Rural health services in Bangladesh are reeling from an acute shortage of doctors and essential facilities, leaving patients without timely treatment and forcing them to travel long distances or rely on costly private care.
Upazila- and district-level hospitals are struggling to provide services but enough doctors are not available in the hospitals, with many of them deputed to various health facilities in and around Dhaka or other urban areas, rendering even basic medical tests unavailable in rural areas.
In the absence of adequate doctors and diagnostic services, patients continue to either flock to local private hospitals and clinics or rush to Dhaka for better treatment, incurring high costs.
In many cases, people travel to Dhaka even with simple diseases that increase healthcare costs and create pressure on specialised hospitals.
Upazila health and family planning officer of Jibannagar in Chuadanga Makbul Hasan said that his hospital was upgraded to a 50-bed facility from a 31-bed one in 2018 in response to public demand but the hospital organogram was not upgraded accordingly.
As per the 31-bed hospital organogram, the facility is entitled to have 10 doctors but it has only 5 doctors in the service, including him.
Three doctors of the hospital were sent to other hospitals on deputation, including two to Dhaka, while two other posts remain vacant.
Bagherpara UHFPO Arup Jyoti Ghosh in Jashore said that there were only four full-time doctors against the 29 sanctioned posts at his 50-bed hospital.
Against the 29 positions, he explained, 17 are now vacant while three doctors are working in Dhaka on deputation and others are attached to other public hospitals in neighbouring facilities on part-time assignments.
Every day they have to struggle to serve some 500 outdoor patients and over 100 indoor patients on average, he said.
鈥楾he hospital bed occupancy rate is 126 per cent on average,鈥� he further said.
Similarly, Gaibandha鈥檚 Saghata upazila hospital was upgraded to a 50-bed facility in 2020, but no additional manpower was sanctioned for it.
Meanwhile in many upazilas, X-ray and ultrasonography machines remain idle for want of technicians.
By contrast, the Tejgaon thana health complex in Dhaka has 17 doctors in the service against just eight sanctioned posts 鈥� most of them deputed from rural areas.
Thana health and family planning officer of the health complex Gazi Ahmad Hasan said that they had only emergency and outdoor聽 services -- no indoor facilities.
According to health sector experts, upazila hospitals across rural Bangladesh remain highly neglected, where village people initially go for treatment.
Bangladesh鈥檚 healthcare delivery system is centralised in Dhaka, increasing treatment costs for customers, they said.
Rural people, they said, have to struggle more for getting primary healthcare as doctors are unwilling to stay in rural area in order to grab other opportunities, including private practice, education for themselves or their children, and to maintain a more enjoyable lifestyle.
Md Arifur Rahman, attendant and younger brother of Md Ashrafur Rahman, a dengue patient under treatment at the Dhaka Medical College Hospital, said that they came from Barguna to take dengue treatment.
He said that they had to fight to access doctors and a bed at the Barguna 250-bed General Hospital. After three days of staying there his brother was transferred to Dhaka.
Public health expert Abu Jamil Faisel said that he could not accept that a district hospital should be unable to treat a dengue patient.
Abdul Halim, 50, owner of a medicine shop in Rangpur, said that he had suffered a heart attack in his hometown Badarganj in the past month. He was rushed to the Rangpur medical College Hospital immediately.
Though doctors of the hospital provided him first-aid treatment, they finally referred him to Dhaka for further treatment.
He said that he later moved to Dhaka for necessary diagnostic tests and surgery though he wanted to avail the treatment in his home district -- Rangpur.
鈥楴early half of my treatment cost went in travel and accommodation expenses. I still have to come to Dhaka from Rangpur for follow-up visits,鈥� he said.
Not only Halim or Ashrafur, everyday several hundred people travel to Dhaka from different districts and divisional cities for healthcare as the government could not ensure quality healthcare services in rural areas.
The 50-bed Charghat Upazila Health Complex is running with vacancies for 15 doctors and 51 staffers while the Chapainawabganj 250-bed Adhunik Hospital is operating with vacancies for 22 doctor, 38 nurses and 58 staff.
Dhaka University Institute of Health Economics professor Syed Abdul Hamid observed that the crisis of doctors was still prevailing everywhere but it was more acute in villages.
鈥榃e have had some good discussions towards the improvement of rural healthcare, but nothing happened practically,鈥� said.
Chief adviser鈥檚 special assistant for health Professor Dr Md Sayedur Rahman admitted that they had huge limitations in the health sector, especially in terms of manpower.
It was planned that 3,000 doctors would be recruited in September 2025 against a shortage of 7,000.
He further said that they would gradually create more posts and go for recruitment accordingly.
Abu Jamil Faisel said that the present government received some good proposals from the Health Sector Reform Commission but no proposal was implemented.
鈥楾he overall health sector remains as before, in some cases it became even worse,鈥� he said, adding that in some cases management deteriorated.
According to public health experts, the health sector failed to get priority also during the interim government and thus there was no significant improvement in the overall healthcare system, particularly in the country鈥檚 rural areas.
