A recent Ittefaq report mentioned around 10,000 patients are visiting the Dhaka Medical College Hospital (DMCH) every day, which is the largest public healthcare institution in the country.
The authorities are struggling to manage this overwhelming situation. Established in 1946, many patients in this hospital end up receiving treatment on verandas, floors, and even staircases, often staying overnight.
After 53 years of independence, why is this still the situation in the country’s premier hospital? Despite the high demand, the hospital lacks the necessary beds and sufficient staff. Furthermore, most district and upazila (sub-district) hospitals do not perform operations after noon, meaning that 80% of patients end up coming to the Dhaka Medical College Hospital.
In light of this, it has been proposed that the 1,054-bed specialized COVID-19 hospital established in Mohakhali during the pandemic be placed under the management of DMCH to alleviate some of the pressure. Additionally, it is reported that a 5,000-bed hospital is being built at DMCH to reduce the patient load. While this will certainly ease some pressure on the hospital, is this the only solution?
In fact, to reduce the pressure of patients coming to Dhaka from across the country, we must realize the importance of decentralizing healthcare services.
As we know, the Ministry of Health in Bangladesh is one of the largest ministries in the country. Under its purview, 37 public medical colleges and hospitals, 67 private medical colleges and hospitals, and almost 14,000 community clinics have been established, marking an unprecedented development in the country’s healthcare system.
However, despite these advancements, the rural population, particularly those with lower incomes, remains deprived of modern healthcare services.
In principle, healthcare services should be available in all 460 upazilas (sub-districts) through their respective upazila hospitals. But for various reasons, the people of these areas are unable to access the services they need. For instance, patients in these hospitals still need to get tests done at outside facilities, and regular attendance of doctors, nurses, and technicians is not yet ensured. Since not all diseases can be treated at the district or upazila level, most people are forced to come to Dhaka for treatment. This creates additional pressure on hospitals in Dhaka.
Patients coming from rural areas are deprived of proper care, fall prey to brokers, lose money, and return home destitute. This also causes delays in urgent care for local patients in Dhaka.
To overcome the situation mentioned above, the decentralization of healthcare services is of utmost importance. We must expand the healthcare system in such a way that, except for highly specialized conditions, rural people should not need to travel to districts or central hospitals for treatment.
This means that we must focus on increasing the capacity of district and upazila hospitals and improving their management. The shortages of doctors, nurses, and technicians in these hospitals must be addressed, ensuring their regular presence and proper functioning according to the official working hours. Moreover, MBBS doctors should be recruited for community clinics, and safe housing should be provided for them, along with necessary medical supplies.
On the other part, every upazila hospital should be equipped with an emergency department, a blood bank, and the necessary pathological testing facilities. These hospitals must also have reliable and continuous access to electricity, water, and gas. Additionally, transparency and accountability must be ensured at every level of the healthcare sector.
Finally, to reduce the burden on DMCH, it is necessary to construct new public hospitals in various parts of the capital and expand the capacity of existing ones.
Specialized healthcare services should be expanded at the divisional hospitals. This will reduce the need for patients from remote regions to travel to Dhaka, sparing them from the unbearable hardships and suffering associated with such long journeys.
