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4. HEALTH RESOURCES
4.1 Human resources
for health
Significant changes in human resources for health have
taken place in recent years leading to overall improvement in the coverage of
health services. These include production and deployment of more health and
health-related personnel, refresher training for health personnel in service,
and greater use of health volunteers. In 1997, the distribution of physician
per 10,000 populations was 2.03, which has increased to 3.0 in 2005, whereas
nurses available per 10,000 populations were only 1.4 in 2004 [Management
Information System (MIS), Directorate General of Health Services (DGHS), Bangladesh].
Actions are being taken, which include the establishment of a permanent
health institute, formulation of a human resource development plan, and
enhancing the quality of medical education.
Related Links Director General of Health Service Human Resources – WHO/HQ
4.2 Financial
resources for health
In 1993-94, the national health expenditure by both public
and private sectors amounted to 3.04 percent of the GNP. It has increased to
3.4 percent in 2003. Public expenditure on health as percentage of total
expenditure on health was 36.5 percent in 1998, which has declined to 25.2
percent in 2002. Government health expenditure as percentage of the total
government expenditure was 6.9 percent in 1998 but it has also declined to
4.4 percent in 2002 (World Health Report 2005). In 1998, the total government
health expenditure per capita was US $ 4, which has increased to US $ 11 in
2002. Constraints of mobilizing
financial resources for health and their efficient use are the inability of
communities to finance health services due to poverty, unwillingness of
donors to support infrastructure development, and lack of coordination in
financial mobilization. The government now gives priority to cost sharing,
decentralization of authority, decision making and programme
implementation at the peripheral level, promotion of community participation,
delivery of a package of essential services to the poor, and mobilization of
financial resources by negotiating with donors such as the World Bank.
Related Links Director general of Health Service
4.3 Physical
infrastructure for health
Since the mid 1980s the government has sought to improve
its health services and teaching institutions. The explicit goal was to build
one Union Sub centre (USC) or
Health and Family Welfare Centre (HFWC) in every union (4415); one health
complex in every thana (397); and one general
hospital or tertiary facility in every district (59). As of 1996, there were
4200 USCs/IFWCs, 379 health complexes and 59
district hospitals. By 1999, there were 460 Thana health complexes, 1362 Union Sub-Centers and 3315 Community
Clinics; there were also 15 government medical colleges and 7
postgraduate/specialized hospitals. There are another 33 private medical and
dental colleges. The total number of hospital beds was 43,293 (1999), which
has increased to 51, 684 in 2005. In 2005, 3.43 beds per 10,000 populations
were available (MIS, DGHS, Bangladesh). To overcome many of the local constraints
in the construction and maintenance of health facilities, the government is
considering introduction of a more need-based health planning process that
will involve all stakeholders and the community.
Related Links Director general of Health Service
4.4 Essential drugs
and other supplies
As early as the 1980s, Bangladesh had a national
essential drugs policy and a list of essential drugs to be procured and used
in health services. These have been maintained to date. Most of the essential
drugs were known by their generic name and were less costly than brand name
drugs. Production and distribution facilities, both in the private sector and
public limited companies, are adequate. Despite these advantages, government
run health facilities did not have sufficient essential drugs to meet their actual
needs, since the budgetary allocation for the procurement of drugs was not
enough. In 1997, a sample of health facilities in remote areas revealed that
only eight percent of essential drugs needed at those levels were available.
Over the period 1990-95, however, the investment (public and private) in
essential drugs, vaccines and ORS increased from 4.31 million to 75.29
million taka.
The government also launched an education programme for providers and users on the rational use of
drugs. The government is considering implementation of a new cost sharing
scheme based on a sliding scale, which would benefit the poor.
Related Links Directorate
of Drug Administration EDM
- WHO/SEARO WHO/HQ WHO/Bangladesh
4.5 International
partnership for health
Bangladesh
willingly shares experiences and expertise with other countries, particularly
in training, research and disease surveillance. WHO has played a major role
in gradually building up the national capacity through regional collaboration. SAARC is another forum used to address
regional issues including health. Partnership arrangements for health have
been established with bilateral agencies, with funds usually channeled
through non-governmental organizations. An NGO bureau regulates and monitors
the funding. There is a need to further strengthen coordination between NGOs
and government activities/programmes.
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