Powerful rackets control private ambulance services at major hospitals across the country, holding patients and their families hostage to extort exorbitant fares in the absence of government oversight.
Insiders in the sector and a number of victims said that the syndicates composed of ambulance owners, hospital staff and local political leaders dominate the ambulance business.
Patients in need of urgent transport are forced to pay inflated fares, often double or triple the regular rate.
Ambulance owners鈥� association leaders said that more than 6,000 privately owned ambulances were now operating across the country.
According to the latest available data from the Directorate General of Health Services, 118 ambulances are now in service in government hospitals across the country, and a request for another 100 has been made to the authorities concerned.
Professor Syed Abdul Hamid of the Institute of Health Economics at the University of Dhaka said that the ambulance was an unavoidable part of healthcare and was as important as treatment.
Availability and affordability of ambulance is very important for healthcare. But the authorities have no attention to make it patient-friendly, he said.
Patients and their relatives said that the ambulance business had turned into a tightly controlled monopoly, leaving them no choice but to comply with the syndicate鈥檚 system.
At government hospitals, ambulance operators form informal 鈥榗ommittees鈥� that control who can pick up patients.
These groups maintain a strict 鈥榮erial鈥� system 鈥斅� meaning only the next ambulance on their list is allowed to take a patient. No other vehicle, even if available or cheaper, is permitted to operate, regardless of whether the patient is critically ill or dead.
Such strong syndicates were found at almost all the public hospitals, including the National Institute of Neurosciences and Hospital, Dhaka Medical College Hospital, National Institute of Traumatology and Orthopaedic Rehabilitation, National Institute of Cardiovascular Diseases, Shaheed Suhrawardy Medical College and Hospital, National Institute of Diseases of the Chest and Hospital, and Sir Salimullah Medical College Mitford Hospital.
鈥榊ou can bring a patient to any hospital,鈥� said Khondoker Md Shakur, who has been in the ambulance business for over two decades. 鈥楤ut when it comes to the question of taking a patient home after treatment or transporting a body from the hospital, only syndicate members are allowed to do that.鈥�
He added that the syndicates charge patients exorbitant fares but pay the ambulance owners a fraction of the amount, keeping the rest as profit through their control over hospital premises.
On August 14, a newborn died after the ambulance carrying him was blocked for one and a half hours by a local ambulance syndicate in Shariatpur, as the baby鈥檚 father had hired an ambulance for Tk 5,000 on its return trip to Dhaka, while local drivers demanded Tk 10,000.
Local ambulance drivers, including Abu Taher who is also a driver at the Shariatpur civil surgeon鈥檚 office, refused to allow any ambulance other than theirs to operate.
Several ambulance drivers from the districts said that they experienced the same when they came to Dhaka.
They said that they, on their return trip from Dhaka, even agreed to give a 50 per cent discount for the patients, but they cannot do it because of the syndicates in Dhaka.
鈥業 have to wait far away from the hospital with my ambulance. Syndicates fix the fare in my absence and they take an additional amount in advance from me to give me a patient. The patients, however, have to pay as per the syndicate鈥檚 rates,鈥� said Sazib Miah, an ambulance driver living in Tangail.
Dhaka Metropolitan Ambulance Owners Association founding secretary Md Liton Khan said that although their association had been trying to curb the influence of ambulance syndicates, the organisation had no legal authority to enforce any action.
鈥楾he people running these syndicates are not genuine ambulance entrepreneurs,鈥� Liton said.
鈥楳ost of them are hospital staff and their relatives. These hospital-based groups use substandard vehicles and operate entirely outside our association鈥檚 oversight,鈥� he added.
Md Rabiul Islam, brother-in-law of Abdul Jalil who died at the Neuroscience Hospital in Dhaka a few weeks ago, said that some hospital staff and ambulance drivers seized all the documents of Jalil immediately after his death.
聽鈥業 had no scope to bargain with anyone,鈥� he said, and added that he later could negotiate and set Tk 11,000 to bring the body back to Rangpur.
Several ambulance owners said that they were compelled to include the hospital staff only to get the documents of the patients from the hospitals.
They also said that they had to pay local political leaders to park their vehicles on the streets and hospital premises and to avoid other troubles.
Ambulance owners at Neuroscience Hospital said that they had to pay Tk 3,000 per month for each of the ambulances to local political leaders for parking. Around 70 ambulances owned by around 20 people operate from Neuroscience Hospital.
The syndicates maintain the entire liaison and raise voices together to protect their benefits.
Health rights activists said that although the ambulance drivers were charging higher amounts, their services were far below the standard.
Professor Hamid said that an ambulance was not merely a vehicle but an essential part of emergency treatment.
But, he said, there was no government body to regulate it.
Anybody can modify any vehicle to make it an ambulance, but they do not install lifesaving tools with the ambulance service.
鈥楢ny vehicle without having ambulatory services cannot be called an ambulance,鈥� he added.
DGHS director Abu Hussain Md Moinul Ahsan said that ambulances were operated by taking licenses from the Bangladesh Road Transport Authority and the health department had nothing to do with the issue.
鈥榃e have drafted a policy to monitor ambulances. But the government is yet to finalise the policy,鈥� he said.
Special assistant to the chief advisor Professor Sayedur Rahman recently said that the government was planning to expand and streamline ambulance services across the country.
According to the officials, around 50 ambulances operate from Mitford hospital premises and all of them are owned by over a dozen hospital staff and their relatives. They do business only with the patients at the hospital.
Hamid suggested that the government should form a strong regulatory body to set the standard, service pattern and fare and to monitor the issues round the clock.
