96pc physicians find problems serving in villages

• 65 per cent physicians remain absent due to trainings

• 41 per cent physicians remain absent for family purposes

• 63 per cent physicians doesn’t live in the allocated houses

The unavailability of physicians in the villages is nothing new to the country. A new study shows some 96 per cent of the physicians faced different sorts of problems or challenges while serving in the villages. The study also shows that physicians who have social and political influences remain absent more.

Some nine researchers from the University of Massachusetts in the USA, University of London in the UK, London School of Hygiene and Tropical Medicine, University of New South Wales in Australia, BRAC University of Bangladesh and Dhaka International Food Policy Research Institute conducted the study.

Their research paper titled ‘Who is absent and why? Factors affecting doctor absenteeism in Bangladesh’ was published in the online version of PLOS Global Public Health Journal on 4 April.

The facility-based cross-sectional survey was conducted in four third tier government hospitals in Dhaka in 2019. Some 308 physicians took part in the survey and provided their opinion.

Although those physicians were posted in Dhaka at the time of the survey, they all had some experience of serving in the rural areas. Some 54 per cent of them were male and 46 per cent were female. Besides, some 31 per cent of the physicians who took part in the survey had an MBBS degree and the remaining of them had postgraduate degrees or were listed for that. Some 47 per cent of these physicians were serving as medical officers at the time of the survey.

Syed Masud Ahmed, researcher of BRAC James P Grant School of Public Health under the BRAC University, was one of the nine researchers involved in the research.

Speaking to Prothom Alo, he said, “We strongly blame every physician for being absent at work. It’s not right. We have found that only the physicians who have the ability to spend money and have social and political influence can shift their posting to Dhaka from villages. There is intense pressure of work in the rural areas. As a result, the quality of the service falls and people complain about the physicians. People only see them at chambers or hospitals.

It is mandatory for the physicians to serve at least for two years in the area where they have been posted after getting the job. However, 26 per cent of the physicians said they didn’t do that. They cited training programmes that they attended as the main reason behind this. And 65 per cent of the physicians said they could not serve in the villages uninterrupted due to the medical training they had to attend. The study also found that some 41 per cent of the physicians remain absent due to family reasons.

The survey report says some 96 per cent of the physicians involved in the study faced different sorts of challenges while serving in the rural areas. The remaining physicians didn’t mention any such problems in the villages.

The physicians have mentioned various types of problems. Some 73 per cent of them cited security concerns in rural areas, 70 per cent verbal abuse from the relatives of the patients and 50 per cent cited the crisis of other health workers.

Some 40 per cent of the physicians wanted help from their families to deal with these problems, 39 per cent wanted help from the local influential persons and 35 per cent wanted help from the neighbours and co-workers. This means many of them look for several alternatives.

The study shows 63 per cent of the physicians don’t live in the house allocated for them in rural areas. Some 76 per cent of the respondents in the study said their families don’t live in the house allocated by the government and mentioned several reasons for that.

Some 77 per cent respondents mentioned security problems, 72 per cent cited lack of basic facilities in these houses and 40 per cent mentioned lack of communication facilities as the reason for not living in the allocated houses.

The crisis of physicians is prevalent in the rural areas. Despite that, some of the physicians still reside at the health complex and continue to serve people. Mostly the physicians who can maintain a good relationship with the people stay in the health complex to provide health services.

The researchers say the problems regarding the absence of physicians at work are not universal and depend a lot on the physician’s social and political connection. Those who don’t have this lag behind in most cases.

Health minister Samanta Lal Sen vowed for strengthening and developing the medical services in the rural parts of the country after taking charge of the health ministry. He sought advice on how to retain physicians in village areas.

The researchers say a policy initiative should be undertaken to reduce threatening and non-supportive behaviour towards the physicians. Rather policy responses must promote opportunities for physicians with weak networks who are willing to attend work with appropriate support.

Speaking to Prothom Alo, Swadhinata Chikitshak Parishad president M Iqbal Arslan, “The study is quite significant. Reality is quite different from how the health ministry depicts the health sector.  The physicians work amid a lot of challenges.  There is discontent among the people regarding health services too.”

“The physicians lag behind in terms of promotion as compared to other professions.  There is dissatisfaction among the physicians over this. The policymakers must work on real issues. This study provides some indications in this regard,” he added.

*This report appeared on the print and online versions of Prothom Alo and has been rewritten in English by Ashish Basu