Crisis of physicians in small towns: Environment and infrastructure need improvement

EditorialProthom Alo illustration

Citing two research surveys, Prothom Alo recently reported about various problems faced by physicians working in small towns (mofussils).

The issue from 19 April reported about medical and public health journal, Lancet identifying 18 problems faced by physicians in a research. Meanwhile the issue from 4 April reported about a survey published in the journal PLOS Global Public Health where 96 per cent of the physicians have said why they don’t want to live in villages.

However, you don’t even need research to know about the pitiful condition of healthcare in villages or in small towns. It can be comprehended just by looking at the wave of patients moving from smaller towns to Dhaka or other big cities every day.

Though the titles of the two studies are different, their objective is the same. The infrastructural weakness in healthcare, lacking of medical rooms and equipment, shortage of health workers, lack of security and housing problems have come up in them.

The later study also mentioned pressure from local influential people and misbehaving with the physicians. Sometimes the patients even attack physicians after being deprived of medical services due to the lack of health workers and equipment, which is very sad.  

If the government truly wants to ensure high-end healthcare in rural areas, adequate number of physicians and health workers have to be appointed there. The mindset of having one person do the work of three has to be shunned.

While delaying is possible in other cases, it doesn’t work in healthcare. There has to be such infrastructure and transport system in villages that the physicians or other government officials are encouraged to go there.  

Despite the issue of physician’s housing in villages being discussed for a long time, what can be the explanation for there being no improvement of the situation? In many places, there’s no living arrangement for physicians while in many other places there are houses but they are inhabitable.

While the government spends a lot of money on unproductive and insignificant projects, they just don’t want to unclench their fists in the health sector.

Among the South Asian countries, Bangladesh has the lowest allocation in healthcare. Then again the bulk of this allocation goes to urban areas indeed. So, there’s only a petty amount of allocation for rural areas and the physicians have to face a lot of problems in turns.

However, you don’t need extra money to solve the policy-related issues that have been mentioned in the survey. You just need an honest and transparent attitude.

If the situation takes such a turn that whoever has the stronger recommendation gets transferred from village to city faster, other physicians also won’t want to stay in villages. What’s the solution to this? If physicians are to be retained in villages, the ‘recommendation culture’ at the directorate of health services needs to be ended.

The policymakers of the government often give physicians ‘strict’ orders to move to villages, but don’t investigate into why that order isn’t being followed.

Health minister Samanta Lal Sen recently at the tenth national neurology conference organised by the Society of Neurosurgeons of Bangladesh (SNB) emphasised on reaching quality healthcare to remote areas and retaining the physicians there to bring the reputation back in healthcare. At the same time, he also promised to increase facilities for those who will provide health care in the villages.

Though several health ministers have said such things in the past, there was no reflection of that in reality. We only hope that the health minister who has gained a name in the medical field will keep his word.  

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