MDG Millennium Development Goal M&E Monitoring and Evaluation MIS Management Information System MOHFW Ministry of Health and Family Welfare MOLGRD Ministry of Local Government, Rural Development and Cooperatives MSA Management Support Agency MTBF Medium-Term Budget Framework MTR Mid-Term Review NASP National AIDS/STD Programme NCD Non-Communicable Disease NEMEW National Electro-Medical Equipment Workshop NGO Non-Governmental Organisation NIPORT National Institute of Population Research and Training NIPSOM National Institute of Preventive and Social Medicine NNP National Nutrition Project/Programme NSAPR National Strategy for Accelerated Poverty Reduction NTCP National Tuberculosis Control Programme PCB Pharmacy Council of Bangladesh PIP Programme Implementation Plan PLMC Procurement and Logistic Monitoring Cell PNC Postnatal Care PWD Public Works Department SMC Social Marketing Company STD Sexually Transmitted Disease SWAp Sector-Wide Approach Sida Swedish International Development Cooperation Agency TB Tuberculosis Tk Taka UHC Upazila Health Complex UHFWC Union Health and Family Welfare Centre UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund UPHCP Urban Primary Health Care Project USAID United States Agency for International Development WHO World Health Organization Executive summary Introduction This Health Sector Profile is a description of the health sector in Bangladesh—including its structure, resources, services, performance and dynamics. This document provides an overview of the sector, based on publicly available reports and data. The document intends to help the Ministry of Health and Family Welfare (MOHFW) and its partners to agree on the way forward and its respective roles in the process. It is neither an evaluation nor a
Table 4.1 Summary of range of facility-based health services by referral level Level of care Geographic level facility Beds Number of facilities (current and proposed) Population served Services offered In-patient/out-patient Tertiary referral Division and districts Urban Teaching hospital/ institute 250–1050 17 govt. medical college hospitals 1 armed forces medical college hospital (Ministry of Defence) 41 private medical college hospitals 10 million Consultant level curative incl. surgery Speciality hospital/ institute Consultant level curative incl. surgery Second referral District Not in Dhaka District hospital 100–250 60a 2.3 million Consultant level curative incl. surgery District, upazila, union Mother & Child Welfare Centre (MCWC) 10–20 98 proposed (70 built: 63 at district, 5 at upazila, 2 at union level) 2.3 million Comprehensive obstetric care Clinical contraception First referral Upazila Rural only Upazila health complex (UHC) 31- 50 413a 270,000 Essential service delivery Treatment of general diseases Basic lab services and x-ray Normal deliveries only Union Rural Health Rural Dispensary (HC) Out-patient 1,134 (estimated)a 30,000 Treatment of minor illness Basic child health care Rural Union Health & Family Welfare Centre (UHFWC) Out-patient 2,430 (estimated)b Family planning Basic child and maternal care Menstrual regulation Treatment of minor illness Community level Ward (13,494 approx) Community clinics Out-patient 10,775 proposed (8,000 built) 6,000 Essential service delivery Preventive, promotion, and limited curative Family Welfare Centre (FWC) Domiciliary care 23,000 7,000 Family planning Basic child and maternal care Menstrual regulation Source: MOHFW; a from Tulane University Associates 2010; b DGFP website estimate is 3,500.
Table 4.2 Summary of staff mix for public sector health services at upazila level and below Facility Staff—health Staff—family planning Upazila health complex Upazila health and family planning officer, head of UHC 1 Upazila family planning officer Assistant upazila family planning officer 1 1 Junior consultant gynaecology Junior consultant surgery Junior consultant medicine Junior consultant anaesthetics Residential medical officer General medical officers Dental surgeon 1 1 1 1 1 1 1 Clinical service: Medical officer MCH officer Family welfare visitor 1 1 1 Nursing supervisor Senior staff nurse Assistant nurse Nurse aide 1 9 1 1 Pharmacist Lab technician Dental tech Radiography technician 5 2 1 1 Sanitary inspector EPI technician Statistician Store keeper Health inspector TB/leprosy control assistant Med technician EPI 1 1 1 1 1 1 1 1 Health inspectors Junior mechanics Others: Driver Cook Aya, ward boys, gardener, mali Security guards Cleaners 1 2 Vary 2 5 Health Sub-centre/Rural Dispensary (except where UHCs exist) Medical assistant Pharmacist Health assistant Health inspector 1 2 1 1 Union Health and Family Welfare Centre (UHFWC) (except where UHCs exist) Sub-assistant community medical officer Family welfare visitor Family planning inspector (supervising family welfare assistants) Pharmacist MLSS 1 1 1 1 Community clinics Health assistant (3 days) 1 Family welfare assistant (3 days) 1 4.3.2 Hospital services The public sector has nearly 36,000 beds in a range of hospitals—district, speciality, and teaching or medical college hospitals (table 4.3). Hospital operations are provided under the aegis of the Directorate of Health Services.