Even when there is no real need, many doctors are coming to government medical colleges and specialized hospitals in Dhaka through temporary attachments.
On the other hand, many hospitals at the district, upazila, and divisional levels have vacant posts for specialist doctors. There is an excess of doctors in one part of the country and an absence of doctors in another. Such a contradiction is not a sign of a healthy healthcare system.
If a country’s capital becomes the primary center for all opportunities and facilities, how can decentralization ever take place? A recent report published in Ittefaq has once again brought this long-standing reality to the forefront.
Temporary attachment is meant to serve an administrative purpose. It is a mechanism for temporarily addressing a need when a hospital suddenly faces a shortage of specialists.
But when attachment arrangements forget the language of necessity and learn the language of influence and lobbying, they cease to be administrative decisions. They become a means of obtaining special privileges.
The report has raised allegations of a syndicate operating around these attachment arrangements. If the allegations are true, this is not merely a violation of rules; it amounts to surrendering the country’s healthcare system to personal interests.
After all, most people in Bangladesh do not live in Dhaka. They live in districts, upazilas, and villages. Illness does not recognize the capital. Heart disease, complications during childbirth, accidents, or symptoms of cancer occur everywhere in the country.
Yet if doctors insist on staying in the capital, patients are also forced to rush to Dhaka. This is one reason why government hospital beds are now full. Patients often have to wait for weeks to be admitted to specialized hospitals.
Many ultimately have no choice but to seek treatment at expensive private hospitals. A disease then ceases to be confined to the body. It consumes a family’s savings, increases its burden of debt, and pushes many families toward poverty.
However, placing the entire blame on doctors would not present the full picture. Dhaka offers better training, research opportunities, education for children, professional networks, and a comparatively better standard of living.
Many doctors working outside Dhaka perform their duties with limited equipment, staff shortages, and uncertain working conditions. As a result, everyone is naturally drawn toward the capital.
Human aspirations cannot simply be suppressed through orders; instead, the state must create an environment in which postings in remote areas can also become places of dignity and opportunity.
This is where one of our major shortcomings lies. This problem has existed for a long time. Regrettably, everyone knows about it, yet no one pays sufficient attention to it.
Now, are any measures taken against those who misuse the attachment system by exercising influence, and against those who assist them? What has been done in the past? When will the answer to these questions finally be positive?
And when will housing, necessary equipment, a safe working environment, and a transparent system of promotion be ensured at district and upazila hospitals? Otherwise, transfer orders may indeed be prepared, but the flow toward Dhaka will not stop.
Another reform has been discussed for a long time: an effective referral system. Not every patient needs to be treated in the capital. Whatever can be managed at the primary level should be done there.
Complex cases should be referred step by step to higher-level institutions. Most developed healthcare systems operate on this principle. Unless this discipline is established in Bangladesh as well, the pressure on hospitals in the capital will continue to increase.
The Directorate General of Health Services has said that it is preparing a list of doctors currently on attachment and taking steps to cancel unnecessary attachments. This initiative must be implemented.
Before sick people from rural areas have to travel hundreds of kilometers in search of medical treatment, they should be able to find reliable care at hospitals in their own districts. When will the country’s healthcare system become one in which that is possible?
