Bangladesh

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

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.

COUNTRY CASE STUDIES & OTHER DOCUMENTS

ALLIANCE MEMBERS WORKING IN BANGLADESH

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KAMPALA DECLARATION AND AGENDA FOR GLOBAL ACTION PROGRESS

Country Progress on the Kampala Declaration and Agenda for Global Action

COUNTRY MAP

Country Map: Bangladesh
This map is an approximation of actual country borders.

STATISTICS

Total population: 142,319,000 (unadjusted), estimated 152,111,000 (adjusted)
Gross national income per capita (PPP international $): 1800 (World Bank, data for 2010)
Life expectancy at birth m/f (years): 66/69

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