Revisiting transfer policy for health service providers

As we are committed to achieving universal health coverage by 2030, there is a growing concern that optimal health care service cannot be delivered by simply ensuring coexistence of infrastructure, medical supplies and committed health care providers. The WHO argued that the improvement in health care service requires a deliberate focus on smart personnel management of hassle-free and convenient transfer, posting and timely promotion policy. A comprehensive data base of personnel management needs to be in place and aspirant applicant needs to know the name of hospitals or health complexes where they will submit their applications on the basis of their best choice against a particular vacant post in a hospital or a health complex. Location based specific vacancies need to be mentioned in the nationwide recruitment circular in newspapers. The Public Service Commission will follow all existing procedures for recruitment and will recommend for appointment as per choices of their preferences in the union sub centers or upazila health complexes, district general hospitals and then medical colleges or specialized hospital etc.

As we know that the government healthcare is steered by the Ministry of Health and Family Welfare through its different directorates such as Health Services, Family Planning, Drug Administration, Nursing and Midwifery, Health Economics Unit, etc. The public health care services are organized at various levels such as union sub-center and upazila health complexes, district and general hospitals and specialized hospitals and medical college hospitals etc.

Government doctors are recruited mainly as Medical Officers or Assistant Surgeons for the hospitals and health complexes situated all over the country ranging from capital city to union sub centers. Managing their transfers and postings at different hospitals and union sub centers need huge arrangement and managerial skills, database systems, expensive time and efforts. Of course many doctors need to stay in urban areas for genuine personal or family reasons.

The management finds it very difficult to manage transfer and posting to fulfill their valid reasons of staying in towns and cities. Sometimes, it is very challenging for the management to fill up vacant posts in the union sub-centers or upazila health complexes. If a doctor working at union sub-center gets chance for higher studies, then finding out substitutes for that post becomes difficult. It is important for the candidate to join the higher course in time. For getting a deputation order for higher studies, a candidate needs to exhaust valuable professional time and efforts. The thing could be easily managed if they are recruited against a particular post at particular hospitals.

Situation turns grave when a doctor couple are posted at different places. This kind of unwanted disposition needs to be addressed by prudent policy options. The doctors themselves also feel very bad about the situation, where they need to engage in an unproductive effort that hampers their dedicated professional health care service delivery time. On the other hand, the health management at the top policy level also finds a very little time to engage in the development of health services planning, implementation of plan and monitoring of the health projects because a substantial time is wasted due to managing transfer and posting.

Doctor’s recruitment, posting and transfer system in UK, USA, Australia and some other developed countries are different. Community based doctors which are called General Physicians (GP) are responsible for primary health care services and doctors in specialized hospitals are responsible for tertiary level health services. GP means a doctor based in the community who treats patients with minor or chronic illnesses and refers those with serious conditions to a hospital. They are recruited against a vacant post of a particular position of a community and specialist doctors are recruited against a vacant position of a specialized hospital of a district. The management published advertisement for recruitment for a specialized hospital or for a community level as GP against a name of vacant post of a particular hospital. Therefore, it is crystal clear to the expectant doctors that he is going to be employed against a particular post of a particular hospital established in a particular district or as a GP in a particular community.

If the aspirant doctor is fully convinced that the appointment will meet up his or her personal or family requirements and at the same time the post is suitable for him or her in all respect with probable promotion prospect, only then candidate will apply for the position and join the post after appointment. The time will never be unnecessarily wasted in trying for securing a transfer order after appointment. In this recruitment process, place of posting is quite known to the candidate before appointment.

In case of Bangladesh context, the same and similar system of recruitment exists only in the private medical colleges, the Bangabandhu Sheikh Mujib Medical University etc., where doctors are recruited against a particular post. The advertisement for recruitment is published against a particular post. If the expectant applicant is fully convinced with the terms and conditions, he applies for the post with a clear idea that he may serve this hospital for his whole life if he likes. Of course, he may want resignation if he desires so.

Another smart part of hospital management in these private or autonomous medical colleges including the Bangabandhu Sheikh Mujib Medical University is department wise budgetary allocation. Each department gets the separate budget to buy things for their own department. The department head has the authority to buy compatible medical equipment including furniture which is required for the department for the sake of quality medical service to its patients. Thus, the management policy of these hospitals is identified as the efficient, effective and patients friendly. But doctors in government hospitals have very limited delegation of power to buy things for their departments and this impedes quality service delivery.

On the other hand, recruitments of doctors countrywide for the government medical hospitals, district general hospitals, upazila health complexes and union sub-centers create an unclear situation for them. If the choices of preference or options for workplaces are given in application form, it might reduce sufferings for securing a place of posting at the beginning. Transfer policy in government hospitals may be revisited for ensuring complete benefit for the doctors so that they can deliver most without any anxiety.

Some health service experts say, there should be interchangeable two tiers of health services like some other developing countries such as National Health Services (NHS) and District Health Services (DHS) for better management of health care services. In addition to that expert opinion is that the third-Party Payment System needs to be introduced, as because the health system is pluralistic in Bangladesh where about fifty percent of the services are provided by the private doctors or private hospitals and the majority of spending is out of pocket payment.

However, government hospitals need a trouble-free transfer policy in consultation with relevant stakeholders, including respective health care professional bodies i.e., Bangladesh Medical Association (BMA), Bangladesh Diploma Nurses Association (BDNA), etc., to avoid the sufferings of transfer and postings. Comprehensive systems of health management policy such as prudent position-based transfer policy and delegation of financial authority including timely promotion may ease the existing set of circumstances of unproductive efforts and wastage of valuable professional time for managing postings.

The writer is an academic. He can be contacted at s22arefin@gmail.com