Sources in the health sector have said that health services in rural areas are suffering as doctors prefer to work in Dhaka.
Despite Prime Minister Sheikh Hasina and the Ministry of Health having repeatedly called for doctors to change their mentality and work in rural areas, the problem seems to only be growing.
According to a recent Bangladesh Demographic Health Survey, the vast majority of MBBS doctors work in urban areas as opposed to rural localities, with as many as 74% in the former.
Major reasons for prioritising Dhaka
Fahmida, an intern at DMCH, said problems faced by her older brother while he was working in rural areas had convinced her not to follow a similar career path.
Dr Mahmud, her brother, was posted to a union health complex in a remote area of Jhenaidah, where he is the only physician.
He successfully completed the Fellow of the College of Physicians and Surgeons (FCPS) part 1 course. However, he failed to continue his training as he had no scope to do so in the district.
“My brother has been working there (Jhenidah) for more than three years, while his classmates are receiving their training on the FCPS part 2 course in Dhaka,” Fahmida said.
“He could not join the training owing to his posting. So, I do not want to risk my career and higher studies by working in rural areas,” she added.
Many a doctor working both inside and outside Dhaka said they prefer to serve in the capital as there are better opportunities for career development, higher studies and training. However, a significant number also highlighted the abundant chances to make extra earnings by working in private clinics or private practice in addition to their government job in Dhaka.
A professor at Dhaka Medical College and Hospital (DMCH), asking to remain anonymous, said: “If one works in a rural area leaving behind one's family in Dhaka, it becomes an uphill task for the person to financially support two households at the same time.”
He added that such hardship was in stark contrast to the opportunities on offer in the capital, where a large number of private hospitals give ample chances for additional income through private practice. Rural areas do not boast as many private hospitals as the people there are not as financially solvent.
Furthermore, many doctors with children said they considered living in rural and remote areas a major hindrance to providing a good education to their sons and daughters.
Meanwhile, local sources said many specialist doctors working in Dhaka and other major cities attend patients at nearby upazilas on the weekends.
DMCH Director Brig Gen Mohammad Mizanur Rahman said: “Not all doctors just stay in the capital. Some doctors do charitable services by tending to patients in need, which is well appreciated as the rural people get improved health services.”
How to address the issue
Experts and physicians say medical students need to change their mindset from the very beginning of their study, and have the courage to treat people even outside Dhaka, and learn how to adjust to the rural level.
Public health specialist and Gonoshasthaya Kendra founder Dr Zafrullah Chowdhury said: “Many doctors do not want to go to villages from the onset of their student life. Their teachers at medical colleges and universities must take the matter into account seriously, asking their students to focus on the healthcare of the vast population of rural Bangladesh.”
He suggested that the government make it mandatory for fresh medical graduates to do their internship in rural areas to help reduce the pressure on public hospitals, mainly in Dhaka.
“90% medical cases in the country can be taken care of at the upazila health complexes outside Dhaka, if the doctors work in rural areas properly and the government gives the highest priority to the matter,” he said.
He added that Patients should only be referred to Dhaka if they were suffering from complicated medical conditions or if they needed specialised treatment.
The public health specialist also emphasised on the need for infrastructural development at rural localities.
When contacted, a professor of National Institute of Cancer Research and Hospital, preferring not to be named, said blaming the doctors will not help fix the problem.
“The government must find out the reasons behind the lack of interest among doctors about working in rural areas and then take proper measures to bring an end to the issue,” he opined.
Dr Chowdhury feared that quality treatment in rural areas will become a rarity if the trend of doctors preferring Dhaka continues.
“If the government does not employ them in Dhaka or other cities, a number of doctors will have no choice but to work in villages and upazilas,” he suggested, demanding that government doctors be disallowed from working in private practice at the same time.
“Quality of health service will not improve otherwise,” he said.