The issue of absentee doctors

Many government doctors in connivance with unscrupulous officials in the ministry of health are able to avoid serving in the rural areas. Many of them remain in Dhaka month after month and draw their salaries and other benefits without doing adequate work at their designated places of work, while health services in the rural areas suffer very seriously from the absence of doctors. Prime Minister (PM) Sheikh Hasina has warned such absentee doctors for their dereliction of duty, time and again. At the 19th annual conference of the Bangladesh Medical Association (BMA) last Saturday, the PM, without mincing any words, once again warned the doctors that they should give up their jobs if they do not like to stay in the rural areas. She also reminded them how their education and training was heavily subsidized by the taxpayers and urged them to be more sincere in providing adequate service in the rural areas. However, the tough words from the PM will count for something only after some corresponding tough actions are taken to ensure that the doctors do indeed feel obligated to serve in the rural areas. This is no easy task. The government needs to provide adequate incentives for the doctors to serve in rural areas while the doctors themselves need to change their attitude and become more service-minded. More importantly, the ministry of health needs to strengthen its supervisory role to ensure the strict enforcement of rules and regulations, making it difficult for the doctors to go on so unconscientiously avoiding their duties in rural areas. In addition, punitive actions should also be taken against such doctors and the ministry officials abating them. The health ministers of nearly all previous governments ordered stronger supervision of doctors posted in the rural areas, to tackle the problem of absentee doctors. But little appears to have been achieved in this direction. It seems that the ministers' directives were thrown to the winds and the tradition of doctors staying away from their places of posting in the rural areas continued in much the same form. Not much positive changes have been experienced in relation to absentee doctors under the present government either. Therefore, the government needs to take a more pragmatic and realistic approach to solve this problem, placing emphasis on the strict enforcement of service rules above everything else to achieve any significant positive results. Nearly 80 per cent of the people of the country live in the rural areas. Successive governments invested substantially in setting up health care centres in the rural areas with a hope that these would extend minimum health care to the rural people. However, even partial benefits of these centres are not being realized due to the phenomenon of absentee doctors. The present government plans to establish 18,000 community clinics and out of these, 8,000 such clinics have been already established mainly in the rural areas with a view to extending health services to rural people. But these functioning community clinics are also suffering from the lack of adequate number of doctors. In addition to receiving their education in a subsidized system, the doctors are also paid a decent salary and other facilities to work in rural areas. In return, the nation should duly expect to get his or her sincere service. If the same is not honestly discharged, then the nation should have the right to apply coercion so that the same is discharged. The problems or complaints by the doctors should also not be ignored and steps should be taken to solve them. But the imperative is to bring discipline in this area based on the service rules, in order to ensure that the rural people receive the necessary health care service.