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The health authorities have launched institutional practice at the government healthcare facilities in 39 districts of the country excluding the divisional cities through introducing specialist chambers.
The initiative, meant for ensuring the betterment of the poor people and reducing their out-of-pocket income, has been taken under a pilot project undertaken by Directorate General of Health Services (DGHS), said Health and Family Welfare Minister Zahid Maleque while inaugurating the practice on Thursday (March 30).
Initially, services would be provided in 12 district hospitals and 39 upazila health complexes where consultation as well as radiology and imaging services would become the focus for now.
According to the ministry, afternoon consultation services would be available in nine districts under Dhaka division while seven districts under Chattogram, four districts under Mymensingh, four districts under Khulna, three districts under Rajshahi, five districts under Rangpur, three districts under Barishal, and four districts under Sylhet division.
District hospitals in Feni, Jamalpur, Naogaon, Bhola, Sunamganj, Cox’s Bazar, Khagrachari, Manikganj, Rajbari, Jhenaidah, Thakurgaon and Kurigram will provide health services. Besides, upazila health complexes in five districts--Chagalnaiya in Feni, Sarishabari in Jamalpur, Sapahar in Naogaon, Char Fashion in Bhola, and Chhatak in Sunamganj--will also provide services.
Again the people of only five districts living in two of the upazilas in that district will get services. The districts are: Dhaka (Savar and Keraniganj), Natore (Gurudaspur and Boraigram), Rangpur (Badarganj and Gangachara), Jashore (Monirampur and Keshabpur) and Sylhet (Bishwanath and Golapganj).
Hospitals will provide five healthcare services
The ministry has approved an institutional practice policy 2023 to make the initiative sustainable.
According to the policy, people will get five types of healthcare services in the afternoon--consultation services, diagnostic and laboratory services, procedures (CAG, endoscopy, laparoscopy, ECHO, TOM and so on), radiology, imaging and surgical services.
Initially, services would be provided twice a week, but the health authorities want to provide services on every working day.
In medical college and specialised hospitals, assistant professor, associate professor and professor will have to provide services at least two days of the week while senior and junior consultants and general practitioners have to provide services two days of the week in general and upazila health complexes.
A lot of challenges lie ahead
While talking to several physicians working at different hospitals ranging from specialised hospitals to upazila health complexes, they were confused about the success of the pilot project.
Seeking anonymity the physicians said that patients in the districts and upazilas rarely have renowned places to go for consultation and so, it will provide the government physicians to have more patients.
They expressed their concern over the fees. According to them, the fees for the districts and upazilas are comparatively higher while the fees for the professor is lower than it should be.
They also feel that the government does not give clear instructions about how institutional practice would be run. They fear that sitting only two days in the respective hospital can force the poor patients to go to the specialist private chamber for getting proper
treatment.
Again they raised questions over the capacity of these hospitals to provide diagnostic and imaging services. Manpower also becomes a concern for them. The physicians fear that it would open a permanent chamber for
the doctors.
Plan for three-layer consultation facilities
Former president of Bangladesh Medical Association Rashid-e-Mahbub said that in the context of Bangladesh, the initiative has a high chance to be a failure. But something good can be brought if it can be implemented in a structured way.
It will help the poor get better services at cheaper rates, he added, mentioning that for these several issues like manpower, testing facilities are needed to be ensured.
Prof Dr Shamiul Islam, director (admin) of DGHS, said that the initiative was taken targeting the poor people to have best consultation services from top-class physicians in specialised and medical college hospitals across
the country.
But for now, DGHS started it on a pilot basis to see how it works and what changes they could need to bring to make the services sustainable through changes, he added.
This initiative has already been taken to provide extra manpower (at least 4 assistants) to the hospitals by the end of this July and the technician problem would be solved soon, he said.
“We want to use all potential services to be rendered to the patients. And so, we want to provide a three-layer consultation service with cheaper fees where most deserved patients from any remote areas can go for a systematic consultation service system from upazila to specialised institute,” he added.
