A Contemporary View on Health Care System in Bangladesh

CHAPTER - 1 Introduction 1. 0 origin and background of the report The report ‘‘A Contemporary view on Health Care System in Bangladesh’’ is the outcome of Internship Program which is a precondition for acquiring MBA Degree. Only curriculum activities are not enough for handling the real business environment, so it is necessary to get the better knowledge about the real scenario. The report is a requirement of the internship program for my MBA Degree. Conduction of Internship/ Dissertation started on 20th December 2009 and ended on 12th February 2010.

My internship supervisor at International Islamic University Chittagong, Dhaka Campus, Mr. R M Nasrullah Zaidi assigned me the topic of my report. The reason behind choosing this topic is getting a clear picture of the health sector of Bangladesh. Working on this topic gives me an opportunity to understand the Problem and prospect of health care system in Bangladesh. In today’s world of globalization Thiland is seeking to encourage “health tourist” to its country under the banner of ‘Thailand: Centre of Excellent Health Care of Asia’, India is building an e-health industry and Singapore is building hospitals abroad.

When scenarios are like that where the health sector of Bangladesh ? Here we try to get a idea about what is the real scenario of various related issues like access to health-relate knowledge and technology, the provision of new hospital and aliened health institution and the availability of health professionals. 1. 1 objectives of the report The objective of my study divided into two segments: 1. 1. 1 Primary Objective The primary objective of this report is to meet the requirements of the course, OCP 5900, Internship. 1. 1. 2 Secondary Objective

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The secondary objectives are: * To confer a clear picture of National health senario. * To know about list and capacity of existing Hospital & clinic * To know about manpower supply capacity and requirement * To know about Morbidity and its rate * To know about Available alternative or traditional medical care system. * To know about health education of mass people * To know about government structure- health system * To know about demographic structure of population * To know about role of different institution in respect of Health Care 1. methodology I have planned to perform the task in four stages: Step 1 Planning of the work Step 2 Data collection Step 3 Analysis and interpretation of data Step 4 Drawing conclusions and recommendations The first stage is the most important stage. I have allocated enormous time for this stage. I am emphasizing on thorough and detailed planning. Planning includes detailed methodology and scheduling of the remaining three stages. I am also emphasizing on documenting detailed planning which would serve as a guideline and performance measure for the whole report.

The second stage is the data collection stage. I have planned to collect data in three main phases. * Collect data from internet, different books and medical journals. * Conduct interviews with selected representatives from different level of health professionals. This phase actually concentrates on clarification and elaboration of data collected from the first phase. * Conduct interviews and communicate with health providers who are in the front line. This phase actually concentrates on accumulating data for the overall scenario. The third stage is the analysis and interpretation of data.

In this stage I would use some statistical and graphical analysis tools to interpret the relationship among different variables and factors. The fourth stage is the stage for drawing conclusions and prescribing recommendations. In this stage the results from the previous stage would be used to draw conclusions about different aspects of concerned matters within the organization and prescribe some recommendation for future improvement. The project is base on both primary and secondary information. Primary Source: * Informal discussion with employees of UHL. Observation while working in different desks * Interview with health care providers. Secondary Sources: * Official Web Site of UHL * Annual Reports of Ministry of Health * Various Manuals and Brochures of DG Health * Different publications of WHO. 1. 3 scope This report solely deals with the health related information of Bangladesh. Here we try to accumulate information from various topics that have role with the health system of a country. The project is based on both primary and secondary information. Health system is a very vast area to work; thousands of issues are related here.

Here we make some major segment to discuss like national health status, health care delivery system, facility based health service, leading public health problems and health education. 1. 4 limitations 1. The major limitation faced in preparing this report is the enormous number of parameters that have relationship to the health care system of a country. 2. Less availability of data at all tiers of service providing especially in the private sector. 3. Less accessibility to data due to shortage of time and proper arrangement and at the same time the authenticity of data not beyond questions. 4.

Health sector requires few specified technical knowhow for better understanding. Being a non medical background some time face some problem to understand technical terminology and frequently needed explanation and further study. CHAPTER - 2 Bangladesh: National Health Status 2. 0Location and Geography Bangladesh was emerged as an independent and sovereign country in 1971 following a nine months war of liberation. The country is one of the largest deltas of the world with a total area of 147,570 sq km. Being a low-lying country it stretches latitudinal between 20? 34' and 26? 38' north and longitudinally between 88? 01' and 92? 1' east. It is mostly surrounded by Indian Territory (West Bengal, Tripura, Assam and Meghalaya), except for a small strip in the southeast by Myanmar. Bay of Bengal lies on the south. The standard time of the country is GMT +6 hrs. 2. 1History Bangladesh has a glorious history and rich heritage. Once it was known as 'Sonar Bangla' or the 'Golden Bengal'. The territory now constituting Bangladesh was under the Muslim rule for over five and a half centuries from 1201 to 1757 AD. Subsequently, it came under the British rule following the defeat of the sovereign ruler, Nawab Sirajuddaula, at the battle of Plessey on 23 June 1757.

The British ruled over the Indian subcontinent including this land for nearly 190 years from 1757 to 1947. During that period, Bangladesh was a part of the British Indian provinces of Bengal and Assam. With the termination of British rule in August 1947, the sub-continent was partitioned into India and Pakistan. Bangladesh was a part of Pakistan and was called 'East Pakistan'. 2. 2Physiography With about half of its surface below the 10 m contour line, Bangladesh is located at the lowermost reaches of three mighty river systems -the Ganges-Padma river system, Brahmaputra-Jamuna river system and Surma-Meghna river system.

Coinciding with the division of the country based on altitude the land can be divided into three major categories of physical units: Tertiary hills, Pleistocene uplands and Recent plains (formed in recent epoch). The heavy monsoon rainfall coupled with the low altitude of major parts of the country makes floods an annual phenomenon in Bangladesh. Quaternary (began about 2 million years ago and extends to the present) sediments, deposited mainly by the Ganges, Brahmaputra (Jamuna) and Meghna rivers and their numerous distributaries, cover about three-quarters of Bangladesh.

The physiography and the drainage pattern of the vast alluvial plains in the central, northern and western regions have gone under considerable alterations in recent times. In the context of physiography, Bangladesh may be classified into three distinct regions: (a) floodplains, (b) terraces and (c) hills, each having distinguishing characteristics of its own. The physiography of the country has been divided into 24 sub-regions and 54 units. 2. 3Climate Bangladesh has a tropical monsoon-type climate, with a hot and rainy summer and a dry winter.

January is the coolest month with temperatures averaging near 260 C (780 F) and April is the warmest with temperatures from 330 to 360 C (910 to 960 F). The climate is one of the wettest in the world. Most places receive more than 1,525 mm of rain a year, and areas near the hills receive 5,080 mm). Most rains occur during the monsoon (June-September) and little in winter (November-February). Bangladesh has warm temperatures throughout the year, with relatively little variation from month to month. January tends to be the coolest month and May the warmest.

In Dhaka, the average January temperature is about 19°C (about 66°F), and the average May temperature is about 29°C (about 84°F). 2. 4Administration From the administrative point of view, Bangladesh is divided into 6 Divisions, 64 Districts, 6 City Corporations, 308 Municipalities, 482 Upazilas and 4498 Unions. The six administrative division's are namely, Dhaka, Chittagong, Rajshahi, Khulna, Barisal and Sylhet. The country is governed by the Parliamentary Democracy and it has a unitary National Parliament, nameBangladesh Jatiya Sangsad. There are 40 Ministries and 12 Divisions.

The Ministry of Health ; Family Welfare is one of largest ministries in the country. At the national level, the Ministry oHealth ; Family Welfare (MOHFW) is responsible for policy, planning and decision making atmacro level. Under MOHFW, there are four Directorates, viz. , Directorate General of HealthServices, Directorate General of Family Planning, Directorate of Nursing Services and Directorate of Drug Administration. Beside, there are a separate National Nutrition Proje(NNP)and Construction, Maintanance and Management Unit (CMMU). . 5Economy Bangladesh has an agrarian economy, although the share of agriculture to GDP has beendecreasing over the last few years. Yet it dominates the economy accommodating major rural labour force. From marketing point of view, Bangladesh has been following a mixed economy that operates on free market principles. The GDP of Bangladesh is 6. 21% and per capitincome is US$ 599. The principal industries of the country include readymade garments,textiles, chemical fertilizers, pharmaceuticals, tea processing, sugar, leather goods etc.

Theprincipal mineral includes Natural gas, Coal, white clay, glass sand etc. 2. 6Communication The transport system of Bangladesh consists of roads, railways, inland waterways, two sea ports, maritime shipping and civil aviation catering for both domestic and international traffic. Presentlythere are about 21,000 km of paved roads; 2,706 route-kilometres of railways (BG-884km and MG -1,822 km); 3,800 km of perennial waterways which increases to 6,000 km durinthe monsoon, 2 seaports (Chittagong and Chalna) and 3 international (Dhaka, Chittagong andSylhet) and 8 domestic airports. . 7Religion and Culture The majority (about 88%) of the people are Muslim. Over 98% of the people speak in Bangla. English, however is widely spoken. Bangladesh is heir to a rich cultural legacy. In two thousand or more years of its chequered history, many illustrious dynasties of kings and Sultans ruled the country and have left their mark in the shape of magnificent cities and monuments. The people of Bangladesh are very simple and friendly. A beautiful communal harmony among the different religions has ensured a very congenial atmosphere.

More than 75% of the population lives in rural areas. Urbanization has, however, been rapid in the last few decades. 2. 8Population and Demography Bangladesh is now Asia's fifth and world's eighth populous country with an estimated population of about 146 million. Density of population is around 979 per square kilometer, the highest in the world. Rural population comprises about 76% while urban constitutes about 24%. Adult literacy rate is 54% (2006). Census of 2001 reveals that 43 per cent of the population is below 15 years of age.

This young age structure constitutes built-in population momentum. Also urban population is increasing quite fast. Though Bangladesh has made progress in reducing poverty and per capita income has been creeping up, a substantial number of population are poor. Progress made in improving Bangladesh's Human Development Index (HDI) has placed her among the medium-ranking HDI countries. Strong policy interventions led to continuous reduction in the annual growth rate of population from the level of 2. 33 % in 1981 to 1. 54 in 2001 and further to 1. 48 (2007). The Total

Fartility Rate (TFR) also went down from 3. 4 in 1993-94 to 2. 2 (2007). The CPR (any method) increased from 44. 6% in 1993-94 to 58. 1% in 2004, but again fell down to 55. 8% in 2007. Life expectancy at birth has continuously been rising, and is now 65 years (2007) from the level of 58 (1994). Reversing past trends, women now live longer than men. The country, however, is over burdened with about two million new faces every year creating extra pressure on food, shelter, education, health, employment, etc. , and thus making the anticipated economic growth difficult. . 9Health Status Since independence Bangladesh has made significant progress in health outcomes. Infant and Child mortality rates have been markedly reduced. The underfive mortality rate in Bangladesh declined from 151 deaths per thousand live births in 1991 to 65 deaths/1000 live births in 2007 and during the same period infant mortality rate reduced from 94 deaths per 1000 live births to 52. EPI coverage extended its reach from 54% in 1991 to 87. 2% in 2006. The MMR reduced from 574/100,000 live births in 1991 to 290 in 2007.

Deliveries attended by skilled birth attendants increased from only 5% in 1990 to 20% in 2006. The prevalence of malaria dropped from 42 cases /100,000 in 2001 to 34 in 2005. Bangladesh has also achieved significant success in halting and reversing the spread of tuberculosis (TB). Detection of TB by the Directly Observed Treatment Short-course (DOTS) has more than doubled between 2002 and 2007, from 34 to 92%. The successful treatment of tuberculosis has progressed from 84% in 2002 to 91% in 2007. Polio and leprosy are virtually eliminated. HIV prevalence is still very low.

Development of countrywide network of health care infrastructure in public sector is remarkable. However, availability of drugs at the health facilities, deployment of adequate health professionals along with maintenance of the health care facilities remain as crucial issues, impacting on optimum utilization of public health facilities 2. 10Nutrition Status There has been considerable progress in reducing malnutrition and micro nutrient deficiencies in Bangladesh. According to BDHS, percentage of U5 underweight (6-59 months) has reduced to 46. (2007) from 67 (1990) and that of U5 stunted (24-59 months) from 54. 6 (1996) to 36. 2 (2007). Percentage of children 1-5 years receiving vitamin-A supplements in last six months has increased from 73. 3 (1999-00) to 88. 3 (2007). The rate of night blindness has reduced to 0. 04 per 1000 people (IPHN, HKI 2006). However, in spite of efforts taken by the government, high rates of malnutrition and micronutrient deficiencies along with gender discrimination remain common in Bangladesh. 2. 11Urban Health Service

The urban areas provide a contrasting picture of availability of different facilities and services for secondary and tertiary level health care, while primary health care facilities and services for the urban population at large and the urban poor in particular are inadequate. Rapid influx of migrants and increased numbers of people living in urban slums in large cities are creating continuous pressure on urban health care service delivery. Since the launching of two urban primary health care projects, the services have been delivered by the city corporations and municipalities through contracted NGOs in the project's area.

Rest of the urban areas and services are being covered by MOHFW's facilities. Moreover, 35 urban dispensaries under the DGHS are providing outdoor patient services including EPI and MCH to the urban population. 2. 12Organizational Setup of MOHFW The Ministry of Health & Family Welfare is one of largest ministries in the country. At the national level, the ministry of Health & Family Welfare (MOH&FW) is responsible for policy, planning and decision making at macro level. 2. 12. 1Executing Authorities of MOHFW:

Under MOHFW, there are four Directorates General or Directorates, e. g. , Directorate General of Health Services, Directorate General of Family Planning, Directorate of Nursing Services and Directorate of Drug Administration. 2. 13Directorate General of health Services (DGHS) The Directorate General of Health Services (DGHS) is entrusted for the implementation of the policy decisions of the Ministry of Health and Family Welfare (MOHFW) as regards health service delivery to all the people under the jurisdiction of the Government of the People's Republic of Bangladesh.

It provides technical guidance to the ministry. DGHS carries out its activities through different directors, line directors, project directors, institution heads, district and upazila health managers and union health staffs. 2. 14Health, Nutrition ; Population Sector Program (HNPSP) The constitution Bangladesh mandates for basic health care services for its people as one of the fundamental responsibilities of the state. Towards this goal, the government has taken different endeavors to extend health facilities to the population.

The broader policy document of the Government of Bangladesh that shapes direction of health care is the Poverty Reduction Strategy Paper (PRSP) although the current government has indicated that it will go for Five Year Plan. The Government of Bangladesh is running a program through which the health care services are provided to the people from the grass root to the central level. The program is entitled Health, Nutrition and Population Sector Program for the period of July 2003 through June 2010 (HNPSP 2003-2010).

The Ministry of Health and Family Welfare (MOHFW) designed the Program Implementation Plan (PIP) in accordance with the PRSP to implement its sector wide program popularly known as Health, Nutrition and Population Sector Program (HNPSP). The HNPSP covers 38 Operational Plans (OP) to be implemented by 38 Line Directors and 14 Projects/Programs. The Government has recently decided to continue HNPSP until 2011. The details of the program are well documented in the form of Program Implementation Plan (PIP) duly endorsed at the highest policy level of the government, the Executive Committee for National Economic Council (ECNEC).

The Implementing Agency of the program is Ministry of Health and Family Welfare (MOHFW) with its attached departments. The financial involvement is estimated to be around Taka 324,503 million which includes contributions for GOB (Government of Bangladesh) and DPs (Development Partners). 2. 15Priority Objectives and Goal One of the important goals of PRSP and HNPSP is attainment of Millennium Development Goals (MDGs). The health sector is specially striving for attainment of health related MDGs.

The priority objectives of HNPSP are: (i) reducing MMR; (ii) reducing TFR; (iii) reducing malnutrition; (iv)reducing infant and under-five mortality; (v) reducing the burden of TB and other diseases; and (vi) prevention and control of noncommunicable diseases including injuries. The commitment of the government targets towards reaching the goal of sustainable improvement in health, nutrition and family planning status of the people by the end of the program period. It may be mentioned here that HNPSP deals with health care service delivery of the public sector.

Nevertheless, it strives to maintain a strong cooperation and coordination with the efforts of the Private Sector as well so as to ensure the overall well-being of every citizen of the country. Of the 38 OPs, 7 are under MOHFW, 19 under Directorate General of Health Services (DGHS), 9 under Directorate General of Family Planning (DGFP), 1 under Directorate of Nursing Services (DNS), 1 under Directorate of Drug Administration (DDA) and 1 under National Institute of Population Research and Training (NIPORT) and.

Of the 14 projects/programs, 1 is under MOHFW, 9 under DGHS, 1 under DGFP, 2 under DNS and 1 under NIPORT. The Health Bulletin 2009 is an attempt of Management Information System (MIS) of DGHS to provide an overview of the current health profiles of Bangladesh. CHAPTER - 3 Health care delivery systems of Bangladesh Distribution of public health care services and facilities follows similar pattern of administrative tiers, viz. national (mostly capital-based in Dhaka), regional (in divisions), district, upazila, union and ward. The country has 7 divisions, 64 districts, 482 upazillas and 4,498 unions.

As the Ministry of health and family Welfare deploys health workforce according to the older ward system, which divides each union into 3 wards. Therefore, number of MOHFW wards is 13,494. Primary health care (PHC), which includes family planning services in the urban area (city corporations and municipalities), is provided by Ministry of Local Government; and in rest of the country by Ministry of Health and Family Welfare (MOHFW) provides health care service. Provision of secondary and tertiary care, in both urban divisional directorates with necessary staff. and rural areas, is the sole responsibility of MOHFW.

The MOHFW delivers its services through two separate executing authorities, viz. Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP). The names explain their functions. PHC services of both DGHS and DGFP begin at the ward level through a set of community health staffs, at least one in each ward (Table). To supervise these field staffs, there is one assistant health inspector (for DGHS) and one family planning inspector (for DGFP) at union level. There are several hundred non-bed community facilities to provide outpatient services (1466 for DGHS and 3500 for DGFP).

Besides DGFP also operates additional 97 maternal and child welfare centers (MCWCs) (union: 23; upazila: 12; district: 62), 471 MCH-FP clinics (upazila: 407; district: 64), 177 NGO clinics (upazila: 68; district: 104; national: 05), 08 model clinics (national: 02; regional: 06) and organizes 30,000 makeshift satellite clinics per month. The public sector hospital care in Bangladesh is mainly provided by DGHS. Primary level hospital care| Secondary level hospital care| Tertiary level hospital care| Begins through Upazila Health Complex (31 to 50 Bed) existing in 418 upazilas. The district hospitals (50 to 375 bed), one each district, provide secondary level hospital care in several specialty areas. | The regional hospital are multidisciplinary tertiary care hospitals (250 to 1700 beds) mostly affiliated with teaching institutes. At the national level, there are postgraduate and specialized hospitals (100 to 600 beds)| 3. 0Divisional level health organization At the divisional level, there is a divisional Director for Health. S/he is the head of a Divisional Directors supervise the activities of the civil Surgeons. 3. 1District level health organization

At the district level, Civil Surgeon is the health manager. S/he has own administrative office supported by various categories of staff. There is either a Sadar Hospital or a General Hospital in each district head quarter. The Hospital provides services under the management of Civil Surgeon with a view to render out-patient, in-patient, emergency, laboratory and imaging services to the people. The in-patient services internal medicine, general surgery, obstetrics and gynecology and other common specialist clinical services. It is the secondary level referral facility of health services of Bangladesh.

Currently there are 59 Sadar district hospitals and 2 General hospitals in the country each having 100-250 bed. 3. 2Upazila level health organization Upazila Health Complex (UHC) is another fixed service delivery point next to district level hospital. It provides the first level referral services to the population. In each UHC, there are posts for 9 (nine) doctors including one Upazila Health and Family Planning Officer (UHFPO). UHFPO is the Chief Health Officer of upazila and also Head of the UHC. Other doctors of UHC are Junior Consultants-4, Resident Medical Officer-1, Assistant Surgeons (MO)-2 and Dental Surgeon-1.

There are 418 Upazila Health Complexes (UHC) in the country of which 153 are 50bed and rests are 31-bed. UHC provides out-patient, in-patient and emergency services, limited diagnostic and imaging services, emergency obstetric care, contraceptive services and dental care. 3. 3Union level health organization There are four types of static health facilities in the union level. These are Rural Health Centers (RHC, 10-bed hospital), Union Sub-centers (USC), Union Health and Family Welfare Centers (UHFWC) and Community Clinics (CC). There are 22 RHCs, in each of these, there are sanctioned posts of 20 staffs.

RHC provides both out-patient and inpatient services. In an USC, there is sanctioned posts for one medical officer, one medical assistant, one pharmacist and one MLSS. Number of USC is 1,362; that for UHFWC is 87. Under HPSP, Government planned for establishing one Community Clinic for every 6000 rural populations. Number of CCs so far built is 11,883. But, these were not made functional. Recently Government has decided to start the CCs again. The total number of CCs will be 18000. The existing UHCs and Union level facilities will also provide services of CCs in the respective communities.

So,13,500 additional CCs will be required. The main health workforce in the union level is the domiciliary staff called health assistants. They are placed in each ward, which is the lowest and smallest administrative unit of the health sector. They visit the homes of the local people for providing primary health care services and collection of routine health data. The health assistants routinely organize satellite clinics for immunization services. Besides there are other small to large hospitals and special purpose hospitals spread across the country both in rural as well as in urban areas.

Under the DGHS, there are altogether 40 teaching/training institutes and 589 small to large hospitals. In Family Planning sector, there are one national research-cum-training institute, two hospital-based training centers, and 32 other training centers (national: 12; regional: 20). Nearly six hundred health managers under DGHS and a similar number under DGFP, from national to upazila levels, play roles in administering the health and family planning services (1,17). This figure does not include the institute and clinic/hospital heads. CHAPTER - 4

Facility Based Health Services Hospital service is one of the important activities of health sector, which is the most visible health service also. This chapter of the Health Bulletin 2009 will provide an overview of the hospitals and their bed capacity as well as utilization based on the information from January through December of 2008. 4. 0Hospitals by bed capacity There are 585 hospitals ranging from 10 beds to 1,700 beds under DGHS currently. All of these hospitals provide a total of 37,090 beds. The table below gives a detail profile. No. f hospitals by bed capacity and total beds under DGHS Sl. No. | Bed capacity | No. of hospitals in this type | Total beds | 1 | 1700 beds | 1 | 1700 | 2 | 1010 beds | 1 | 1010 | 3 | 900 beds | 1 | 900 | 4 | 800 beds | 1 | 800 | 5 | 600 beds | 5 | 3000 | 6 | 500 beds | 3 | 1500 | 7 | 414 beds | 1 | 414 | 8 | 375 beds | 1 | 375 | 9 | 250 beds | 19 | 4750 | 10 | 200 beds | 2 | 400 | 11 | 150 beds | 3 | 450 | 12 | 100 beds | 53 | 5300 | 13 | 80 beds | 1 | 80 | 14 | 56 beds | 1 | 56 | 15 | 50 beds | 158 | 7900 | 16 | 31 beds | 271 | 8401 | 17 | 30 beds | 1 | 30 | 8 | 25 beds | 1 | 25 | 19 | 20 beds | 43 | 860 | 20 | 10 beds | 22 | 220 | | Total = | 589 | 3817138171| Type of hospitals Following list gives an overview of the type of hospitals currently in operation under DGHS Type of hospitals | No. of hospitals | Total bed capacity | Postgraduate institute hospital | 7 | 2014 | Dental college hospital | 1 | 20 | Hospital for alternative medicine | 2 | 200 | Medical college hospital | 14 | 8685 | Mental hospital, Pabna | 1 | 500 | Shekh Abu Naser Specialized Hospital | 1 | 250 | Narayanganj 200 bed Hospital | 1 | 200 |

Specialized Health center (Asthma ; Burn unit) | 2 | 150 | Sarkari karmochari hospital | 1 | 100 | Chest hospital | 12 | 566 | Infectious disease hospital | 5 | 180 | Leprosy hospital | 3 | 130 | District Level Hospital | 60 | 8100 | 50 bed hospital(Tongi, Saidpur) | 2 | 100 | 100 bed hospital (Narsingdi) | 1 | 100 | 25 bed hospital (Jhenidah) | 1 | 25 | Bangladesh korea moitree hospital | 1 | 20 | Upazila health complex | 421 | 15958 | Health complex (31 bed) | 3 | 93 | 20 bed hospital | 28 | 560 | 10 bed hospital | 22 | 220 | Postgraduate Institute Hospitals all are national level hospitals and are located in Dhaka) Total = 7 | No. of beds | | Total | Revenue | Develop. | Proposed | Beds will Increase | 1. National Institute of Chest Disease and Hospital (NIDCH) | 600 | 600 | 0 | 0 | 0 | 2. National Institute of Cardiovascular Disease (NICVD) | 414 | 250 | 164 | 0 | 0 | 3. National Institute of Traumatology and Rehabilitation (NITOR) | 500 | 500 | 0 | 0 | 0 | 4 National Institute of Cancer Research and Hospital (NICR;H) | 50 | 50 | 0 | 250 | 200 | 5 National Institute of Ophthalmology (NIO) | 250 | 250 | 0 | 0 | | 6.

National Institute of Kidney Disease and Hospital (NIKDU) | 100 | 0 | 100 | 0 | 0 | 7. National Institute of Mental Health (NIMHR) | 100 | 50 | 50 | 0 | | Total = | 2014 | 1700 | 314 | 250 | 200 | Medical College Hospitals of Teaching Hospitals of equivalent level (Regional hospitals and are used as undergraduate and postgraduate teaching hospitals). Division | District | Name of hospital (Total = 17) | No. of beds | | | | Beds | Revenue | Develop. | Proposed | Bed will increase | Barisal | Barisal | Sher-e-Bangla Medical College Hospital | 00 | 600 | 0 | 1000 | 400 | Chittagong | Chittagong | Chittagong Medical College Hospital | 1010 | 1010 | 0 | 0 | 0 | | Comilla | Comilla Medical College Hospital | 250 | 250 | 0 | 500 | 250 | Dhaka | Dhaka | Dhaka Medical College Hospital | 1700 | 1700 | 0 | 2000 | 300 | | | Sir Salimullh Medical College Hospital | 600 | 600 | 0 | 0 | 0 | | | Shahid Suhrawardy Hospital, Dhaka | 375 | 375 | 0 | 0 | 0 | | | Homoeopathic Degree College ; Hospital | 100 | 100 | 0 | 0 | 0 | | | Unani ; Ayurvadic College ; Hospital | 100 | 100 | 0 | 0 | 0 | | | Dental College and Hospital, Dhaka | 20 | 20 | 0 | 200 | 180 | | Faridpur | Faridpur Medical College Hospital | 250 | 250 | 0 | 0 | 0 | | Mymensingh | Mymensingh Medical College Hospital | 800 | 800 | 0 | 1000 | 200 | Khulna | | Khulna Medical College Hospital | 250 | 250 | 0 | 500 | 250 | Rajshahi | Bogra | SZR Medical College Hospital | 500 | 500 | 0 | 0 | 0 | | Dinajpur | Dinajpur Medical College Hospital | 250 | 250 | 0 | 500 | 250 | | Rajshahi | Rajshahi Medical College Hospital | 600 | 600 | 0 | 0 | 0 | | Rangpur | Rangpur Medical College Hospital | 600 | 600 | 0 | 1000 | 400 | Sylhet | Sylhet | MAG Osmani Medical College Hospital | 900 | 900 | 0 | 1000 | 100 | Total = | 8905 | 8905 | 0 | 7700 | 2330 | Specialized Centers under DGHS with bed capacity (Year 2008) Division | District | Name of hospital (Total = 2) | No. of beds | | | | Beds | Revenue | Develop. | Proposed | Bed will increase | Dhaka | Dhaka | 1. National Asthma Center at NIDCH | 100 | 0 | 100 | 0 | 0 | | | 2. Burn Unit | 50 | 0 | 50 | 200 | 150 | Total = | 150 | 0 | 150 | 200 | 150 | | | 4. 1BSMMU Bangabandhu Sheikh Mujib Medical University (BSMMU) is the premier Postgraduate Medical Institution of the country. It bears the heritage to Institute of Postgraduate Medical Research (IPGMR)which was established in December 1965.

In the year 1998 the Government converted IPGMR into a Medical University for expanding the facilities for higher medical education and research in the country. It has an enviable reputation for providing high quality postgraduate education in different specialties. The university has strong link with other professional bodies at home and abroad. The university is expanding rapidly and at present, the university has many departments equipped with modern technology for service, teaching and research. Besides education, the university plays the vital role of promoting research activities in various discipline of medicine. Since its inception, the university has also been delivering general and specialized clinical service as a tertiary level healthcare center.

The university provides patient care services on various disciplines like Psychiatry, Physical medicine, Pediatrics, Neonatology, Pediatric neurology, Pediatric surgery, Clinical pathology, Dermatology, Colorectal surgery, Nephrology, Urology, Neurology, Neuro-Surgery, Internal Medicine, Gastroenterology, Hepatology, Ophthalmology, ENT, Obstetrics ; gynecology, Surgery, Hepatobiliary Surgery, dentistry, and blood transfusion services. It provides different treatment services like Intensive Care, Lithotripsy, Pain management and diagnostic services like radiology, endoscopy, CT scan ; MRI and a one-stop laboratory service. BSMMU runs Institute of Nuclear Medicine (INM). INM is a joint project of Bangladesh Atomic Energy Commission and BSMMU. The INM has modern diagnostic and therapeutic facilities including computerized ultrasonography, gamma camera and a well equipped radioimmunoassay (RIA) laboratory.

This is considered to be the best center for noninvasive diagnoses. 4. 2Smiling Sun Franchise Program  (SSFP) The Smiling Sun Franchise Program is a project funded by the United States Agency for International Development (USAID). It is intended to complement the wide network of healthcare facilities set up by the Government of Bangladesh resorting to an innovative approach to health care franchising. SSFP is committed to improve the quality of life of all Bangladeshis by providing superior, friendly and affordable health services in a sustainable manner. To achieve relevant health outcomes, SSFP is jointly working with partnering NGOs to convert the existing network into a viable social health system.

SSFP objective is to strengthen partnering organization's quality of care while helping them to enhance their financial sustainability, thus enabling them to continue serving an important segment of the Bangladeshi society, including the poorest of the poor. Currently 29 NGOs are providing health care services to women, children and through 319 static and 8,500 satellite clinics in 61 districts of Bangladesh. 34 clinics of this network are providing Emergency Obstetric Care (EmOC) services. This network will continue to expand the volume and types of quality health care under ESD provided to the able-to-pay customers as well as underserved and poor clients. 4. 3Urban Primary Health Care Project (UPHCP-II): About 35 million people representing almost 25 percent of the population of Bangladesh live in urban areas, a large proportion of whom are slum dwellers.

The health knowledge of the urban slum dwellers and their access to essential basic health services are low. Children living in urban slums are deprived of education and health care, and vulnerable to violence, abuse and exploitation. On the other hand, high rate of mortality and morbidity exists among women who remain neglected in terms of meeting their basic health needs and ensuring their rights. The Government of Bangladesh is committed to put in place strategies to address the issues of improving the health status of the urban population. This is to be done through improved access to and utilization of efficient, effective and sustainable Primary Health Care Services.

The provision of public health services in urban areas is the responsibility of Local Government Bodies by dint of City Corporation Ordinance of 1983 and Pouroshova Ordinance of 1977. For primary health care services delivery, the public sector works in partnership with NGOs and the local government institutions such as the City Corporations and Pouroshovas. The health service delivery mechanism in urban areas involves diverse roles of the government (MOLGRD&C and MOHFW), NGOs and the private sector. CHAPTER - 5 Leading Public Health Problems 5. 0Communicable disease The prevention and control of communicable diseases represent a significant challenge to those providing health-care services in Bangladesh.

Sound knowledge on the disease epidemiology is a must for the health service providers in various levels. The Bangladesh population is namely affected by diarrheal diseases, cholera, hepatitis A & E, Malaria, Mycobacterial Disease like Tuberculosis and Leprosy, Dengue, Japanese encephalitis, Nipah virus infection, etc. Crowding, poor access to safe water, inadequate hygiene and toilet facilities, and unsafe food preparation and handling practices are associated with transmission. Cholera is endemic Bangladesh, between 800 and 1000 cases are usually being recorded daily at the hospital of the ICCDR, B in Dhaka. Hepatitis A and E levels are usually high in the country.

Malaria risk exists throughout the year in Bangladesh. Thirteen out of 64 administrative districts are high malaria endemic areas. 98% of all malaria cases reported are from these districts, which are mainly located in the border areas of India and Myanmar. Tuberculosis still remains as a major public health problem, which ranks Bangladesh fifth among the high-TB burden countries in the world. The present revised National Tuberculosis Programme (NTP) was launched and field implementation of DOTS (Directly Observed Treatment short course) was started in 1993. Kala Azar or Leishmaniasis or is endemic in Bangladesh and has an incidence of 175 per 100,000 per annum.

It is caused by a protozoa which is transmitted from the bite of infected sandfly and may present in cutaneous or visceral forms (particularly common in Bangladesh). Filariasis is a mosquito borne parasitic disease causality urogenital organs, breast, etc. with long arm disability. In Bangladesh, it is endemic in 23 districts, mostly the bordering ones. About 20 million people are already infected, most of whom are incapacitated. Leprosy has been a major health problem in Bangladesh for a long time. Bangladesh was considered a high endemic country and was listed among ten countries with high case load (1992). Leprosy situation has changed globally after 1981 when the Multi Drugs Treatment (MDT) were introduced.

Hepatitis A virus infection is common in Bangladesh with a prevalence of about 2% to 7%. Prevalence of hepatitis C virus infection is less than 1%. Sporadic outbreak is often seen caused by hepatitis E virus infection; but presence of hepatitis D infection is not exactly known. Polio free status prevailed from 2001 until now (June 2009) except a small window period in 2006 when 18 cases of child polio were seen in boarder areas of Bangladesh. it is assumed that these cases were imported from India. Dengue fever/Dengue hemorrhagic fever (DF/ DHF) is a viral disease transmitted by the Aedes aegypty mosquito. It is on the increase in South East Asia. Bangladesh reported 100, 000 cases in 2005.

However case fatality rate (CFR) remained <1% up to 2006. 5. 1Non-communicable disease There have been a number of demographic and lifestyle changes over the past two decades in Bangladesh. Improvement in health care delivery has increased the number in aging population. Similarly, industrialization has enhanced urbanization and change in life pattern. The rise in aging population and urbanization are accompanied by an increase in non-communicable diseases and mental health problems. The lifestyle changes associated with change in dietary pattern, lack of physical exercise and rest and recreation, use of tobacco etc. , are all changing the epidemiology of morbidity and mortality in Bangladesh.

Noncommunicable diseases such as cardio vascular disease, diabetes mellitus, cancer, chronic renal disease, mental problems are some of the important emerging non-communicable health problems in country like Bangladesh. Other conditions like injuries especially road traffic injuries, violence against women are on the rise. Data from some of the major health institutions who deals with noncommunicable disease are presented here. The data will give an indirect impression about the disease burden of NCDs in the country. 5. 1. 1Cardiovascular Diseases Cardiovascular diseases are the leading cause of death and disability in most of industrialized countries. They are also increasing in the developing world as well as in our country too. Major Cardiovascular diseases include Coronary Heart Disease, Hypertension, Rheumatic Heart disease etc.

Statistics from National Institute of Cardiovascular Disease (NICVD) and National Center for Control of Rheumatic Fever and Heart Diseases indicates that numbers of patients suffering from cardiovascular diseases are rising over the years. 5. 1. 2Rheumatic heart disease (RHD) Rheumatic heart disease (RHD) is a consequence of rheumatic fever and is the commonest heart ailment among the pediatric age-group and young adults of Bangladesh. In our country context, poverty, overcrowding, lack of nutrition and lack of health education concentrates the problem more. Statistics from the National Center for Control of Rheumatic Fever and Heart Diseases shows the increasing trend of rheumatic heart disease. 5. 1. 3Diabetes Diabetes is a major public health problem for not only developed countries but also developing countries like us.

The prevalence and the morbidity-mortality data due to diabetes are grossly under estimated all over the world. And the economic burden of the disease is also increasing. Without emphasis on prevention it will not be possible for Bangladesh to combat the disease epidemic. We are yet to develop large scale structured program on primary prevention of diabetes or secondary prevention of diabetes complication. Next to public sector, Diabetic Association of Bangladesh (BADAS) is playing a major role in treatment of diabetes in Bangladesh. Data from BIRDEM and affiliated associations under BADAS shows that diabetic patients are ever increasing. 5. 1. 4Cancer

Cancer is emerging as a public health concern worldwide. Though cancer occurs predominantly in elderly people of developed countries, developing country like Bangladesh is also having increased number of malignancies annually. As the health system is improving, mortality rate is gradually declining with the consequence of increased people in the elderly group. Rapid urbanization, environmental pollution, and change in lifestyle along with change in food habit are influencing the rise in number of cancer incidences of our country. The National Institute of Cancer Research and Hospital (NICRH) is the leading institute for cancer related hospital services and programs.

Some of the Cancer related data provided by NICRH are included in the current health bulletin. 5. 1. 5Renal Disease Various type of renal disease is occurring in our country that includes not only acute but also chronic renal failure. Lack of optimum personal hygiene, inadequate health education and improper lifestyle influences the incidences of renal disease. Chronic renal failure not only increases disease burden but also creates huge economic burden. National Institute of Kidney Disease and Urology has taken a central role in treating the renal disease. Data from NIKDU shows that annual incidences of patients suffering from different type of renal diseases are constantly increasing. 5. 1. 6Mental Health

Many people in our country suffer from mental illness and some of them are predicted to have serious and disabling mental disorders, and some to have psychosomatic disorders. Though epidemiological studies are not available, small scale studies suggest that prevalence of mental disorders is on increase in our country. National institute of Mental Health (NIMH) is one of the key institutes in treatment of mental disorders. To focus some light on the mental health related illness, this bulletin has included some of the patient related statistics of NIMH. 5. 2Occupational diseases The main occupational diseases include pneumoconiosis, poisoning, and physical injury.

Because of poor working conditions and the lack of effective protection, the prevalence of occupational diseases has been rising rapidly in recent years. Nearly 20 million workers still work in harmful environments, which are present in at thousands of enterprises throughout the country. 5. 3Unhealthy life-style Smoking has been steadily increasing in recent years, especially in the young. Among middle school students, 34% of boys and 4% of girls smoke. alcohol consumption has also increased since the 1980s, as has alcohol dependence, with the age of the onset becoming younger. 5. 4Population aging A large population over 60 years old has emerged in many big cities and economically developed rural areas.

In 2000, the total number of people over 60 was 10% of the country's population. Nearly 30% of the aged are in poor health. Hypertension, coronary heart disease, chronic bronchitis, stroke, cancer, diabetes mellitus, and benign prostatic hypertrophy pose serious threats to the elderly, which at present make up 8% of the total population. 5. 2Top 10 death causes by age group The causes of death s for 27,789 cases were grouped according to age. In age group, distribution of the cause of deaths was made to find the top 10 causes of deaths. It is found that birth asphyxia (44. 9%) and complications of pre-term low birth weight (23. 8%) are the two top causes of deaths in the newborns aged 0-to 7-days; septicemia (25. %) and pneumonia rank first and second position in top 10 causes of deaths respectively in 7-to 28days' age group. Causes of deaths like complications of pre-term low birth weight (12. 5%) and birth asphyxia (11. 3%) descend to third and fourth position in this age group. Pneumonia is at the top of the causes of death in 1 month-to 1 year's (42. 4%) and 1-to 4-years' (28. 1%) age group respectively. Among the 5-to 14-years' age group, encephalitis (11. 1%) tops the causes of deaths list followed by pneumonia (8. 4%). Among the 15-to 49years' age group, respiratory failure (12. 3%) and pesticide poisoning (8. 0%)rank first and second position in the list of causes of deaths.

Acute myocardial infarction (14. 5%) tops the causes of deaths in the age group of 50to 59-years, indicating the rise in prevalence of cardiac problems in elderly population of Bangladesh. Similarly, another non communicable disease the cerebrovascular disease (17. 4%) is at the top of the causes of deaths in the 60+ years' age group. CHAPTER - 6 Health Education,HRM ; Promotion Program 6. 0Background Health promotion aims for improvement in health, preventing specific disease rather than treating illness alone. The major principles that underpin health promotion ideology are that health is essential for achieving a socially and economically productive life.

Successful implementation of health promotion strategies needs political and social actions to modify public policy. Without the policy support for creating enabling environment it will be difficult to change behavior only through health education and promotion. 6. 1Initiatives There are significant health promotion initiatives around the Globe. The Government of Bangladesh has initiated several health promotion policies such as Millennium Development Goals which include several health promoting objectives i. e. poverty reduction, water supply and sustaining the environment, reduction of maternal ; infant mortality rate, improvement of health status and reduce disease burden.

The Government of Bangladesh has ratified global framework convention of tobacco control adopted by World Health Organization. Bangladesh has been working on all these agenda with special emphasis to health promotion in a multi sectored approach. 6. 2Country Profile Health education as health promotion initiative has started in Bangladesh in 1958 under the Directorate General of Health Services. It is considered as precondition for successful implementation of health care. The network of health promotion is extended up to the grass root level. The key strategic components of health education and promotion in Bangladesh are: ? Community Health Education ? School Health Education ? Industrial Health Education ? Hospital Health Education Environmental Health Education ? Education for prevention and control of communicable and non-communicable disease. ? Health Education for improvement of maternal and child health. ? Health Education for Diet and Physical activity. ? Education for improvement of nutritional status of the people. 6. 3Methods and Media for Health Promotion in Bangladesh ? Interpersonal communication and counseling. ? Group discussion and peer group education by the health care providers. ? Projection of documentary films, Videos on health issues in the community. ? Distribution and display of IEC materials on priority health issues. ? Social mobilization and advocacy at different levels. Use of Electronic and Print media to disseminate health messages. ? Dissemination of health messages through Audio-visual equipments in the hospitals and clinics. ? Health education and promotion campaign on different health problems. ? Health Education in the mosques and other religious institutions. 6. 4National Priority Ministry of Health and Family Welfare has given priority on Health Education and Promotion program in the country. Health Promotion has been incorporated as an essential component in the Health, Nutrition and population sector program of the Government of Bangladesh with financial allocation of Taka 900 million for the period 2003-2010.

This has been guided by health policy and aim to be contributed towards poverty alleviation, gender equity, violence against women, acid prevention, environment protection, disease prevention and control of drug abuse, maternal child health nutrition. The Country has been strengthening health promotion program at macro and micro level based on actual health needs of the community. 6. 5Vision 2015 ? Improve knowledge, attitude and practices of the people towards prevention and control of communicable and non-communicable diseases. ? Strengthen multisectoral approach and stakeholders participation in the development of health promotion. ? Improve knowledge and skills of health service providers in communication. ? Establish community Support System in every village for health promotion program. Incorporate health promotion in all the ongoing health program. ? Strengthen Bureau of health Education and its network up to the sub-district levels. ? Share knowledge and experiences with regional countries to implement health promotion in a better way. ? Improve knowledge and skills of Health Education professionals through training, study tour in abroad. ? Conduct operational research and impact evaluation. ? Establish health promotion network within the region. 6. 6Grounding of Health Professionals The Directorate General of Health Services is the key government organization, which is responsible for delivering health care to the people all over Bangladesh.

In order to deliver the service over one lakh health care personnel and staffs are manned by DGHS throughout Bangladesh. The manpower deployment and redeployment process is very dynamic and at every point of time the picture is changing. Retirement, placement, transfer of manpower is constantly occurring and it influences the process of distribution of human resources. Besides this, depending upon the personnel category, transfer and posting may take place at different level viz. , MOHFW, DGHS and offices of the Divisional Directors of Health and Civil Surgeons office. So limitations arise at any given point of time when we try to pick up accurate picture of human resource distribution. 6. 6. 01Alternative Medical Care

Forty five Medical Officers (15 Unani, 15 Ayurvedic and 15 Homoeopathic) on Alternative Medicine have been appointed in the selected district level hospitals under the work plan of HPNSP, so that the patients of these districts have the option to receive the types of treatment according to their own choice. To assist the medical officers 64 support personnel (compounder) have been appointed. To develop awareness on medicinal plants, 467 herbal gardens. 6. 6. 02Human Resource Development As the population of the country is increasing, the country will need large number of physicians, nurses, medical technologists and other paramedical workforces to cope up with the growing need.

Along with the national development, the country is experiencing a positive growth in the development of human resources for health. Both the public and private sectors are expanding their respective capacities of developing skilled health personnel that include physicians, nurses, medical technologists and other staffs like pharmacists. Bangladesh health personnel are also working in the different parts of the world and there is a growing need of Bangladeshi personnel globally. In the subsequent part of this chapter, information on capacity of teaching/training institutes for development of human resources for health will be outlined. 6. 6. 03Postgraduate medical degree

There are 33 institutes in Bangladesh which offer postgraduate specialist degrees in medical fields. Of these institutes, 22 are in public sector, 5 are non-profit organizations (these institutes receive financial grants from government to run the institutes or their affiliated hospitals), one is operated by Bangladesh Armed Forces and others are in private and NGO sector. Of the public sector institutes, 19 are under Directorate General of Health Services (DGHS) and one is autonomous medical university. Of the 19 institutes under DGHS, 9 are postgraduate institutes offering onlypostgraduate medical degrees. Others are medical or dental colleges and offer both undergraduate and postgraduate medical degrees.

List of postgraduate medical institutes (total number: 11) under DGHS 1. Institute of Child and Mother Health (ICMH), Matuail, Dhaka 2. Institute of Nuclear Medicine and Hospital 3. National Institute of Cancer Research and Hospital (NICRH), Mohakhali, Dhaka 4. National Institute of Cardiovascular Diseases (NICVD), Sher-E-Bangla Nagar, 5. National Institute of Diseases of the Chest and Hospital (NIDCH 6. National Institute of Kidney Diseases and Urology (NIKDU) 7. National Institute of Mental Health and Research (NIMHR), Sher-E-Bangla Nagar 8. National Institute of Ophthalmology (NIO), Sher-E-Bangla Nagar 9. National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, 10.

National Institute of Traumatology, Orthopedic and Rehabilitation (NITOR) 11. Center for Medical Education List of medical colleges under DGHS, which in addition to providing postgraduate medical degrees (total number: 10) 1. Chittagong Medical College, Chittagong 2. Dhaka Dental College, Dhaka 3. Dhaka Medical College, Dhaka 4. MAG Osmani Medical College, Sylhet 5. Mymensingh Medical College, Mymensingh 6. Rajshahi Medical College , Rajshahi 7. Rangpur Medical College , Rangpur 8. Sher-e-Bangla Medical College, Barisal 9. Sir Salimullah Medical College , Dhaka 10. SZR Medical College, Bogra Medical University under MOHFW (total number: 1) 1.

Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka Postgraduate Institute under Bangladesh Armed Forces (total number: 1) 1. Armed Forces Medical Institute List of non-profit institutes which offer postgraduate medical degrees (these institutes receive government grants for running their institute or affiliated hospital; total number: 4) 1. Bangladesh College of Physicians and Surgeons (BCPS), Mohakhali, Dhaka 2. Bangladesh Institute of Child Health, Sher-e-Bangla Nagar, Dhaka 3. Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Shahbagh, Dhaka 4. National Heart Foundation Hospital and Research Institute, Mirpur, Dhaka

List of other institutes in private and NGO sector which offer postgraduate medical degrees (total number: 9) 1. Chattagram Maa and Shishu and General Hospital, Chittagong 2. Institute of Child Health and Shishu Hospital, Shishu Sasthya Foundation, 3. Lions Eye Institute and Hospital, Lions Bhaban, Agragaon, Dhaka 4. MAI Institute of Ophthalmology and Islamia Hospital, Sher-e-Bangla Nagar, 5. Institute of Health Sciences (Under USTC), Foy’s Lake, Chittagong 6. Institute of community Opthalmology, Chittagong 7. James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka 8. State University of Bangladesh, Dhanmondi R/A, Dhaka 9. Gono Bisshobidhyaloya (People’s University) 6. 6. 04Undergraduate medical degree

There are 59 medical colleges and 14 dental colleges in the country to offer bachelor's degree in medicine (MBBS) and dentistry (BDS). Of the 59 medical colleges, 17 are under the MOHFW, one under Bangladesh Armed Forces and 41 are in the private sector. Of the 14 dental colleges, 3 are under MOHFW and 11 are in the private sector. The medical colleges currently have capacity of annual admission 5,549 students for MBBS course. These include 2,494 seats in medical colleges under MOHFW, 100 seats in Armed Forces Medical College and 3,055 seats in private medical colleges. Out of these seats in medical colleges under MOHFW, 40 seats are reserved for children of freedom fighters, 20 for tribal students and 84 for foreign students. 6. 6. 05Nursing education

There are 13 nursing colleges and 69 nursing institutes in the country for production of nursing workforce. The nursing colleges offer BSc nursing degree, and the nursing institutes offer diploma in nursing. Of the 13 nursing colleges, 5 are under MOHFW and 7 under private sector and one is manned by Bangladesh Armed Forces Of the 69 nursing institutes, 46 are under MOHFW, 1 under Bangladesh Armed Forces and 22 under private sector. Under the MOHFW, 6 nursing institutes are attached with medical college hospitals, 11 with general hospitals and 17 with district hospitals. The nursing institute under the Bangladesh Armed Forces is attached with the Armed Forces Medical Institute, Dhaka.

Besides, 2 institutes produce specialized nurses. These are National Heart Foundation, Mirpur, Dhaka (20 seats; intensive care unit, coronary care unit, cardiac nursing) and Bangladesh Health Professionals Institute, Savar, Dhaka (20 seats; rehabilitation nursing). 6. 6. 06Production of medical assistants Medical assistants are the assistants to the doctors working at the upazila health complexes or union sub-centers. Bangladesh has a shortage of graduate medical doctors. In this context, the medical assistants serve as the doctors. Currently there are 7 medical assistant training schools in the country which together have seat capacity of 650 students.

Medical assistant's course requires a student to complete a 3 years' course to obtain a medical diploma. 6. 6. 07Production of medical technologists Medical technologists are technicians who perform the laboratory tests, take x-ray images, provide physiotherapy or radiotherapy, help making artificial dentures, etc. To produce medical technologists there are currently both graduate and diploma courses in the country. Sixteen institutes conduct BSc medical technology courses in laboratory medicine, physiotherapy, occupational therapy and dentistry. Total seat capacity is 1065. Of the 16 institutes, 3 are under MOHFW and the rests are in private sector.

To produce diploma medical technologists, the DGHS has 3 institutes of health technology (IHT) in the government sector. They altogether have 1010 seats. There are 47 private IHTs which have total seat capacities of 5696. These IHTs offer 3 years diploma in medical technology in 7 disciplines, viz. laboratory, radiography, physiotherapy, dental technology, radiotherapy and pharmacy. Currently 50 institutes both in government and private sector have total seat capacity of 6706. Two institutes (Gonobisshobidhyaloya, Savar and BHPI, Savar: total 25 seats) have started MSc course in medical technology in discipline of physiotherapy. Top of Form | | |

Number of seats in the different postgraduate medical courses provided under institutes and colleges Institute | Name of course with number of seats | | MS| MD| M. Phil| Diploma| MPH| Other| Total| 1. BSMMU | 140| 150| 70| 106| -| MTM-10| 476| 2. Centre for Medical Education (CME) | -| -| -| -| -| MMED-15| 15| 3. Dhaka Medical College | 70| 110| 86| 82| 06| -| 354| 4. Chittagong Medical College | 37| 48| 29| 48| 03| -| 165| 5. Mymensingh Medical College | 22| 40| 33| 59| -| -| 154| 6. Rajshahi Medical College | 10| 19| 25| 41| 05| -| 100| 7. MAG Osmani Medical College | 20| 12| 28| 40| -| -| 100| 8. Sher-E-Bangla Medical College | 04| -| 08| 22| -| -| 34| 9. Rangpur Medical College | 08| 08| 08| 22| -| -| 46| 10.

Sir Salimullah Medical College | 21| 36| 18| 40| 05| -| 120| 11. BIRDEM | 10| 22| 15| 14| -| -| 61| 12. NICVD | 20| 20| -| 14| -| -| 54| 13. NIDCH | 06| 15| -| 20| -| -| 41| 14. Institute of Child Health and Shishu Hospital | -| -| -| 06| -| -| 06| 15. National Institute of Child Health | 10| 15| -| 15| -| -| 40| 16. National Institute of Cancer Research and Hospital | 06| 12| -| -| -| -| 18| 17. NIPSOM, Dhaka | -| -| 07| -| 166| -| 173| 18. National Heart Foundation | 05| 05| -| -| -| -| 10| 19. Institute of Nuclear Medicine and Hospital | -| -| -| 10| -| -| 10| 20. Institute of Child & Mother Health (ICMH) | 10| 10| -| 30| -| -| 50| 21.

National Instit

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