Plan to cut doctors at DMCH's Shishu Bikash Kendra may hurt special-need children’s treatment
However, treatment for special-needs children like Usaid is now at risk, as the government plans to remove doctors from all 35 Shishu Bikash Kendras
Since he was 15 days old, 1-year-6-month-old Usaid Abdullah, who has Down syndrome, has been receiving treatment at the Shishu Bikash Kendra of Dhaka Medical College Hospital (DMCH). His father, Hafiz Omar Farooq, said he is happy with the regular check-ups for his son at the centre for only Tk10 per visit.
However, treatment for special-needs children like Usaid is now at risk, as the government plans to remove doctors from all 35 Shishu Bikash Kendras.
The project, launched in 2008 during the former caretaker government, provides physical and mental healthcare for children with special needs.
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According to the Directorate General of Health Services (DGHS), the centres operate under the 'Hospital Services Management' plan, part of the Health, Population and Nutrition Sector Development Program, across 24 medical college hospitals and 11 Sadar district hospitals.
They serve children aged 0-16 with autism, Down syndrome, neurodevelopmental disorders, cerebral palsy, ADHD, seizures and epilepsy, intellectual and learning disabilities, delayed speech, and speech difficulties.
Each centre is staffed by a paediatrician, developmental therapist, and child psychologist, operating daily from 8am to 2:30pm. More than 1,000 children receive treatment daily, and from August 2008 to last July, a total of 2,43,934 special-needs children have been treated. Patient numbers have steadily increased from 9,910 in 2008–2009 to 56,172 in 2022–2023.
Officials said that since June last year, when the 4th sector programme ended, doctors and staff at the Shishu Bikash Kendras have not been paid, yet they continued providing treatment.
To maintain essential health services, the Ministry of Health recently launched a project called "Implementation of Essential Activities of the Directorate General of Health Services, Directorate General of Drug Administration, and Community Clinic Health Assistance Trust."
However, the Ministry of Finance submitted the project proposal to the Planning Commission without including child development specialist posts, instead proposing to appoint 35 therapists and 12 child psychologists through outsourcing.
The health ministry is considering running the centres with other paediatricians, but health experts warn that without trained doctors, patients will not get proper care.
Dr Shaidur Rahman Shohag, resident physician in the Department of Paediatrics and Head of the Paediatric Outdoor Service at DMCH, said, "If doctors at the Shishu Bikash Kendra are laid off, it will create huge problems because they are specialists in this field. Developmental paediatricians assess the growth and development of special-needs children, which requires a lot of time per patient. They have been trained in this work for 13–14 years—others cannot do it.
"I see more than 50 patients a day; how can I give that much time to special-needs children? Our outpatient department serves 600–700 patients daily. There's no way to spend half an hour on a single special-needs child."
He added, "General paediatricians simply cannot give that much time to developmental cases. These patients need counselling, therapy—many things. Others just cannot provide that. You can't plant a banyan tree and expect to get mangoes.
"Patients get services at DMCH for Tk10, while similar services cost Tk5,000–6,000 at corporate centres. If the government removes doctors from here, where will poor people go? This is a very unfortunate decision."
Hafiz Omar Faruq told The Business Standard, "I've taken my child to private chambers several times, but there, doctors don't spend as much time as the doctors at the Shishu Bikash Kendra.
"Under the centre's supervision, my child has been improving day by day. If there are no doctors there, parents of special-needs children like us will face serious problems. Besides financial loss, we are also worried about not receiving proper care."
Dr Toshiba Rahman, in charge of the Shishu Bikash Kendra at DMCH, told TBS, "Special-needs children need specialist doctors. Treatment cannot be done with only psychologists or therapists and no doctors. This is an integrated treatment system, and accurate diagnosis is essential.
"At the centre, observing each child takes 30 to 45 minutes, so we cannot see more than 20 patients a day. Here, quality is more important than quantity. If we rush, diagnostic errors happen—and that harms the child."
She added, "We haven't received salaries for the past 14 months, yet we continue working. Patients have been coming to us for 15–16 years, receiving services for just Tk10. Since 2009, patients have had our phone numbers. Without doctors, can an accurate diagnosis even be possible for these children?"
Prof Dr Md Sayedur Rahman, special assistant to the chief adviser for the health ministry, said, "We are preparing Development Project Proposals (DPP) to maintain essential manpower and other resources for all critically important projects. Using only essential manpower and resources, these bridging DPPs will continue until June 2026, ensuring that only critically important staff are retained."
