According to DGHS data, among the 26,438 posts sanctioned for the directorate countrywide, 20.4% (5,380) are currently vacant
Despite a shortage of government appointed physicians in rural, and remote areas of Bangladesh, Dhaka alone has 2,514 more doctors than the total number of posts sanctioned for the division under the Directorate General of Health Services (DGHS).
According to DGHS data, among the 26,438 posts sanctioned for the directorate countrywide, 20.4% (5,380) are currently vacant.
Dr Iqbal Anwar, scientist and coordinator of the Strengthening Health, Applying Research Evidence (SHARE) project under the Universal Health Coverage Programme of icddr,b, revealed the data on Saturday, while speaking at the fourth edition of the Health Policy Dialogue (HPD), at CIRDAP in Dhaka.
“4,749 ninth grade doctors are posted as attachment [officer on special duties] in Dhaka division, against 643 sanctioned posts,” Iqbal said, adding that this had resulted in a severe shortage of doctors in the "district level, and below.”
According to his presentation on the current situation of Bangladesh's health workforce distribution, all divisions except Dhaka have at least 40% vacant posts.
Government appointed healthcare professionals in rural areas have long been accused of being absent from their workplaces, and the DGHS chief has repeatedly said that they are trying to encourage doctors to fulfill their duties in their respective areas.
DGHS Director General Dr Abul Kalam Azad said physicians prefer not to be posted in remote locations as there is little scope of profiting from private practice in such areas.
However, he added they are making it mandatory for the assigned physicians to be present at the hospitals during work hours. "Yet, a good number of physicians want to move to Dhaka, and this mentality needs to be changed."
Prime Minister Sheikh Hasina, and the Ministry of Health and Family Welfare (MoHFW) have also repeatedly called for doctors to work in rural areas, but the problem seems only to be growing.
Previously in May, Health Minister Zahid Maleque said the government will not allow or accept any lobbying from doctors or nurses wishing to be transferred to Dhaka from other parts of the country.
"Doctors and nurses, who are posted outside of the capital, lobby hard to be transferred to Dhaka by making various excuses. As a result, hospitals outside of Dhaka have an acute crisis of physicians, and this is not at all acceptable," the minister had said, adding that people living in rural areas also have the right to proper health care.
Dr Iqbal presented several setbacks of the existing health workforce distribution system, which includes: an overly centralized health system; weak governance and regulatory framework; weak management and institutional capacity of MoHFW; inequitable allocation of doctors; high vacancy rates in the upazila level; high number of deputation postings; and inadequate amenities, and lack of proper educational facilities for children of the health professionals posted in rural areas.
Discussants at the event stressed on the importance of immediate coordinated efforts from multiple stakeholders to eliminate the existing setbacks, and strengthen the present health system.
DG Abul Kalam Azad further said: “We have made significant progress, and now have the data to identify shortcomings in the system. However, we need better coordination among stakeholders, and a united approach to address these.”
In the closing remarks, chairperson of the dialogue, and former DGHS Director General, Prof Dr MA Faiz, said: “The health policy dialogue has taken into consideration the recommendations discussed, and we will share them with the relevant authorities, and policy makers to bring a positive change in the existing health system of the country.”