Public Sector Health Servicesin Bangladesh

20 May 2016

Public Sector Health ServicesMainly Ministry of Health and Family Welfare (MOHFW) along with two others Ministries

• Urban Primary Health Care is the responsibilities of respective Local Government Institutions, like City Corporations and Municipalities, which are under Ministry of Local Government Rural Development and Cooperatives (MOLGRD&C)

• Health services in Chittagong Hill Tracts (3 districts) are under respective Hill District Councils, which are under Ministry of Chittagong Hill Tracts Affairs (MOCHTA)

Public Sector Health ServicesHowever all most all government ministries/ departments have some types of health services delivery:

• Combined Military Hospitals (under Ministry of Defense)• Border Guard Bangladesh (BGB) Hospitals, Police Hospitals,

Jail Hospitals, Central Drug Addiction Treatment Hospital (under Ministry of Home)

• Railway Hospitals and Health Centers (under Ministry of Railway)

• Sarkari Karmachari (Government Employees) Hospital under Ministry of Public Administration

• Labour Hospitals and Health Centers (under Ministry of Lobour and Employment)

Public Sector Health Services

Ministry of Health and Family Welfare (MOHFW) has two departments

Directorate General of Health Services (DGHS)

Directorate General of Family Planning (DGFP)

Both Health and Family Planning have field-based and facility based services

Public Sector Health Services Field-based services in rural areas• Health• 26, 482 domiciliary workers• Health Assistant (HA): 1 for every 5-6,000 rural

population (? Old 3 Ward); Male/Female; HSC pass (now); 20,881 posts; 16,690 filled-in (2013); Class III; Health promotion and Public Health Activities; EPI

• Assistant Health Inspector (AHI): promoted from HA and supervise HA ( 1 per ?5 HA); 4,202 posts; 4,042 filled-in (2013)

Field based Health services• Health Inspector (HI): promoted from AHI

and supervise AHI (1 for ? 3 AHI); 1,399 posts, 1,313 filled-in (2013)

================================• Sanitary Inspector (SI): looks after food

safety; Trained for 3 years in Institute of Health Technology after selection from HA/AHI/HI; 1 per upazila; 491 posts; 436 filled-in (2013)

Public Sector Health Services in Bangladesh

Field-based services in rural areas Family Planning

Family Welfare Assistant (FWA) for 6,000 population; Female, FP promotion, contraceptive distribution & referral; Posts: 23,500; 21,113 filled-in (in 2013)

Family Planning Inspector (FPI) supervises FWA; one in each union; Male; Posts: 4,500; 3,549 filled-in (in 2013)Satellite Clinics conducts by Family Welfare Visitor (FWV); 30,000 per months

Public Sector Health Services

• Facility-based services in rural areas• Village level

Community Clinic for 6,000 population; 18,500 required; 13,500 planned; 12,584 functioning Staff: Community Health Care Provider (CHCP)plusHA

FWA

Public Sector Health Services in Bangladesh contd.

• Union level• Health: Rural Dispensary (RD)/

Union Sub Center (USC); 1,362Posts: Medical Officer (MO), Medical Assistant (MA/SACMO), Pharmacist, Peon;Provides Out Patient ServicesAlso 3,176 posts of Assistant Surgeons and MA at union level

Public Sector Health Services in Bangladesh contd.

• Union level• Family Planning: Health and Family Welfare

Center (H&FWC); 3,622 (upgraded 1,500); Posts: Sub-Assistant Community Medical Officer (SACMO/MA), Family Welfare Visitor (FWV), Pharmacist, Aya, Guard; Provides Out Patient Services; 250 posts of MO (Family Welfare); Non H&FWC: FWV and Aya; Mother and Child Welfare Center: 23

Public Sector Health Services in Bangladesh contd.

Health10 bed Rural Health Center: 13; Posts: MO-2, Senior Staff Nurse-2, Nursing Attendants-4, Laboratory Technician-1, Pharmacist-1, Ward Boy -2 etc.; provides outdoor and indoor services

20 bed hospital: 18; Posts: RMO-1, MO-4, Senior Staff Nurse-4, Laboratory Technician-2, Pharmacist-2, Ward Boy -2, Aya-2 etc.; provides outdoor and indoor services

Public Sector Health Services in Bangladesh contd.

• Health• Upazila Health Complex: Hospital plus controls

field services; 425 Upazila Health Complex 50 bed: 268 31 bed: 146 10 bed: 11

• 11 Hospitals at Upazila level other than UHC 31 bed Hospital: 5 30 bed Hospital: 1 20 bed Trauma Centre: 5

Upazila Health Complex• Provides outdoor, indoor and emergency services•  31 bed: 4 Consultants in Medicine, Surgery,

Gynaecology/Obstetrics & Anaesthesiology•  50 bed: 10 Consultant; additional for Eye, ENT,

Cardiology, Paediatrics, Orthopaedics. Skin/VD• 31 bed: 9 doctors: UHFPO, RMO, DS, 4 consultants,

2 MO (implications of HPNSDP)•  5 Sweepers, 3 Ward Boy, 2 Aya• Comprehensive Emergency Obstetrical Care (CEmOC):

132 (2011) reduced to 85 (2012); 75 (2013)

Public Sector Health Services

• Family Planning – UpazilaMaternal and Child Health Unit (not in all UZHC)Medical Officer – Maternal, Child Health/Family Planning (MCH-FP)

Maternal and Child Welfare Center (MCWC): 12

Public Sector Health Services

Health District Hospitals: 53General Hospitals: 21100, 150, 200, 250, 278, 300 BedsSome districts (Narayanganj and Narsingdi)

have 2 hospitalsDhaka, Mymensingh, Rajshahi, Dinajpur

have no district hospital

Public Sector Health Services

• HealthSchool Health Clinics – 23Chest Clinics – 43Chest Hospitals -12 [20 bed: 7, 60 bed: 1,

100 bed: 2, 150 bed: 1, 250 bed:1]Leprosy Hospitals – 3 [ 20,30,80 bed]Infectious diseases Hospitals – 5 [ 20 bed:4,

100 bed:1]

Public Sector Health Services

• Family PlanningMother and Child Welfare Center (MCWC):

60 at district level except Dhaka, Chittagong, Gazipur and Shariatpur

Provides outdoor and indoor and emergency obstetrical services

MO (Clinic) in-chargeSadar MO (MCH-FP)

Public Sector Health Services Health: Medical College Hospitals:

Dhaka Medical College Hospital – 2400 bed, Mitford Hospital – 600 bed, Shahid Sharwardi Medical College Hospital – 720, Faridpur Medical College Hospital – 500 bed, Mymensingh Medical College Hospital – 1000 bed, Chittagong Medical College Hospital – 1313 bed, Comilla Medical College Hospital – 500 bed, Bogura Medical College Hospital – 500 bed, Dinajpur Medical College Hospital – 500 bed, Rajshahi Medical College Hospital – 530 bed, Rangpur Medical College Hospital - 1000 bed, Khulna Medical College Hospital – 500 bed, Sher-e-Bangla MC Hospital, Barisal – 500 bed, MAG Osmani MC Hospital, Sylhet – 900 bed

Public Sector Health Services • Health: Specialized Hospitals: • National Institute of Chest Diseases and Hospital (NIDCH), Dhaka – 670

bed• National Institute of Traumatology & Research (NITOR), Dhaka – 500 bed• National Asthma Center, Mohakhali, Dhaka – 100 bed• National Center for Rheumatic Fever & Heart Diseases, Dhaka – NO bed• National Institute of Cancer Research & Hospital(NICH&R),Dhaka -150

bed• National Institute of Cardiovascular Diseases (NICVD), Dhaka – 414 bed• National Institute of Kidney Diseases & Urology(NIKD&U), Dhaka-150 bed• National Institute of Mental Health (NIMH), Dhaka – 200 bed• National Institute of Opthalmology & Hospital (NIO&H), Dhaka – 200 bed• National Institute of Mental Health, Pabna – 500 bed

Public Sector Health Services

• Family Planning

• Azimpur Maternity and Child Health Training Center, Dhaka

• Mohammadpur Fertility Services and Training Center, Dhaka

Urban Primary Health Care

• Urban Primary Health Care Projects since 1998 through contracted NGOs for different areas

Primary Health Care Centers (PHCC) with Satellite Clinics

Comprehensive Reproductive Health Care Centers (CRHCC)

Urban Primary Health Care• Current phase for 2012-2017 covers 10 city corporations

(Dhaka North and South, Rajshahi, Khulna, Barisal, Sylhet, Rangpur, Narayanganj, Comilla and Gazipur) and 4 municipalities (Sirajganj, Gopalganj, Kushtia and Kishoraganj) through 24 areas

• During the first phase of 1998-2005, the then four city corporations (Dhaka, Chittagong, Rajshahi and Khulna) were served through 16 areas.

• In second phase during 2005-2012 six city corporations (Dhaka, Chittagong, Rajshahi, Khulna, Barisal and Sylhet) and five municipalities (Bogura, Sirajganj, Comilla, Savar and Madobdi) were covered through 24 areas.

Dhaka City Corporation

• Dhaka Mohanagar General Hospital – 50 beds

• Dhaka Mohanagar Shishu Hospital – 100 beds

• Nazira Bazar Maternity – 31 beds• Dispensaries - 8

Chittagong City Corporation

• Memon-1 100 beds• Memon-2 45 beds• Bandortila Maternity 32 beds• South Bakolia Maternity 18 beds• East Bakolia Maternity 30 beds• Dispensaries - 20

Other City Corporations

• Khulna : Lal Hospital, Taltola Hospital – only outdoor

• Rajshahi: City Hospital – 20 beds• Sylhet: Dispensary - 1

CHT Health by HDCs

• Community Health Services Workers (CHSWs)/Community Skilled Birth Attendants

• Mobile Medical Team – Doctor, Nurse, Pharmacist, Laboratory Technician to conduct satellite clinics

• 15 upazilas (out of 25 upazilas)• Supported by UNDP

CHT

DGHS and DGFP’s usual field and facility based services continued with limitations

• Availability• AccessibilityPhysicalNon-discrimination InformationEconomic• Acceptability• Quality