Govt hospitals: 21pc physicians not available for treatment

“Wherever I go, I hear physicians don’t stay at hospitals”, regretted health minister Samanta Lal Sen.

Meanwhile, the health ministry and the Directorate General of Health Services themselves have made 7,459 physicians OSD (officers on special duty), which comprises 21 per cent of the total number of government physicians.

Officer on special duty (OSD) means these physicians are away from providing treatment at government hospitals. And this is one of the main reasons behind physicians’ scarcity at government hospitals.

In many cases, patients don’t receive services in government hospitals due to the shortage of physicians. After failing to receive better treatment in upazila and district levels, patients are usually shifted to Dhaka. 

Speaking to officials of the health ministry and the DGHS, it has been learned that government physicians are made OSD basically for four reasons.

First of all, physicians take training or study leave for higher studies. Secondly, they work in other organisation (apart from providing treatment at government hospitals) on lien or taking leave.

Thirdly, some are made OSD when the number of promoted physicians exceeds the number of approved posts. And fourthly, physicians are made OSD as a punishment when they commit a crime. 

Sources at the DGHS said the number of physicians made OSD as a punitive measure is below 50. On the other hand, the number of physicians made OSD for training and study is nearly 4,500.

Concerned people say that physicians in some cases are enjoying OSD facility through irregularity, corruption and nepotism whereas, many despite being eligible can’t avail the opportunity. Effective guidelines are required in this case.

Secretary general of Bangladesh Medical Association (BMA), the largest organisation of physicians, Ehteshamul Huq Choudhury believes the trend of making physicians OSD in greater number should end.

Bangladesh cannot afford to put such a huge number of physicians on leave. Greater number of OSD is one of the key reasons for physician’s scarcity in government hospitals despite there being adequate staff as per the number of approved posts, he said.

The crisis of physicians is an old issue. After physicians are appointed in districts and upazilas, it is noticed that they stay there for a few months and then leave on OSD. A lot of discussions and meetings have been held on this issue. But no effective steps have been taken to resolve the problem.

Meanwhile, health minister Samanta Lal Sen in a conference of neurology specialists held at capital’s Bangamata Sheikh Fazilatunnesa Mujib Convention Centre on 5 March said, “When I go to the national parliament, parliament members tells me that physicians don’t stay in their area.”

“Wherever I go, I hear physicians don’t stay at hospitals. This is not a good sign. How would the villagers get better healthcare if the physicians do not want to stay at upazila hospitals?,” he continued.

Commenting on the issue of a huge number of physicians being made OSD health minister Samanta Lal Sen told Prothom Alo last Thursday, “We’ll have a discussion on this matter in the coming month of Ramadan.”

The DGHS says there are a total of 35,503 posts approved for physicians in all the union health centres, upazila health complexes, district or Sadar hospitals, medical college hospitals and in specialised hospitals. As of Thursday, 7,459 physicians are made OSD. Every one of them receives regular salaries and allowances.

As per rules, maximum 10 per cent of officers of the total approved posts can be made OSD. However, no instance of 10 per cent officers being made OSD has been heard of in any other ministries.

Abiding by the government rules, there was a scope to make maximum 3,550 physicians OSD. But the health ministry has made physicians OSD more than twice.

To end the crisis of physicians at the field level, a meeting was held at the health ministry a year ago on 20 March 2023. The meeting was presided over by the then health minister Zahid Maleque.

The minutes of that meeting state that a vast number of physicians being made OSD created an alarming crisis at the field level.

The minutes shows that the director (admin) of the DGHS had said in that meeting that many of the physicians made OSD for study purposes do not join their posts on time even after the courses have been completed.

“Some of the physicians when failing the courses, stay away from their duty posts (workplace) successively using the study leave, earned leave and even the extraordinary leave,” he had added.

Speaking to officers at the DGHS, it has been found that some of the physicians with the help of higher officials keep taking leaves again and again.

Unwilling to disclose name, an officer at the directorate giving example of a certain physician told Prothom Alo that the physician concerned had taken a leave of total three years for a post graduate degree on gynaecology first.

Within a few days of joining work after that degree they took another two years off for higher studies on gynaecology ‘sub-specialty’, infertility. There are many such instances. 

In 2021, an officer was promoted to the post of deputy director at the DGHS as ‘leave reserve’. That means they were made OSD even after promotion for there being no empty posts there.

They were attached to the DGHS. That physician moved to Chattogram. They live and practices there now. They are still collecting regular salary and allowances as an OSD, said an official concerned at the DGHS.  

That physician made OSD however complained to Prothom Alo on Friday that they are not at all being given the chance to work. They are not being posted anywhere. And, they are being wronged.

It’s not a new allegation that unlike other professionals, physicians in government hospitals aren’t consistently present at their workplace on various grounds.

Meanwhile, six physicians from Shaheed M Monsur Ali Medical College Hospital in Sirajganj have returned their salaries to the government.

It was caught in the monitoring of the directorate of health services that those six physicians were absent from the hospital for several days last year, without taking leave.

So, the directorate told them to return the exact amount of money that is equivalent to their salaries from the days of absence. As a result, some of them have given back Tk 26,000, some Tk 40,000.

Principal of Shaheed M Monsur Ali Medical College, Amirul Hussain Chowdhury told Prothom Alo last Thursday, “You can say that those six physicians have become more regular in providing treatment than before.”

A report on the crisis of physicians in villages and the load of patients in cities was published on Prothom Alo on 3 December last year. In that report, Prothom Alo Bagerhat correspondent Sardar Inzamamul Haque had shown that there are a total 310 posts for physicians at all the government hospitals and health complexes in the district. But, only 142 physicians were serving in their posts.

To know about the current situation in Bagerhat, the office of the district civil surgeon was contacted. Sources there reported that the situation has deteriorated even further now.

Public health expert Be-Nazir Ahmed told Prothom Alo, “Physicians do need the OSD option for post-graduation medical studies. But it has to be ensured that those higher study degrees don’t come at the cost of negligence in service at the hospitals.”

He said that the number of physicians who require higher degrees in which subject has not been determined, nor is there a plan. This too is necessary.

*This report appeared in the print and online versions of Prothom Alo and has been re-written for Prothom Alo English by Nourin Ahmed Monisha.