Bangladesh suffers from both a shortage of and geographic mal-distribution of HRH. There are an estimated 3.05 physicians per 10,000 population and 1.07 nurses per 10,000 population (estimates based on MoHFW HRD 2011). There is a severe gap between sanctioned and filled health worker positions: 36% vacancy in sanctioned health worker positions and only 32% of facilities have 75% or more of the sanctioned staff working in the facilities (World Bank, 2009). 28% of treatment provided in government health facilities is through alternative medicine (Ayurveda, Unani, and Homeopathy), yet as of June 2011, there was a 50% vacancy rate for alternative medicine providers (MoHFW AMC 2011).
Health workers are concentrated in urban secondary and tertiary hospitals, although 70% of the population lives in rural areas (Country Case study (GHWA, 2008). Major challenges include: an overly- centralized health system, weak governance structure and regulatory framework, weak management and institutional capacity in the Ministry of Health and Family Welfare (MoHFW), fragmented public service delivery, inefficient allocation of public resources, lack of regulation of the private sector – which employs 58% of all physicians, shortage of HRH, high turnover and absenteeism of health workers, and poor maintenance of health facilities and medical equipment.
Despite these challenges and the fact that HRH was not considered a priority in the current sector program, there have been recent successes including: increase in the number of graduates and health worker training facilities, and an increased number of rural health facilities. The MoHFW prepared its new sector program - the Health, Population and Nutrition Sector Development Program (HPNSDP) and is revising its draft National Health Policy, based on lessons learned from previous programs. Goals include: developing an HRH plan, creating a functional HRH Information System (HRIS), scaling up the production of critical health workers, introducing incentive packages to deploy and retain critical health workers in remote and rural areas, addressing the challenge of skilled birth attendance by training community-based SBAs and/or nurse-midwives and family welfare visitors, and streamlining the recruitment and promotion of nurses (PID, World Bank, 2011).
COUNTRY COORDINATION AND FACILITATION (CCF) IN BANGLADESH:
The first stakeholder dialogue on Human Resource for Health (HRH) in Bangladesh took place on 28th March 2012. The dialogue was mainly to start advocacy on the need of adequate and skilled health workforce for well functioning health system and advocate for the Country Coordination and Facilitation (CCF) process as initiated by the Alliance.
HEALTH WORKFORCE DATA
- The latest data from multiple WHO source
- HRH Data Sheet-2011, Government of the People’s Republic of Bangladesh, Ministry of Health and Family Welfare, Human Resources Development Unit
- Alternative Medicine HRH 2011, Government of the People’s Republic of Bangladesh, Ministry of Health and Family Welfare, Human Resources Development Unit
- Latest statistics available from Government of the People’s Republic of Bangladesh Directorate-General of Health Services
HUMAN RESOURCES FOR HEALTH PLAN
A comprehensive HRH strategy is currently being developed by the Human Resource Development Unit of Ministry of Health & Family Welfare, Bangladesh Secretariat (MOHFW).
The past Bangladesh Workforce Strategy (2008) focused on integrating the system of managing and accreditation of HR across the public, private and NGO sectors. Included measures were:
- development of an HR master plan
- improved incentives to work in rural and remote areas
- increased community-focused aspects into training programs, and
- improved quality of health workforce education and planning, including improving the capacity of teaching and training institutions with a shift from a more knowledge-based to skills-based approach.
Other focuses were stewardship/regulation of health HR, recruitment and career development and retention, performance management processes, leadership and coordination of HR functions, public-private partnerships, effective financing and an Integrated Human Resource Management Information System.
HEALTH SECTOR STRATEGIES / PLANS
The Ministry of Health and Family Welfare is currently in the midst of a dialogue process with the different stakeholders for finalizing the draft document of National Health Policy Health and Family Welfare.There are currently 16 principals and 38 working strategies in the policy including formulation of National Health Development Council to strengthen inter-ministerial health related tasks and provide guidelines in implementing the policy.The specific goals of the policy are ensuring primary and emergency health services for all, expanding equity based quality health services and encouraging people to seek healthcare.
- Directorate General of Health Services (DGHS) sector-wide multi-year development program: Health, Population and Nutrition Sector Development Program 2011-2016 (HPNSDP 2011-2016)
COUNTRY CASE STUDIES & OTHER DOCUMENTS
- Factors affecting recruitment and retention of community health workers in a newborn care intervention in Bangladesh (2010)
Bangladesh Trains Health Workers to Reduce Maternal Mortality (2008)
- WHO Country Cooperation Strategy 2008-2013
- Update Millennium Development Goals (2011)
- Ministry of Health and Family Welfare Performance Report (2009-2010)
- Health Care Network of Bangladesh under the Ministry of Health and Family Welfare (2011)
- MNRH at community level: A profile of Bangladesh (2011)
- MoHFW Health Bulletin 2010
- Review of National and International Experiences with Human Resources Incentive Packages (MoHFW, 2010)
ALLIANCE MEMBERS WORKING IN BANGLADESH
- Public health foundation of Bangladesh (PHFBD)
- Enfants du Monde
- World Lung Foundation
- Human Resource Development Unit of Ministry of Health & Family welfare, Bangladesh
- Sustainable Resource Foundation (SuRF)
- University of Melbourne, Nossal Institute for Global Health, Carlton, Australia
- University of Dhaka
- Bangladesh Public Health Forum, Dhaka, Bangladesh
- Siam Health Care Foundation, Bangladesh
- Wemos Foundation, Netherlands