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Public Health Administration in Bangladesh: Looking for a Pro-people Policy

Article · March 2008

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Mohammad Nashir Uddin

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 Soci€ry&Charyc
v.l II. No l. January March 2008
,",,,.".,,,,,;.j:,1'i,::,l,ltiii;;

I AmLson, L., Knudsen, ( . 2l)04. Pstchosocial carc and ecti p

in €nrctgcncies: A fickl guidc. Sale theChildlctr Fcdr.rion.l
2. .hrndra, v' ay ld,r,'\.l{Jt$l' Ol n Roucnco \rl'nlr. Public Health Administration in Bangladcsh:
L Choudhury, W A.. Qun'shi, F A.. Haquc, Looking for, Pro-peoplc Polict
psychosill aspecis ol rlielld prcparcdrcss
Mohammad Nashir tlddin'
Revicwo, lsy.lirtr. Vohrnc l8,Nunber6,p5
TolayelAhned""
Dash, S. 2006 hych.sicir iinp.cls ol di d pros'! 1 initiatives. Asian
Disa$$ M msrno,l Ncws. Vol 12 .o. I
5 DnBli:006i Nlrntrl hulrh a.'l L'\p(rr of d'astd
prcn.RdNsl.t cmalnf llkview oa Peoplc ofBangladesh, mostly livins in rhc rurul a@s arc very hardworki B
Frcdcrict. ( l l9s5 Cl\iklr$ by carrslrophir siloiri{,ns.ln S. Elh
with pmven capacity to prcscrvc mcntal strcngth in the event ofunexpectcd
rDdll S l)y oos (eds), P(Nc ic Slrcsa Disonl.rs D ( hildren: 73 99. extensive loss due to nalur0l cdlamitics (lloods, cyclones, eridcmic elc).
W.shi Ekni, D( An).rio n But unro.tunntely their basic nccds ollivelihoods incldding hcrhh care havc
7. Covc'iDerl ol l|c P.oplc\ r€mained largcly unm€t. Population explosion, trequent nntural disastcrs.
ol Annlladcsh Minisny ol Food and
Plan for D'snstcr D.n.goncnt 2007- incompelen.c ofpolilical lcadcrship, w@kness in public adminishtion and
20t5 aovemece arc held primarily eponsiblc which lead lo shorlage ol'
l,adsogh-D M resoudes for investitrg in sooial sector viz. litcracy, lcarl. sanitalion ctc
1985 r olnrc psycholosicrl cllsF oldisasrer.
rflry (eds.), Peapccrivcs on Disaslcr RNov€ry:22 60. lmproper distribution ol scarce .esources and sodous dcfcch if
manasement rre aho claimed to cxis0'. Bangladesh wiLh 142 ol'
populalion is one ol the world's mosi denscly populatcd countnes 'nillions
which
Shrnl!!!. N & Edwurds, G. 2004 Nalual disster and
Asia l'sychialry and Clinisl Ndrcscide. Vol,58, tl0 spend on US$ 7 pe. @pita ,br health. Surprisingly enough agaiDst this palc
I16.
backSround, Bangladesh has n good in{iast.ucturc for delivffing primary
Ndronal Ad.prdrron Potsrdm or A(tron (NAPA). wdte' .healtb care, )d sadly cnouglr rhlt the tirll polcr)tial olthis infmstructurc fias
Nalural Di$stcr& H€ltl Secto!, Warer Resourocs Planning
ncver bcen utilizcd due to lrck ol propc y implcmcntable hcalth servicc
policy and manflgement. 'lhc indcpcndencc of Bangladcsh l97l actcd as !
llodlrh orsanizarion (WHo) 2005. Manual ror Connruniry Lcvel
brealthroush li,r thc de\(lopm{ r or puhlic l,(ohh in rhis pafl ul land lhe
ro ltov'dc Psychowial Carc to Comrunnis Attirrnl by rhc
i l)isnsrd ResioDal ()llice ao. Soudlnjsl ,{si,. N* Dcltri. of Alm. ,ti'. ut-gradalior ol hqlrh inldsrtucrurc (rn 1982) xr
'16laml'on
conneclion with the general administmrive rclbnns, adoption ofHcalth and
Population Sccror Prosramnlc (HPSP) wnh thc hclp of World Bank (wB)
was expected to significanlly reshape tle public health situation of thc

The health retwork includcd esrablashmcnr of incdical and dcnr.l

college, upazila health complex, postgmduatc institrte lbr higher sludiu\,
establishins aulonomous bodies likc Banglddcsn Medical and t)cDt l
Council (BMDC), Bangladcsh Nursing Council (BNC), Bansladcsh Shrc
Medical Faculty (BSMF) 10 rcgulale sta dard and quality ol nrcdierl,

telurcr, Dcpad'nenl orPublic Admi'risrdlioo, Shrhjalal Univcisity ol 1ii.n(c

& Tshnolosy. Sylhcl, Brrurladcsh.
Assooiatc Prolessor. Del)lnrrenr ol Busilrc$ Adnitrisrftti(nr, 1..r,| rf
Univesily, Modhuban, Sylhct, Ban!:lad€sh

42 43

Y'FGTlEffi-ffi'
Public H@llt Admin'stEtion iD Brnsladush
nursing and paramcdicdl cdtentnn. National Instiiule ol Prcveniive and
Social Medicinc (NIPS()M) wrs csrablishcd L{) servc as the national focil
point lbr highereduca{io,r in flbl,c healthr.
Bangladcsh expre$e{l il\ co,nmitmen{ with the world comhuniiy lo
rends minimum he'tth . ! scrvicc li,r ils people and fosnulated national
srraksics and plan olr.ri,D li'r {rrliniog Hcallh Fo. All (HFAf by fixing
up a numb$ 01 nriJor lierllli iss,,.s rclatcd to national hcalth stalus, servicc
delivery, covcrrBc ni(l ,]! ily ol lifc. Accordnrgly. Primary Health Carc
(PHC) rcoci!c(l Iighcn |ri(!ily,n ihc ncxt national fivc year plan
emph'si7.d or hu, nfiirr i'cns (viz. i preveme.t of hcalth slalos,
dc.vckDncor ('l lrxlrl, crre dclivc.y syslcrn, imprcvcmenl ofquality of lil!
rnd cxbrsidr or'eovcrr!c, tl r(.cssihility i rbrmrlation ofnational HFA
by thc yclr ?ol)l)) lhis .hu[( riu,scd on I re tcorSlnizatiol of the heallh
inlr slrudllR.rs tIt ol rh( Ard$ l r(lnirislrdlivc rclb n prcgra'nnrc. l1
wrs rls' noliecrble in ll,c lin rfhlrnr oi nrlitnul d ,g polic' Bul cv€n
now thc l rgctcd Borl hrs n(,1 bccn Nl,icvcd 'lh.rc wc.e somc imPorlanl
s(ldies on rhc hc.llh scet,n nn{l hcrllh *-Niccs in l} ngladcsh Khan
Ahmcd. Andnlccb, Mcndoz! ard srbir. Alrd r J lld(luc. lirincc and olhcr
highlighted some sisDills rr issucs nr thcir w{trks which nrainly cxplorcd
the cxisling struclural and firncli(tul tspccts. nr.t$ health programmcs,
perfomancc of diffcrcDt scctors, and in,rbility of cole ng the total
population under hcalth carc seNae syslems. Awareness 6isin8 and
cducalion were ako emphasiz.d here. 8ul none of the r€scl1rche prcvidld
impo.tancc on pro people policy. administmtion ard responsive redesign of
health ir the changing rcalities and dillerenccs anong the beneficialics
bccause ol their stalus. gcographical location and acccss lo righl. In the
contexr of Bangladesh. it is an endcalor of the presenl sludy to make
preliminrry ctlbrr a1 undcrslanding hcallh sector.
On this hrckdrop this paper aims at idcnlitying thc rcul condilion ol
exisling public hcrlth. public hcalth adninistration rn(l public hcdlth
practiccs. and rcconnncD(liirs Dcccss{y rnc su,cs tbr I foo. ftlendly4no-
people holllh p(ticl rdDrinisLrNli, rs wcll s r slurg rtrd sound heahh
serviccsvstc tur l|.oAlidcsh.
Conceploollrrncwork
Health is rrctabolic olllciercy conxrslir)g t() sickncss as a mctabolic
irelliciency. Nobody is trn lly herllhy or lolrlly sick. Edch ofus is a uniquc
(ombinafiun or hulrh .rn,l \hhrcs. Arrl ,a.1,
^l u.i hac a _urique
combination ol ab,lrtr rntl rl'$r,ililks. ht{h cmor,onal rn.i phystcal'.
. Hcallh car bedefincd n.Balivcly. s lhc abscnce ofillncss, tuf,clionally,
as the abilily to copc with cvcryday activities. or positively. as fitncss
and well-bcing. 1n uy orsdnism, ltcAlth is a fom ol homeostasis. l his
is a stat0 of balaDce, with inpuls ird outputs ol- ener'gy and matter in
'-- *.*-"---
"., ".",,,,,,,.:::;,i:';1,:,1'rllr;:,
cquilibrium (allowing tbt 8r()wth)- Hcalth also implics 8oo(L 1)rt)\ r(.Ls
tbr conlinucd survival. It scnticnl dealurcs such as hunans. rcallLr ,t iL
. IIaXh is viewcd holistically as an interacling system with mcnl l
emotional and physical components lf rctuse lo 'a sralc ol co,nplorr
physical, menlal and social well being and not herely the abscnce o
diseasc or infirmity" (wlJO I9941.
Public health is community hcalth. lt has beerr said th.t: "Hcallh carc is
vital to all ofus some of thc timc. but publi. Icallh is vital 1o all ofus rll ol
On thc othcr hand Public llcalth Adminis$ation k a pan ol publie
Adminisbationt havitrg ! molb b Jclivq scrviccs on one ol thc basi. ncod
as well as a hunrrn right ol lhc pooPle. It is d sclicxplanatory concept bv lrs
name. All aspects of adNinistratios a.e dcalt with here like hunla!
re$urcB manaS€mcnl ie. pc.sonnel managcmenl including rcduitmcnt
seleclion,lraining and dcvelopmcnt, Promolion, discipline, transfcr. wage &
salary adminiskation lor rcmunention. Iocal governtncnt i.c involvemenr
ol local bodics and local pcople ibr €nsuring their primary hcalthcalc
facilities at grassroots revcl, (rural and urban), linancial managcment for tlrc
very requn€mcnts offinancial base to delivcr lhc scn''6 smoothly through
' Public lI€ahh administrution includest hcalrh services rclaling l()
combinations of both curativc nd prcvcntive medici.c ir centrc anlt
pe.iphery, ervironmcnlal sanjlallon, pcBonal hcalth. conrnrLrnity heallh,
cont.ol of communicablc diseascs, vital statistics, prot-essional educalion
and tmining as well ds s@ial welfarc and social sdurity, labour welthrc.
nutrilion, recrcation, family pl0nning and olhcr h€alth relaled activilics (likc
msss vaccinalion and checking of iood udultefttion.
Like other public agcncies, thc public hcallh administration rlso
r(qrre5 organi&ror. srruilurc. p1\nnne alJ Lheir derelopnren. flar'r''r't
dnd manasemenl.'ll equaliy need pldnning. ortsdn,zrng, slarlinE. d,(cl,ni:
coordi.aling, repo.ring, budgeling. line and slaff posilnD of fic.lrl'
p(^onncl. lcalcr pru.es\. llncrionJ organrzarrnns. JdminrslrJ " rrnl
rLl
mdnaaemenl oper.tional iunction\
Brckground ofpublic he.lth administr|tion in Bangladesh
The historyol public hellh in Aansladesh (as part of the sub-conrincnr)
dates backlo tle colonial rul€ of British lndian eE, mearl lhc pnntcri,nr
and promotion of health oflhe personnel and thcir civili{ns l I
administrative machinery was meani io govcnr as a policc sltile rri(l fLrhl .
'nilitary
health was a transfered sullect.rrTbe real developNcrr ir fublie h.ilrl,
45
l-
Public Hcalth Administration nr IJ.ngL!dcsh
sdministration bcgan in 185, whcn thc rule were laken over... by thc tlrilish
crownn Afterwa.ds, sigDillexrl trogrcss has becn made penaininS lo
decisions a.d acts .s ecll rs building ol institutions. In the Pakislan
mrvlmcnr. rh<rr uJr ., r, plcrc breakoo$n ^f nJbl.(
adminislralion, but it was dc(.nlrilizcd with mdimum authorny aiven lo
rhc provincial govcnnncnrs. rhe govcnnnc r ofEasl Pakistan, through a fiec
year plan. anirialc{ ..r nnrs li)r ric inrrov€nent of the health adminisrralion.
'Ihat was a $hcmc wirh n vicw lo
Dn)viding integmted and comprchcnsive
healih clrc t,) Lfic nnl F)nulrri(D. lirl ljasl Pakistan (lhtr independent
Bangladcsh) di(l nol rceci!c ertoihhlc shlre of central allocation and
supforr li)r lhc (lclcl.l ,cnl ol ils hcrlrh nanpower and be.llh servicestr.
{nd il wrs ,r)l w.l t)lxr,ed di(l (ln] r!'l keqr pace wilh the increased nccd
ol cw wcll:re sliL{c. lh s i!,)ss (lisprtrily ir thc dcvclopment ofheallh
scrvices r(lriiD(,rr!n rln) lil|,lllei st)hcrcs developed a scnsc of
doprivrli(n,:trn(n,g ll,. ((r, Lry,rtr Nheh rc$,ltcd inlo thc bidh ol
BanglLrdosh rs r rdclien(leirl !,!( .i8n slrlc. .rust atlcr independencc, a
good Iutrrbcr ol rri(rrli!cs liivc 1!a Lrl,eri itr lhe ilckl olfublic health with
righr cnnrsl lt s rarinsl llls brr\!,,rrn lhxl thc fros.trl oraanizalional
sel-up of hrahh scrvicL\ ir l).D8ln(l.s[.trrcr g.rl.
-l-hc
hdhh scNiccs syslcnr n! lrrorh.lcsh cdltniscs tlrrcc orrponmls-
public, privale and NGo cuN voluntary scer('
rr
lhc oqarizrtion structure
of hcalth $crvicc nr BanEla{lcsh l('ll(Ni tic flcrd l dorioislralivc pattern
ofthc counlry. Thc prcscnl struclLnc n(l li cli,!rin8 ol lhc hcaltfi services
is oricntcd toward dclivcry ol frirtriry hcrllll !rre (l'llC) to vast rural
popllation through a netwo ol hcllth l cilrlics dtrlopctulioral lield stall'
to scrve th€ minimum nccds to bc solrr{l ,)i th( |eot)k.'5 nqrccrs of public
heallh administration can bc catcgolizcd irrlo lh,ee-li)l(l points- orsanizAl;on
structur€, maopower and delelophelr1, . d hcxlth planning
development. The eftbrts of public hcrlllr rd rnisLrrtnJn are dircctcd
towards raising the level ol health l)y Dhn ins- ortsanizin8- slaffing.
Jircctrng. (@rdrnatrng. hudgel'n8 !D,l r.,ll rl,ese pnn.ipic5 oI
'{st({xl,,,a
OrglnlHtion ind Management ol l'ul'li( Sc(lor health Senices
Brnglrdesh
Ihc organization structure o{ healthMrc dcliv$y system is bascd on a
patcmalistic (bureaucratic/top down) mo(lcl rrthcr than potulist (bottom
up) onc. llerc is a top down pol;cy d€cisiurs rcs.rdnrs manpower planniirg
and developmenl, dcvelopment of thc syslem ilselt, cxtension ol lhcilitics
and allocation of rcsources and financc. Ilrsicrlly, policy is fomulated at
the central level and is caricd oul thc docisiors at va.ious levels liom
nationallo 8.ass roots level
46
So,r.r.('.rr
vol.Jl No l..r rLi ] Nttr,ri,r a
ahte t: L4ttts ol lubti ht|tth.n'? tn,'it'itrutiul
Lev€lG)
hcahh
Div/Disr
Dist
Ar rhe lop (national) levcl, rbe hiAhesr admnristrativc (supervisory)
auftorny lies ir lhe Ministry of Heallh and Family Weltitrc (MoHt:W)
headed by lh€ mirister and assisred by a sccrelary, an administRrivc
_ sclion, one joinl secrehry for he.llth a'd famity ptannins divisior Thcy
are also assisted by dcputy s$rclarjcs and assjstanr sccrelaries. l.hc
direclorale Sencml ol healrh sdvicc (DcHS) operalcs underlhe minisrry ji,r
health seraicc only {in ocrrral lovcl) Thc DGHS is assisred by one dssistair
director seneral (ADC), 8 dirccros dnd I Dumbcr of deputy d;eckns,
assislant dircckxs and olhcr srppofling slatll
The ministry is responsible ti), Ibmulatjon ofpolicy, decision{aknr'l.
used egr'ldrion rn roordinario', siLh ,,rt"c, minsrr.ci and bi,3rer.,t ..rii
intcrnational healh agencies and Dc js cntrusted wiih ptanniis.
irnpleDcntatior, moniloring aDd revicwing of progBmDre and proi.ds. ir
the national levcl. national speializcd inslirutioDs provide a widc mnBc ol
seni@s well known as super spcciatiz:diN healthcar€ tike cancer, tliabcrcs.
i. cardiac sur8ery, onhopedic, ncurosurgcry erc
National lcvcl policy and progrannne includes srrcnAthcnin[
ir ltulrucrJrc: ndlional tirLB nol,.v. narh,nu. p,,tir1 fcr rCrninrrrrr:,, ..
nredical studcnt and nsw incumbcntst Mcdicat Co cre Hospital (M(.lt) r d
lamily planningi Expanded Prosranme on Immunizatiol (Hpt); conlk,t ,,t
diarrhoeal discAs€s and disaster managcrnent; nurririon prugr.nrnrci ,ri.r,
baclerial diserse contfol. production and suppty oi druss, vrc.incs. sc,i,.
tluids and reagcnts; supply of salc drinking warer n(t srn,rrry trtrL rds.
A.senic conhol nnd mitiSation proS.ammci Sexux y trrnsrni .(t t)is.Js.\
4l
l,ublic Ilealth Administ@lio. n Bangladcsh

(STDS) and HIV/AIDS: ficrlth . rc qualily assurance; hcalth educatior; dnd ',",
,, ,,, , ,, i|i; ;,i 1,, l;t1it,
!e
multlsectoral approach for s'ciocconohicdevelopmenr ULSS. The Union Setuicc Cenlre (tjSC) is srafied by ore n,c(tic.t 1,|.(.
or e n crnc., .r dno ore Vl \\
Ward is the lowest unit of pubtic heatth adminjstrarion lvsrcn $.h.,.
At thc divisional lcvcl. divisiLr!1 dircctor is responsible for supcrvision.
monitorirg aDd coordnhriof ol holth dctivitics in all dislricis under ilrc
lerlr\ soi",. pror de doo^,-o ,cr\ip. Lo te t(opp 'tr.. ,,. ,..
donlciliary seNices and ficld visils.
division. S/hc is rssislcl l)y llrc rssistdnl d;€otors- one lor administration
and the olher tbr Ccnr,e liir (liscrsc Ornttol (CDC) and by othei staft':o At the village levet, there are comnuniiy ctinics; sale ile ctintcs ds
There are tuedical colLer.ic h)stlilrLs rn c.ch dlvision, providing specialized ost perjpheral level heaith serices tacitities w h a view to prcvntc
and laboratlry lacijilics lir llrr lr..lrndrl 01 complicatcd diseases. lt also minimum ca.o. From time to timc, this seNices are delivered (say oncc I
takes up thc crses rclcnc(l lo by lhr oer rnd districl level hospitals. There nro,I ) lne pr..e1rs a-e morird.co r^ dn.r"o rd\c \er.1.c\ rhe.e t\( I t,l
is limitcd rdn,i,, slrrri\ c rL,(lr{r ily nl this lclcl Ordr R!-h) ora,,on I heidp) rOR L +, \ iccs. awdcneR raisins abour .c: tr .,
sanilation nutrilion conlnrunicable diseases ctc. The skffin; palter oJ. thc
l'h. (ivil su,sc,r, (( S). i,i llt rlislrieL Level, as thc team lcadcr ald .l.rL r. onc heJlr .
hcaltl uthorily, is ,!sIo,,sL rlc iir rll lrcr lh xclivitics- illsLitutional and J.ss'd r. on\ tJ it) trF.arc \rs,ror. A..r t,u.,t,
donriciliriy ci..tlinA fre(lic,rl collcgcs rr!L lrostll.ls atlached. He is
assistcd br- oic dcDuty.iviL srilc,nr rn(i ,ni , edi.rl olliccr and other Health Services in Priv*e atrd NGO Secrors
lcchnicNl rn gcnctul sLali. Ihcsc hosJrihls [c sdvrig rs lhc rclirdl {br Pr;vaLe srctors arc in$easingly taking part jn heatrh secro. of thc colnrra
lowc. levcl heNllh conrtlc\cs (!trzild) liJr lirnhc, t,.rtiic l wilh bcd sl'ch s ea(il) \r,bl< ir ctrrc. dnd o"glo{r..rcrr-e A.uw- pa t, Jr,,l
liicilitics vlrying t.on 50 to 250. Sonrc dist,icLs [n!c nrcdic l college c\e1u\de lr ,sror nL.h o ta,,t,dr pn\drr.*, n,.dc ta) rs t..,t ,,;
hospilals. Herc, servioes provided atc ol spcciali(, l$oratoy and r. e he.Lr\ -are alrhurg\ 'h, rtrc oo^r parro r. gorc-nre,rL tro"p . rr,
.ri.l 'rrle mdior p,ovioeF A tdirt\ ."rgc ru-bi.r NuO J.a pdlr "
At the heart ol tire system Upazila fioalth Conplex (UHC) plays a Dnrpllil r^h nrm"l\ BRAr' con^ Ssr\)r K.nJro. VH\s. ta;,r,;r
pivotal role in public health delivery system providing scNioes diversified Planlrng dsso, iJr\.n ut Bangladc\h tn rod i {. ro r.)ar rhe ..prrdri,,.:l
:e1 .
a ,d LUmple\ rn .,luencild nr p'e\enr.(. .urJl p ( 1p.' :crr. Jul-pd donor agencies, viz. wHO. UNlCEF, UNDp, UN!-pA, ADB and WB. sonrc
arae ro.r;. t "na
prom 'r.. e'' lt Jc ' I 'e rcleadl scr\ iLd ro unrnr I edl l olher organizaiions iakc parr in bi laroal programmcs. viz. USAID, SIDA.
cenre. In the same timc, belongs 1o the hierarchical siruclure of the DANIDA,.JAICA, NORAD ct.. other inlernarional o.ganizalions also
secondary and tcrdary levels. It also extcnds sesices of management, de.enL nen,on.rIl .d\LI rI ILJI, . Lro,UK.Us.A-n.d,",,.,.,
training, technical supporl and coordination to ihe gmssroots level health D.\ Homnre.. ( ARL, Pd ht,nJd, Ht I D. u\t \M eLc {
senices agencies and pe$ons. The upazila health and fanily plann'ng Table 2: H.ahh ure sticeJbtilitia\ at t.qtu,ctls
officer plays role i$ the team leadd hlving assistance from medical
otlicers/specialists, denlal surgeon, sanitary inspccto (fbod & sanitation). Orernizltion & No. otR.di
hcalth inspectors, nurscs, laboratory technicians and odrcr are supporting Rcr,$erll docbn IMBBS FDsr
stafa This unit is enn!$ed with providing primary hcalthcate sewiccs.
Simultaneously. it prcvidcs some specialiTcd carc likc n nnjdicine, surgery.
dentishy and gynecology
12219
Union lcvcl,1': as the ]ower lcvcl/gmsstrDts and sustainable
administrative unit p.ovid€s scrvices includiDs hcalthcf€ to pcople. This is Resisrcrcd tein.tc hcahh insic.ror

the smallest and mosl peripheral healthcarc scrvicc unit havitg sub centrc The availablc heallh care seNicc facitiljes are not adequarc enough conrp e
which provides out patient seNices tbr injuries, woLurds and ailments and to the sjze ofpopulalion ol Bangladesh.
wiih no diagnostic. su.gical or bed lacilities. This unit is undcr lhe
leadership of one modical oilicer as in charsc and is assisred by onc
In 1998-1999. The Centre fbr Policy Diatoaue (CpD) condrerc(t I
.rudy on rhc parier.. g^.ng dbroJd and tolnJ abo r' 851. ,,t tn1,r
medical assistant, one phamacist, one family welfare assistant and one .t. , ,rJ
that the physicians did not concenlrate on them as much as thcy nccd ?6

49
Public Health Adminislraliu $ lld glidcsh
vol ll.No .Ja'0xyM (r.,u[
Per!onnel dministrAtirt, i Pr.cliccs ofpublic bealth
The dubhc hc.llh Dfl\r!'nLl J,lnrurrsl'ilron nrcludes virious lunerius 'rf
quch d\'hc rf(,1,r'ncnl irld
Dcrjonn(l r1 lhe h:a'.t.j(!r,,. ..t llr JounrD D$ignrtion
1.i"."- .*"a,. . t(...r1, , rri. .,1\. rl ri, rturniIA. ,o\ancene,,r rnrou;|, Male
.-.ot...,r'.t mtri\.,r ', rl'n{.!" $id(. salary and inccnri\c\' Jt{rrrulin 581 '72 651
l',"rr, a""'"r,'.'" .(rx lir( titln,'rrn\' translbr. Puorshment erc
' 65 55
-"n"i"..'r L.'"rr"*',r'rt'-'{,r'('. ;iscd in Dlblic hcdlrh'c1"r' The
..' t'..,"*' {(\'{rlllL, r". JJrrfirc' in Lhe recrlinlcn 608 608
"'nini".us,,r
an.l selcctior pn)ccdu,c i,i rht l)ubli( licrlth lcrsonncl
RecommcrdarioN rnd Conclodins Remrrks
The htrpolv.r tlrtrni,u Nl dcv.l'IDcrl lnlicv basicallv tbllows lhc
n,,t,.' ,,r ..'irrr. r'"'"'.r,:' ' ' t\', r,i.l rrr,rragLm(nl iD h(dlr!' Article 18 (l) of thc constitution of lhe pcople s Rcpublic of Bangladesll
l,-'a'.:..rr rr."'', 'r" r.", 'i"'tl"'L .r '.rri.'u' lc\r't lr'n r(co8rr/ed pdol,c.hcalrh a5 d llndJm<nlal ritsht a d !s lnraa durl or rhc
n.tntrrl r() t)crit,henl otres. sure lo ensurc ii'. h also rfl'vrded lo rais( the l€v<l ol nullr nn ard
Ar lnsi. s sc. llN syslc'n ol r.ertriln'trrl 'r'll( S (llcalth) and BCS rmpmving public hcal(h and in doing s lo adopt elfecrive measurcs. Sincc
,l ',,,1t l'-,",',u*, . u.t, llr' 'l\ '!\lr't hr'i rr'n r ir'( ld'-l Public indQendencc the govemment hs undenaken a iairly number of
ii. ,, i r' . , ..,t r-l.1r(
. . itr'r,,
r rru.l r"n rr 'rrrrr *r;r' hcaltI programmes lor €fticietrt delivery ofhealth care services as a ri8hr. A chunk
r.ir"r- t"' "'"rv."u irr *r,,As (lL r '' li .'Pf' rrrrrrrrrrl: "r tl'(lori h rh(
r

'
ol ihe mass p€oplc remained out of proper health care faciliiies. llcalrh tin
minrsrri ot sr,rt't'strmcnr tM;Ur rr l ll(n xs .nlrrs'r' l"\lY n qu(s's lh'' all, (a commitment with wo.ld community) could nor be achievcd so far
( 't\ .ch1r lil:('l
llarrclafe.ll I'L,Orr Scr\rc urrrm..r^r' IBPS( ' " 'lu This rcalily rationalizes the necds to ex mine thc aspcct for adopring
c"naiAot* tlrrouglt a cobpelitive cxamiDalron rnd rccotrlncnd lnr inal sunable policies and plans lb.hcallh care dcvclopment ofrhc ciriz.ens.
- in the The early eflbrts of halth adminisrralion wcre dirocted to alleviare the
i' tL. "e*rv introduced svstcm, rhcrc is a slide chanae suffe.in8s of the peoplc due kr sickncss tnostly catcrinS to the needs of
oroces' br BPSC I-\crv (andi'lale has r' go under a pruecs\ ot
-,--,r'on *ut uhipic Jh',ice quelr^ns (\4cOl ol l00
urbatr elite class whicfi was subscquontly cxtcndcd to enall rowns.3': But
"."1i.*,"
".'ril'. -ii.n rhrough 000 mJ*s wrrren'nd lu0 ndr k' vi\'
most ofthc people ot thc wholc cornlry r,e living in rural areas. t his aspect
o*'in"a.*. *'" to sia rr. should b€ addr6*d in thd hcnlrh r,olicy ol nation for rheir ovenll
HLe hcs rhe dilfcrence wirh seneral o'de *wicc
profcssional rhar
'oee. like health ro takc 200 nurks (2 paPcrs) written examirarion on
c;drc has
Thc government healrh carc scrvlces rc growing dissalisfacrion among
Fo' , , inslance, arc pr.'enling r{o r.hlcs c\plJin'ng llc nrdnpu$er the peoplc because ofunneccssary srowing ofcost without improvemenr of
"e quality or cxpmion offacilirics i,r consisrcnr wirh ev€rsrcwins need ofthe
ol hcalth ( doclors & nurss) ofDMCH he.c:
population. On the olhcr hand, privdlc ciirrics and hospitals are rather more
Tab\e : Ps snr/ oldocton" commcrcial than humanitarian. Thcy p,ovidc seoices only for wcll ollt of
the society wilh a hish cost which is olicn (. alibrdable fb. the poor mass.rl
DBianrlior Mal€ So, the s€nse of s.ial justice has Do$ bcen rclar€d to ihe hcahh ca.c
scnices, as il is a basic right of thc counrfmen which should be rcflecled
l0 29 39
in public hcalth administralion and poUcy.
2 0lt 27 :15
35 The wholecoudtry is conslilutcd with a variety of people from diiler€nl
06
_l geographical loqtion such as pcoplc living in hilly arcas, in the rcmore
t0 52 62
islands Iikc Swendip, Hatia and oihcr places out ofsound transportalion aDd
Hdnourarv nedical otfi c€. 80 r00 180
5 comnunication network. They desenc to have policics of propcr health
6 :15 53 88 care facilitics which they suit. Our study cmphasizes lhe significance of
,7
50 r05 155 necesary policy chang€s of this aspecl by removing thc limitations ofthc
100 395 594 ex isting policy neasurcs identical for all of lhe citizens by the authonty.

50 5l
Public Helth Adninisfalion in Btnghdcsh
The systematic inJlznnrcture ofthe public hcrllh catc scrviccs nctwork
ofthc country could ncithcrclm l!ltsatisfaction ol ll
could conpletcly lrardle thc problems in this rcgrrd. Therc a.e scveral
opinions from vari([s quancrs. the previd.B $ually claim limitcd
allostion ofresourccs Lo hc responsiblc whilc Polioy,nrkcB and recipient!
o! serviccs c'ainr hek ol lanspar€ncy, accounhbility, monlity and
mismanagrmcnr.r' Olhcrs claim extremcly ccnlrulizcd bur€aucracy and/or
incompclent tolilical lcadcrship as hindranccs ir lhc w.y ofcradicalion of
such ptublcnr\ 'lhis nudy likes to suggest thc clinrinrlion ofthc causes
behiftl l|c foor rnd incnoclive modc of dclivcry syslcnr ol Ptrblic hcallh
€rc scrviccs. lIc sovdnNcnt and relevart rulhorilics should kccp lhis
rnattcr h consi(lorntnn whil€ formation ol-policy.
'lhc govcnnncrl ltrovides he.lth carc sdviccs coorFchcnsivcly and
cxn ol,cratc il Iionr r macfo levcl which is inLe l|l.d (luc to inadcquate
inliastruclurc, cquipmcntvitrputs, lack of iunds, suilnhlc sctvicc dclirerv
mcchunisnN. aDd lrarncd s(all] Blrt in case olfrivnlc scctff and NGOS it is a
micro level. sectoril prosramm€ workins oo specilic issues. For.tr ovc6ll
success in both levcls, thc government should encouragc NCOS and Privlte
sccbrs to promore thcn suPplem@tary and complemcntary rolcs in thc
rmplern(nrul,on oi le nrr.onJl prng,arrne rr'. (u Ir-o\rrE .on-clrec:\e
and nauonally rcplrcable models$ Som( suSEesr lor lully nnlarr/zrron of
the ]realth seclor for improving overall managemcnt eDsuring bettcr heahh
care lor lhe people. This is mother outcome of our s(udy b lind out thc
prcpcr relationship of publio. private NCO scctor in attainirg morc benciit
,, -" , ,, )t:,'t,)',]'rtii;i
",,,
1n the prevailiDg (nklilion health sector whcre arscnrc. adL lreLrl,Ltri ,,1
fbod, bird nu, lllV/AIDS rrc coming with its alaming fom an.l ntrli,,ir r/r'
situation risky and lul|ci blc, therc is lationale to be carclul li)r nrlri!
public hqllh adminisLration peple orientcd, ti.ne-rcsponsivr Ixl
mcaningful. Thc totrl systcm of public hcalth sector requires rc(lressinr r('
response to thc chanAing situalion.
Considering the above mcntioned points. We conclude also by nr k,nA
strona rccommendation for conducling such kind of itr-depfi sludy r
empirioal one oD public heallh and administation with a view to h vc ir
pro-peoplepoor-fricndly public h@lth p<nicy and rc,rponsive aDd scosibl!
adhinistrarion lor Bangladesh which will rcllect community l€adeBIiit,,
sharcd decisron makrnC. I'nkages w h orho ortsdn,ar'ons. p,'sir'vr
organizational climalc fbr peoplcs satisiaction and particlpalion. I i.
Sovemmcnl along with privale slor and NCOS should conccnlralc lhrl
atleniion in thjs regard
Not€s and rcferences
L world Bank (19{)9),: raralalcsh D.ftlopth"nt rbntn :Dcvclopnis( Panm's.lli'
sutnons lnr inrproled govcmanoeand raslo refom\ lorgEdtcrpor.ny allcv'di,)
'
Ncws Rclca$ No. 9911999
2 Wo d Hcrlth Orsiniztrri.n (l9?tl),: Al .-ikPamarylleallhCare,tar,/ir
t.r
-11l:.t /. wHO. Ce c!a- 1978
I Azhd, K ^ra& H.quo, A (1999): l)clclopmcm and Slatus ol ll.llth rr

for ndrbnal devcbpment as a whole and can help in avoiding duplication in

Bzn9ladE h".ll
"rn(r
Jo ,ul al Prhlic tl!
lttt Elncarah.l.D.84.1999

herlth cdc scrvicc progra,rms.

4. Part. K., (19?O): Pa* lr /-rrthoo* ol Prrcnt^z an.l StLidl M"dicin4ltt aL .rnn'i
M/S. BaM^idas Bhamt Publishers, lrtia. l970
Ashcrlthc.ri! wrnrnls considcr li(nr ol hum nit rirn rmioach. privalc 5. hupJewe.oaani.rd,or'twlufishcalth.hrDli .ls s€ nrrrtl.t // f'995) Ir\r
secl(tr sho(l(l bc prl)trcrly gunlcrl Lt, fby lh.l socitl tcq\)nsibllity Thc BookolConmunityMcdicincfy''o/),Dh{k.:llHM Publisncs, .lrr?,/r,n /0
.egulrtory f cliccs o' Ai)vcrrtrrcnl ovo |,iv.lc.nd NGO scctoB;l Rasned, K M, R.hman, M, & Htd.t. opzir, p i4
providing hcallh crrc s.,licts sh,rl(l bc ,hcctcd wilh ploper carc afd sc. Rahinan, M.R. (2000): tlcrhh Sofrices Synem in BaDrhdrsll. ,rr,,
Asniiothn oI lnittl Scien@ Ihen tu'rt I^SSI) 9'daerl. v.l rs . N.1 .
Policy advo.rtcs snssc$ lhrl Sovcrnnent should adoplr6 L Raslled, K. M. R.nman. M& llydcr. S.,(1995):,/5i4 r.l4
deccntmliz!tion of r(lmirislrrt,rnr, nrobillz tion of morc local resourccs,
morc a@ountability, pru.liec ol clhics & moralily in providing servic6.
incorporating beneticirric$ ii the {lccisbnrn!king process, and training ol ll. Al!n. S., AllegDntc, j) J.& Alrrdl, D,(1994): HeulLh l](hLurlnfr l ,r!, rii
the peBonncl .elating to lhc prrticular sclor. I-he possibility and prcspects Sm|egid Reomncndaiotr for FuluE RMrcI" H"zft r-.r,dta,t t{ ulk^ut.
of pmclices of thesc phcnomcrra in drc healih care s€rvice seclor in vol-22 No 3.1994
Bangladesh should be renped ellicicntly by the aulhority The govcmmcnt l2 Aad, ,{.K & H.que, . ( 1999): ibid , p. 83
shoul'1be mor€ conscious about thcsc phelrom€Da iD the health car€ ser{iqe /.J Rdshed, K. M, Rahnran, M. & Htd.r, S, (200.1),/.r, r -,,,
s€{loroflhe country for cilizen s bettcnnenl and thereby salisfaction.
5l
52
 Sotr,lya',1i1!!
Public Health Adninistration in aangladcsh

15. Rannan, M.R., (2000): .?.i/, trJ

16. Rashed, K. M.l{ahman. M3/t\y,]'et,S..op.it, | 39
t1 se. POSDCORa coh.t?r,/ l(rhcr culLick & LyndalUrwick PaFrs on Sc,ence
oa Ad'ninisharion. (Nc$ Y.rk I'rsilul. of Public Ad'ninistrarion), 1937 in Complementary Fccding I'r.rcticc i
Rahman, M S, Prbnc AdDin'nr"rbn Theory and Bansladesh Admini(mtion,' Slurn and Non-Slunt arc ,r
& Cd . Dhrkx,2l)01
Khan Brothers l)haka Cit! : {. Cnmpalatirc t rdr
18. CoNtructed bascd on i,ri,nnnLi,[ ni Lturrh, Nutnian hd Pap,lot)on sdL,.,
Covcmmenl ol l
thc l,coplc ltcDuh ic ol aanaladesh, 2005i also scc Direcror
Oenuol .l llullh SlNntll)(;tlS).19ri wnh sone modificanons quoted in
Rahman. M ll, {2000)r,/,,r. t 6t)
l9 Rahmrn. M R., (l')rr')) I',)lr!r l:.onon)' ol llcillh in Ban3ladesh, LrnpublishEd
M.Phil ,tis\r'irrnnr . risxl'i r
Nd,nr th,'vc'r{y. New Delhi. 1999; se also
l)i\rr\ (;(n(hrl rl thlrltL:;,,n.(/)atl/t. Ll. ghdcsh Bulletinc. 1996 (Dhrka
llfl llli Irl,r,ili.' ll i L. i)t;l lS. l\'ll,l lIW. l9')rl) Banglr(lcsh. wilh x popuhlion o[ 1,1t.4 Drillion ry't{c ,,r' tl,e r ' tr,11
20 Az(1, A ( li llilqrc, A I lt)9'))r r. 86 8!). ltr{)9 counr,ics ii lhe world wilh an .stimalcd I4 millj
'?, t,f
2t Iiash.l, K M.l{ahnur. M &Iltrl.r,S.(11104)./!r, |29,2004 51)00 slu N of ils cily Dhaka 'l_hc ovcull condilj ofa shm arca rrc trol
Ildsltn. li.,(20061 U,o1 r t No q\( rx"t OLtri.ttn, tl h k e in \rrr\1:r.r.N all olcr Lhe world bccalsc nn,sr lh. qhm dwcllers a.c trol
lItuhL riL.s ht 8.rd ]^h l.D Publi.didrs,l)hrk\ t)fi1.2006
cducatcd and e.ononricrlly sourd. Aftt tio th,r dnm dweiles live in .rl
SLt

2l Rash€d, K. M,l(ahnrrn, M. & Ilylcr, S,,r.i/. r.lt,20Oa

crvitrinrrcn{ thrl has iDrtacL on lhen heal ildrg with tlre consunpti(,n ol'
Jl Hashem, F..(2006.)r .?.t, p82,2004)
I,r\ f,',rgn d,ct t.r sh,ch lh.) 'ultc n a varicly ol aculc and clrrNkl
25. Construcled based on inlomaiion provrdcd in l{ashcd. K. M.laa| un. M. & tlyder.
;n !ulncMhlc lo lbod insccurily.
S., (2004) op.r. p.29, 2004t Sclim, lt.. (2004) Publ'c H.illh Adh,nNaaion rn di\crsc\ Mnny dcvclopjrg counl es
B,ngldesh, i. The Els@tials af Cau uniry Mcdi.u1. (t' ed.), Escnce r ,Lr urL t "n. !r,l i hfxlrh drsfi inprcsslvc .dvances of heallh sccr,n'
lublication. Dhaka, 2004 nr reccft dccrtlc\ bc.ruse nulri I hli.lilc l.nd lo bc conccnlfute(l
rnxDg rhc arlvrntrgcd gurps ( ,rld Bdnk 20i)0/200I.l hang NM. I\,l)krn
2?. Preparcd on basis of readinss of Uashenr, F.,(2006)rrrrd, & Aad, A K & Haquc, A LrNl (t irrr ,2.r. L M, trL),i" D .1001). Inlanl. child and indlcinLl
Ln,l rut,,r,{,,i
U,r ll.rlcnl rir. rvorst i rh. rvorld hcre morc thr 5lrll,i'
28 s.caanel.nlrsh sn iniLalYL rbook,2Ao4 !r. lcverc to nrodc,alcly n,{ir\hrd (N4Lrr.rul Jl . lot7,21r0j) ArL,i'ling
29 t\nr n ttiLnr) is onc ollhc leadirrg causcs ol chilill,ir!l
' Chsr LLrl. (
TheAikcr KaEoj, Matcn 48.2402
l0 GolenneDr .l
ol lhc Peoplc\ R€public Banshdesh (2t)O4) A, rrl Rrpa 4 nr hri r! .rrl m,,Ltrl in udghdcsh bccausc ol' l$! birth rvc i1lr1
Ranslo.t.th Prhlk S?^rLr Contdssnt' 1AA4
(ACC SCN.2u0ri). ng pLacticcs. irrcludiDg breastleeding. watcr nrppli,
ll. Co!ea!r.o( ol llr
Pcoplc s Rcpublic ol Ban8lrdesh (:0o5) llangladcsh Publi.
,r' ln LhJ( .\J4cLJl pJrJ:r'('rd i,. \
Scrvi.. (dDrrissnr,. Stltdlnr! kr'UCS llwn,ntth, ,?00J, Deruty Controllcr.
Cove.rnent lEss. Dhakn. 2005 csidcncc, afd socirl nctwork lnd iamily sutl a (ltcl(s
72. M'HFW,Hopitirl Wi 1! l. 8trt1:rrl.r/,&.dd&,/.lur.ryIl,2006 ll\ el Jl (2r)riry licy SA at cl.. ( 1988)i Irellcticr DL (1994): Brqr iAll11
33.
14. coneilnlionof 71tc PopL sRtp htif rlBotrtnt.tt \wna\e.l *ol20a6l in rcccnt yc rs. rhe issuc ol complcmcnL y lccffg irL
35 Rabnan. M R , (2000): ./,. tr. p65 r12.2000 (\rntries has bcen rccciving incrclsed.Ltctho if il,e
36 Azad,A.K& .qtrc.A.(1999) ,/.r. Dll2 l0l,199') dl rurritior.onlnrunity. Wbile thcrc has heen cofhlJvdsl ,tr(,
HaslEIn. F.,(2006,/i i?.t, p 1.1.2006 conr .ftcnl ry ticdine sh({ld eo|nrence at liJrt or si\ n!) il F,,r
18. A?ad, A K& Haque,A (1999):,/.r. 87, l9t9
')
. Deparhnent olPopulation sciences, Universityol Dhllta
Studcnt, Deparhnent olPopulaiion Scicnc6, Univcrsily ol Dhrkr.

54 55

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