Bangladesh - Health Care Facilities

The Ministry of Health and Family Planning was responsible for developing, coordinating, and implementing the national health and mother-and-child health care programs. Population control also was within the purview of the ministry. The government's policy objectives in the health care sector were to provide a minimum level of health care services for all, primarily through the construction of health facilities in rural areas and the training of health care workers. The strategy of universal health care by the year 2000 had become accepted, and government efforts toward infrastructure development included the widespread construction of rural hospitals, dispensaries, and clinics for outpatient care. Program implementation, however, was limited by severe financial constraints, insufficient program management and supervision, personnel shortages, inadequate staff performance, and insufficient numbers of buildings, equipment, and supplies.
In the late 1980s, government health care facilities in rural areas consisted of subdistrict health centers, union-level health and family welfare centers, and rural dispensaries. A subdistrict health center in the mid-1980s typically had a thirty-one-bed hospital, an outpatient service, and a home-service unit staffed with field workers. Some of the services, however, were largely nonoperative because of staffing problems and a lack of support services. Health services in urban areas also were inadequate, and their coverage seemed to be deteriorating. In many urban areas, nongovernment organizations provide the bulk of urban health care services. Programming and priorities of the nongovernment organizations were at best loosely coordinated.
A union-level health and family welfare center provided the first contact between the people and the health care system and was the nucleus of primary health care delivery. As of 1985 there were 341 functional subdistrict health centers, 1,275 rural dispensaries (to be converted to union-level health and family welfare centers), and 1,054 union-level health and family welfare centers. The total number of hospital beds at the subdistrict level and below was 8,100.
District hospitals and some infectious-disease and specialized hospitals constituted the second level of referral for health care. In the mid-1980s, there were 14 general hospitals (with capacities ranging from 100 to 150 beds), 43 general district hospitals (50 beds each), 12 tuberculosis hospitals (20 to 120 beds each), and 1 mental hospital (400 beds). Besides these, there were thirty-eight urban outpatient clinics, forty-four tuberculosis clinics, and twenty-three school health clinics. Ten medical college hospitals and eight postgraduate specialized institutes with attached hospitals constituted the third level of health care.
In the mid-1980s, of the country's 21,637 hospital beds, about 85 percent belonged to the government health services. There was only about one hospital bed for every 3,600 people. In spite of government plans, the gap between rural and urban areas in the availability of medical facilities and personnel remained wide. During the monsoon season and other recurrent natural disasters, the already meager services for the rural population were severely disrupted.