The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution

Abstract

BackgroundBangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007.MethodsThe study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward.ResultsHCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditional healers, homeopaths (qualified and non-qualified) and basic care providers.ConclusionsBangladesh is suffering from a severe HRH crisis--in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution--which requires immediate attention from policy makers.

Incidences and Costs of Illness for Diarrhea and Acute Respiratory Infections for Children < 5 Years of Age in Rural Bangladesh

“…20 Unqualified practitioner do not charge visiting fees, and they are abundant in rural communities, minimizing transportation costs and wage loss. [21][22][23] However, since they often run their own drug shops, they may prescribe a greater quantity of drugs compared with qualified health-care practitioners, [24][25][26] increasing overall cost per episode of illness, suggested by analysis of medicine costs in this study.…”

Access to a Skilled Birth Attendant in Bangladesh: What We Know and what Health System Framework can Teach Us

“…Health Resource for Human (HRH) is an important determinant and factor for measuring health outcome for maternal health and MMR [20,21]. Bangladesh has been found to be one of the 58 crisis countries with the critical shortage of HRH/ health service providers (doctors, nurses and midwives) [22].…”

A Qualitative Assessment of the Effectiveness of the “Incentive Package” Piloted in Shahjahanpur, Bogra under “Alive and Thrive” Program

“…[18]. This shortage of qualified health workers is considered one of the major barriers to achieve the health-related Millennium Development Goals (MDGs 4, 5, 6) in Bangladesh [19]. Breast milk is viewed as the ideal food for healthy infant growth because it not only strengthens the emotional bond between mother and child, but is also the most economically feasible method of feeding an infant.…”