Partisan appointments: Weak health sector marred by instability

Partisans have weakened the health sector as the governing people preferred individuals’ and groups’ interests to the improvement of service quality.

Instability has persisted at hospitals and educational institutions since the fall of the Awami League government. Now the question is whether the interim government would maintain a political balance in the health sector or run it with competent people.

The Swadhinata Chikitsak Parishad (SWACHIP), a platform of pro-Awami League physicians, had heavily controlled healthcare and medical education sectors till the fall of the Awami League government on 5 August since they came to power in 2009. SWACHIP leaders also did business in the health sector in addition to influencing recruitment and transfers.

SWACHIP even deprived the members of the pro-BNP physicians’ body, Doctors Association of Bangladesh (DAB), in various ways.

The pro-BNP physicians were not promoted on time despite fulfilling all criteria. They were made chief of no project. Physicians who were involved in neither SWACHIP nor DAB were also deprived.  Many even left government jobs out of frustration, as well as from the insult of not being evaluated properly.

The scenario was just the opposite during the BNP government’s term in 2001 to 2006. DAB maintained sole dominance in the health sector, cornering the leaders and activists of SWACHIP. Physicians with no affiliation had similar experiences.

However, the healthcare sector and medical education system are the worst hit by this power practice of SWACHIP and DAB by rotation, and group interests hamper the flourishing of the health sector.

Public health expert Abu Jamil Faysal told Prothom Alo that the health sector was a glaring example of how much the partisan appointments could weaken a service sector.

Ban on partisans in the health sector should be on the priority list of the interim government, and it will not be possible to reform the health sector by keeping SWACHIP and DAB functioning, he insisted.

The majority of the activities in the health sector are implemented through the Health Population and Nutrition Sector Programme (HPNSP), which is a five-year programme.

Its fourth programme ended two years ago and the fifth programme was scheduled to begin in July this year. The government is the main financier of the programme while the development partners provide a portion.

Thirty-one operation plans (OPs) including nutrition, infectious disease, non-communicable disease, preliminary treatment, alternative treatment, and maternity and child healthcare are operated through the HPNSP. Funds were allocated for Ops for five years.

There are three attractive positions in each OP – line director, programme manager and deputy programme manager. An OP has a line director, one or two programme managers and 2-12 deputy programme managers.

Currently, SWACHIP members, who were posted disregarding merit or skills, hold almost all the positions. These officials were involved with Bangladesh Chhatra League, the student front of the ousted Awami League from power, at various medical colleges.

Usually, senior BCL leaders from the campus hold line director posts, relatively juniors hold programme officers and most juniors work as deputy programme officers.

This political fraternity allegedly looks after procurement in the health sector, visits foreign countries and commits corruption in training.

When the coronavirus pandemic broke out in 2020 then-director general at the Directorate General of Health Services (DGHS) professor Abul Kalam Azad resigned amid allegations of huge corruption.

Professor Abul Bashar Mohammed Khurshid Alam, who conducted an important surgery on former health minister Zahid Maleque at Dhaka Medical College Hospital, was appointed as the director general of the DGHS despite having no administrative experience.

His government job age ended in December 2020 and the government extended his appointment on contract till December 2024.

The top posts of 11 institutions and medical colleges have been filled with contractual appointments. Similarly, the tenure of several professors has also been extended. However, no pro-BNP physician enjoyed this privilege.

The anger and frustration of pro-BNP physicians can be understood from a step taken by the interim government. The incumbent government cancelled the contractual appointment of professor Abul Bashar Mohammed Khurshid Alam and made professor Robed Amin acting director general of the DGHS.

Robed Amin was the line director at the Non-Communicable Disease Control (NCDC) division of the DGHS.

But as of Tuesday, Robed Amin could not join the office since DAB leaders and activists locked the office demanding that someone from the deprived camp be made the director general.

Currently, DAB is waging a movement against Robed Amin.

Health adviser Nurjahan Begum and Robeb Amin along with several DGHS officials went to the DNCC Hospital in the capital’s Mohakhali. At that time, several DAB leaders and activists along with a group of fourth-class employees stormed there. Fistfights broke out; DAB leaders-activists started shouting; at one stage, a physician stood on the table.

Protesters alleged that Robed Amin was involved in corruption and was against the student movement that toppled the Awami League government. The health adviser was seen sitting helplessly throughout the incident.

After the incident, Robed Amin told Prothom Alo all allegations brought against him were false.

Incidents at the Bangabandhu Sheikh Mujib Medical University (BSMMU) are the ultimate examples of partisan practices. All five vice-chancellors, who were appointed since 2009, are either SWACHIP members or directly involved with the Awami League.

Pro-vice chancellors, proctors and other office bearers are also members of SWACHIP. None with different opinions holds a bid post there.

A total of 173 physicians, who were appointed during the BNP’s term in 2003, 2004 and 2006 were promoted in just a day on 8 August, three days after the fall of the AL government on 5 August. Promotions of other teachers involved in different politics were also on hold and they are now being promoted secretly.

When the process of these promotions was about to end, BSMMU’s vice-chancellor, two pro-vice chancellors, and several top officials resigned under pressure at that time.

The Awami League government prepared to open four more medical colleges by appointing the SWACHIP members as vice-chancellors.

Such a partisan practice not only existed at medical universities, principles of the 37 public medical colleges were also involved with the Awami League. Fifty out of 64 civil surgeons are either members of SWACHIP or close to Awami League.

Currently, there are 495 upazila health complexes in the country. Those who maintained loyalty to the party got the responsibility of the upazila health officer. Party people also hold important positions from central to the grassroots.

In the meantime, professor Titu Miah, director general of the Directorate General of Medical Education (DGME), and two additional directors general professor Baizid Khoorshid Riaz and professor Kamrul Hasan Hasan were made officers on special duty (OSD).

The three were involved with Bangladesh Chhatra League in the past and are currently with SWACHIP. Kamrul Hasan is the present secretary general of SAWCHIP. DAB leaders wanted to install their people in these positions.

Essential Drugs Company Limited (EDCL) is a state-owned lone pharmaceutical company.

EDCL manufactures drugs at its factories in Dhaka, Bogura and Gopalganj. Condoms were manufactured at a factory in Khulna while rubbers were produced in Madhupur.

The managing director of the EDCL is a leader of the Awami League. He is neither a dermatologist nor a pharmaceutical scientist.

More than 4,000 people, mostly workers, are employed at the EDCL.

Experts said this company can be operated with half of the total human resources. People from a certain district dominate the lone state-owned commercial entity in the health sector.

Those who were deprived said that the time has arrived to take back the dues. DAB physicians are becoming aggressive towards the authorities. Vandalism has already been reported from various organisations including BSMMU, National Institute Of Mental Health and Hospital, Shaheed Suhrawardy Medical College and Hospital, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), and Sheikh Russel National Gastro-liver Institute and Hospital.

Nurses, third and fourth-class employees along with the physicians brought demonstrations at various institutes and joined in vandalism. They said they have been deprived in various ways over the past 16 years.

It is very difficult to turn the health organisations that face allegations of partisan practices and deprivation into service-friendly, the experts say.

A senior official of the Health Services Division told Prothom Alo on condition of anonymity that everyone knows who are honest and competent. They must get priority now. Besides, preference must be given to the competent but deprived whereas people from both parties should be given equal space to bring political balance. Otherwise, the quality of service will not increase.

Replying to a query on what to do now, Syed Abdul Hamid, professor at the Institute of Health Economics, Dhaka University, told Prothom Alo that it is not that a government has come to office by removing another government. The context is different here. This government came to power through the student movement intending to reform the state.

“The government must form a search committee and find competent people. Competent and deprived people must be given the place they deserve,” he added.

The health sector would not function smoothly by continuing the deprivation and leaving out competent people, Syed Abdul Hamid pointed out.