With doctor shortage, rural hospitals hang patients out to dry

An ayurvedic practitioner prescribes allopathic medicines in Bhola, a Satkhira hospital remains off limits to surgery patients for years, while nurses and ward boys run the emergency unit of a Netrokona government facility. These are some of the grim pictures at government healthcare facilities in rural Bangladesh.

Currently as many as 58% of upazila hospitals do not have all the physicians they are supposed to have, while some of the health facilities have eight of the ten posts empty, according to available data from the health directorate.

With a severe doctor shortage in rural areas, the authorities say their hands are tied as they cannot provide non-Covid patients with proper medical services that were halted for about a year and a half due to the pandemic-led exhausting pressure on the healthcare system.

With a patient rush, doctor shortage now often forces hospitals to come up with desperate choices that are sheer quackery.

Take for instance the 250-bed Bhola district hospital that now has its 48 physician posts vacant. In the hospital, an ayurvedic practitioner has been tasked to tackle the patient rush at the outdoor unit. The alternative medicine doctor, who is said to have gathered medical experience from on-duty doctors, prescribes allopathic drugs for 500-700 patients per day.                  

"What better could I do?" Dr Md Serajuddin, superintendent of the hospital, replied when asked whether such "experience" is enough to treat patients.    

"We try to give our best. But the skeleton manpower regularly stretches our working hours," he told The Business Standard, adding that better medical care could have been provided if there had not been a workforce crisis.

In Satkhira's Shyamnagar upazila, only four doctors are available against 33 posts. There is no resident medical officer, junior consultant of obstetrics and gynaecology and junior consultant anesthetist; and the hospital cannot conduct any surgery either.

In Netrokona's Khaliajuri 31-bed upazila hospital, fourth class nurses and ward boys run the emergency unit as there is only one doctor against five posts.        

According to the real time health information dashboard of the health directorate, there are 10,471 physician posts at upazila health complexes across the country, with 6,130 of them now vacant. Doctor shortage at grade-9, the entry level post for doctors in government service, is the severest as more than 61% of the posts are now vacant.           

Doctor shortage more in Barishal, less in Dhaka  

In Dhaka division, the lowest 42% of physician posts are vacant while Barishal has more than 73% of the posts empty, according to the health directorate.    

In Barishal, only 147 grade-9 doctors are available against 555 posts while there are 32 junior consultants against 222 posts.

There are no physician vacancies in Gazipur, Narayanganj, Narsingdi, Nawabganj, Keraniganj and other upazila hospitals in Dhaka division.

However, some of the posts are vacant in Kishoreganj district of Dhaka division. More than 70% posts of doctors are empty in Austagram upazila health complex in Kishoreganj – a remote haor region that does not have smooth road communication.

Doctors' unwillingness the cause   

Public health experts said the doctor shortage at the upazila healthcare facilities prevails since physicians do not prefer posting at rural hospitals.

On condition of anonymity, a senior official at the health directorate said an additional number of physicians are now attached with Dhaka Medical College Hospital and Sir Salimullah Medical College Hospital.

"They are staying in the capital for various reasons, including higher education, while patients in rural areas are being deprived of services," said the health directorate official.

Dr Md Selim Miah, civil surgeon at Netrokona district, said his colleagues do not want to live in the haor region due to the poor road communication.

"If someone is posted here, he or she starts lobbying for a transfer within a few days of joining. We are trying to minimise the shortage by outsourcing the manpower," he added.

A lack of policy support responsible too  

There has been a study by James P Grant School of Public Health at Brac University to investigate the reasons why physicians do not want to stay in the districts, upazilas and rural areas.

The study, "Retaining Doctors in Rural Bangladesh: A Policy Analysis", said doctors do not want to be in rural areas thanks to their recruitment in obscure areas, late promotions and lack of higher education scope in districts.

Female physicians usually do not want to stay in villages away from the family. Additionally, there have been no clear instructions about how many years a doctor will have to be in rural hospitals, the study noted as the reasons.  

Dr Khalequzzaman, associate professor at the public health and informatics department at Bangabandhu Sheikh Mujib Medical University, said there should be policy support for doctors serving at rural hospitals.

Dr Khalequzzaman told TBS that there also should be clear instructions that a physician would be allowed to come to the cities for higher education after serving at rural hospitals for two years.

"The doctors at the upazila hospitals should be provided with basic needs such as enough supporting staff, logistical support, lucrative accommodation and office setting. Then doctors will be interested to work at the rural hospitals," he added.

DG health on field visits to ease up the crisis.  

As Covid-19 infections slow down in the country, health directorate Director General Prof Abul Bashar Mohammed Khurshid Alam has been visiting rural hospitals to address the issue of doctor shortage.  

"We now are listing how many doctors are actually needed at the hospitals and there will be recruitments to them accordingly," he told TBS.   

"We are working to appoint consultants and necessary doctors in every hospital. Besides, the 4,000 physicians who were recruited to tackle the pandemic-led health situation will be utilised to ease the crisis," noted Prof Khurshid Alam.