and working in Bangladesh. The BM & DC should enlist the registered doctors who have already expired. The BM & DC along with the Ministry of Health & Family Welfare should also enlist the registered doctors who are no longer involved in care and treatment of ailing patients. About one third of government doctors are working as health administrators, who are in no way involved directly in caring and treating patients. They should also be enlisted. The Ministry of Health & Family Welfare in collaboration with the Directorate General of Health Services and the BM&DC should also enlist the registered doctors who left the country for job as well as for job plus citizenship abroad. The Ministry of Health & Family Welfare cannot avoid its pivotal role in correcting all these existing discrepancies in health statistics.
It has been learnt that at present there are 6,220 posts of graduate MBBS doctors, while 2229 posts of qualified diploma nurses are lying vacant in the governmental sector. In addition, a huge number of positions numbering 30,367 are lying vacant throughout the country. These vacancies are substantially increasing in number day by day. It is the prime responsibility of the Ministry of Health & Family Welfare of Bangladesh to take necessary steps to employ manpower against these vacant posts. But it is very sad to state that the Ministry is quite careless about, and indifferent towards, performing its sacred duty. Rather, the said ministry is engaged in promulgating a 'New Health Policy' based on very weak foundation and erroneous health statistics.
No doctor in the world is able to work all the 24 hours in a day, the 168 hours in a week, all the 720 hours a month sand all the 8,736 hours in a year without any rest. But many of the government doctors in our country are being forced to work 24 hours in a day, all the 168 hours a week, 720 hours a month and 8,736 hours a year without any rest. Even they are not entitled to enjoy weekly, national and religious holidays. There is none in the government to see and remove all these inhuman system in the health sector.
The government doctors are being deprived of promotion, time scale, selection grade scale, regularization of their appointment at entry and higher levels in due time. Depriving the working doctors of their rights, it is absolutely impossible to implement the dream of any health policy.
It is to be recollected that our population is increasing by 2.5 million each year and the number of graduate, qualified doctors and paraprofessionals are not increasing proportionately. The government has not taken adequate steps to raise the number of graduate, qualified doctors and paraprofessionals in our country. It is a huge obstacle to the expansion of our health service in the government and the private sectors.
No government hospital in our country is provided with adequate number of doctors and paramedics to meet the demands of that hospital to run it smoothly. Internee doctors in the Medical College Hospitals are being made to work as senior government doctors, thereby seriously deteriorating the standard and level of treatment. Honorary doctors working in the government hospitals are not given any honorarium. For all practical purposes, these honorary doctors should be paid by the government. Their service and labour should not in any way be devaluated. Each upazila hospital caters to three hundred thousand people within its catchment area, but surprisingly the government has not created emergency department with the posts of Emergency Medical Officers there. Though more than 15,000 doctors are unemployed in the country, without appointing doctors to the 11,000 community clinics, the Ministry of Health & Family Welfare is handing over these clinics to the non-government organisation (NGO) businessmen to win the heart of NGO personalities now working as advisers and special assistants of the government.
Needless to say, the manpower and the logistic supports in all the government hospitals are very weak and poor. All these discrepancies at all levels of government hospitals are created and maintained by the bureaucrats of the Ministry of Health & Family Welfare. The so-called New Health Policy of the bureaucrats wouldn't solve these problems.
Can we expect this caretaker government (CTG) to extend its honest hand to solve these problems in the health sector for the greater interest of our beloved country and the countrymen?
The writer can be reached at
e-mail: monirudd@bangla.net