Unhealthy state of health services for rural masses

Only four doctors are there for half a million people in two upazilas in southern Barguna district, as of first week of June. Upazila health complexes of Amtali and Taltali are in fact supposed to have 39 medical officers but 35 posts lie vacant.

Moreover, according to an investigation, there are no medical officers in three sub-health complexes and seven union health clinics under these two upazilas to serve the grassroots people.

The health complexes all over the country are found to have nothing but inoperative medical and diagnostic equipment and of course an acute shortage of physicians.

Farhana Akhter, an eight-month pregnant woman, was admitted to Kaliganj upazila health complex one day in March. Her relatives said after two days of her stay at the hospital she fell ill but there was no doctor on duty at 8:00pm.

When her relatives called the physician concerned, he refused to visit the patient at the time. Farhana was then shifted to a nearby private clinic where she had C-section surgery by none but the same doctor.

“What could be more pathetic when you see government a doctor practicing in private clinic?” Farhana’s cousin Akhi told Prothom Alo over the phone. “The same thing happened to another of my cousins in April.”

Naming the doctor, Akhi said, “He conducted surgery on both my cousins at the private clinic whereas he was supposed to be at the upazila health complex.”

Shyamnagar, an upazila in Satkhira with over 400,000 population, has a health complex with its sub-health centres and union health clinics. Thirty out of 34 posts of physicians remain vacant, according to the Prothom Alo investigation.

Omar Faruk Chowdhury, a medical officer of Shyamnagar upazila health complex, said, “We are four and we have to look after indoor and outdoor service as well as the operation theatre at the same time.”

When asked about such condition, he still said, “This is far better than the condition in many other upazila health complexes across the country.”

In Chhagalnaiya, Feni, 15 of 27 posts of medical officers have fallen vacant. The same is the condition in Parshuram upazila health complex.

When reached, a medical assistant there said the doctors are more interested in private practice than attending patients at the government hospital.

Assasuni upazila health complex, Satkhira, has only three doctors on duty, found the weeklong investigation in May-June. There is no gynaecologist and surgeon for emergency caesarean sections in the health complex.

“The doctors cannot cover 24 hours a week and this is because of their shortage in terms of number,” the Upazila Health and Family Planning officer of the hospital told Prothom Alo.

Sharmin Akhter Taz of Kaliganj health complex said, there is no paediatrician or gynaecologists there. As a result, the local people suffer, she said.

“We cannot provide proper treatment to the mothers who come here for childbirth. Most of them later go to nearby private hospitals,” said Sharmin, sub-assistant medical officer at the hospital.

More than 50 per cent (53% to be specific) of the mothers who die while giving birth, are victims of unsafe childbirth by inefficient midwives or medical assistants, according to a 2016 government survey report.

It said, only three per cent of the healthcare centres across the country have minimum health facilities for normal delivery, let alone childbirth by C-section.

Caesarean section, also known as C-section or caesarean delivery, is the use of surgery to deliver babies.

In fact, no C-section facility is available, nor is there any anaesthetist in most of these hospitals, Prothom Alo came to know talking to officials in a number of health complexes.

Dhamrai health complex, in the vicinity of Dhaka city, has no anaesthetist. “C-section service for pregnant mothers is unavailable here since February,” said a senior official of the health complex on last Wednesday.

Terakhada upazila health complex in Khulna has no facility for C-section for the last 25 years as there is no anaesthetist there, said Prothom Alo’s Khulna correspondent.

Health officials in remote places said most of the doctors try to take transfers to hospitals in the cities as soon as they get posted.

Finance minister AMA Muhith, however, dismissed complaints when some members of parliament raised the matter. ““Sorry, I don’t buy that. Now a good number of doctors stay in the upazilas,” he said at a pre-budget discussion in Dhaka on 18 March.

Upazila health complexes in Dhaka district are relatively in better shape. Dhamrai has 23 posts for medical officers and 18 posts are filled, said a senior official of the hospital.

Keraniganj upazila health complex has all 15 posts filled.

Still, a medical officer said, the number of doctors is not adequate as there is a huge rush of patients every day -- 450-500 patients. 

But, districts away from the capital are in worse conditions. They are handicapped by either inoperative X-ray machine or absence of technical persons.

Paikgachha upazila has 21 posts for medical officers but 17 are vacant.

Against 10,640 posts of medical officers at upazila level across the country, there are 4,770 doctors available, meaning 5,870 or 55.2 per cent positions are vacant, shows the data on official website of Directorate General of Health Service.

Chowdhury Mahbub-e-Elahi Khan, acting director of icddr,b’s universal health coverage programme, said an upazila health complex has five recruited doctors and two may be on deputation in another hospital, generally a higher level hospital.

“So the post of upazila health complex s/he was recruited for would be occupied officially but the people would not be able to avail of her/his service,” he pointed out.

* Prothom Alo's Barguna, Feni, Khulna and Sathkhira correspondents contributed to filing of this report