Providing rural health services

Unauthorised absence of on-duty physicians from government rural hospitals remains a major challenge to government's objective of ensuring health care services for the common people living in the remote areas. When doctors remain reluctant to stay in villages to render services to the poor and helpless people, health centres like community clinics and union health and family welfare centres are of little use.
MBBS and specialist doctors in the government service, like most other public service professionals, remain overtly or covertly loyal to the political parties. They are members of their respective professional bodies, which are divided along political lines. This is an unfortunate reality in Bangladesh.
It is observed that the pro-government doctors in the public service cadre always lead their professional bodies. The members of such factions often behave like unruly workers of trade unions. They exert pressure on the government not to execute the rules, regulations and office orders and, thus, afford to keep themselves absent from their place of postings in the rural health centres.
On the other hand, it is a matter of more concern that students are losing interest in studying science subjects at secondary and higher secondary levels. After studying in the science group, students at present get very limited opportunities to study further in science-based professions in the country. Setting up of more medical colleges can encourage students to study science subjects at secondary and higher secondary levels.
The government is committed to providing health services to the people in both rural and urban areas. But it has become difficult to engage doctors to serve in the health centres located in rural areas. This problem has been persistent for long. To address this practical problem, it is necessary to set up 45 medical colleges in all the new district towns and to create a Rural Medical Service Cadre for the qualified doctors.
Under-graduate doctors from these institutions should be required to serve in government-run health centres and hospitals in the rural areas. The government should also create adequate number of positions for under-graduate doctors at Union- and Upazila-level public healthcare centres and
hospitals.
No post is to be created for such rural doctors at urban hospital or health care centres. Thus, from the very beginning of their study they will be mentally prepared to serve in the rural areas.
After serving in rural areas for certain years, interested under-graduate doctors may be allowed to go abroad with employment that will open new vistas for employment and help reduce the existing acute unemployment problem in the country. It will also contribute to foreign exchange earnings by the country and reduce unemployment problem.
Seven medical colleges may be set up at the seven divisional cities for providing graduate-level courses in medical science in order to provide the rural doctors an opportunity to pursue higher studies, after completion of a few years of service in the rural areas. These institutions should also impart special courses and training to help doctors to upgrade their skill and knowledge.
Bangladesh has enough teachers to impart medical courses at the under-graduate level. It is a great advantage. The Government needs to utilise this opportunity. The country only needs to invest a substantial amount of public funds to set up and operate such medical institutions and colleges.
The Government should take up a five-year action plan to set up such medical colleges in each new district in phases and later set up graduate-level medical collages in each divisional headquarters.
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