Your ID: 2018010000106

Your Name: Khairul Islam Jobayer

Topic for the Assignment 2 for continuous assessment (25 marks):

How proper training and development can revolutionize the healthcare service sector in Bangladesh?

Guidelines: Make an analysis on the healthcare sector in Bangladesh. Identify the relevant organizations
like hospitals, diagnostic centers, vaccination centers and so on. Identify why people are not satisfied
with the services in this sector. Then find the particular areas where proper training of development of
the employees are not enough right now. Also, describe how that organization can benefit from proper
training of development of the employees in those particular areas. You must submit them within 11
pm, January 30, 2022 without fail. Any files submitted after the deadline will not be graded without an
approval. This assignment contains 25 marks. The study should be kept brief. Only put relevant and
genuine information. Plagiarism will cause penalty. Do not change text formatting.

(Start writing from here)

Answer:

Proper training and development will revolutionize the healthcare sector in Bangladesh:

In Bangladesh, health care is provided through government hospitals or privately run clinics. Bangladesh
is still lagging behind in health care services for the poor and affluent. In recent years, our neighbors
India and Thailand have developed in terms of expertise and experience of physicians, development of
health care technologies and high quality hospitals and health management organizations. To achieve
this in our country, technical cooperation with technologically advanced hospitals is required and health
management organizations in developed countries in Asia and the West need to follow suit.

Related institutions such as hospitals, diagnostic centers, vaccination centers:

Bangladesh is a poor and densely populated South Asian country. In 2013, it had a population of 156.6
million, which is projected to grow to nearly 218 million by 2030. The country is facing a lot of social and
economic changes. The country is facing high urbanization. For example, the capital city of Dhaka's
population is projected to increase from 5.8 million in 1990 to 10.2 million in 2000 and 16.8 million by
2015.

Types of Hospital No. of Hospital No. of Beds

District Hospital 53 7850
General Hospital 11 1350
Infection Disease Hospital 5 180
Medical/Dental College 22 11960
Hospital
Specialized Hospital 7 2300
BSMMU (Medical University) 01 1212
Others 28 2201
Why people are not satisfied with the services in this sector:

Despite these successes, the Bangladeshi health system continues to suffer from a number of
shortcomings, some of which are significant.

1. Limited public facilities:

A total of 536 government hospitals provide inpatient care with 37,387 beds for a population of 160
million in Bangladesh. There are 413 sub-district (sub-district) health complexes with limited patient
care services. Most UHCs have 20 beds, mainly to meet the emergency needs of pregnant women.
District hospitals are commonly referred to as secondary care hospitals because they have less
specialized care facilities than medical college hospitals. Apart from these, there are various specialized
care centers such as infectious disease hospitals, tuberculosis hospitals and leprosy hospitals which
come under the purview of the secondary district hospitals, which is a common occurrence. 65% of
ambulances at these facilities do not operate at any time due to lack of maintenance or fuel money.

2. Shortage of essential commodities:

The availability of medicines, medical supplies and family planning items in many public health facilities
in Bangladesh is an almost constant problem. While the lack of effective supply chain management is
part of the problem, the lack of funds to pay for supplies (or the timely release of available funds) is also
a serious problem.

3. Unavailability of Health Workforce:

Unlike many service sectors, inpatient healthcare requires a highly qualified workforce (health
workforce) including physicians, dentists, nurses, midwives and medical technicians. The Government of
Bangladesh has approved 20,234 posts for doctors, of which 11,300 are currently being filled, which
means that 44.2% of the total posts are vacant. There are currently a total of 13,483 nurses working in
public health facilities, while the total number of sanctioned posts is 17,183. Nearly 96 per cent of senior
nurse posts were found to be vacant in the distribution of vacancies of various levels of nurses. The
highest number of medical staff vacancies were in Barisal (64.9%), Khulna (58.2%), Rajshahi (55.3%),
Sylhet (54.7%), Chittagong (50.7%) and Dhaka (25.4%).

4. Lack of transfer:

Despite being decentralized, the health system has never gone through a transfer process. In other
words, power and decision-making are concentrated in the MHFW in Dhaka, which carries out only the
plans and activities determined by the UHC Ministry. Therefore, plans and programs often do not reflect
local realities. In addition, a lack of decision-making power at the local level often prevents local health
professionals from responding effectively to specific local-level emergencies or crises.
5. Lack of local level planning:

It flows from the absence of a previous transfer. It seems that the sub-district health and family planning
authorities have always been asked to formulate action plans to be implemented in the coming year
based on local epidemiological and demographic conditions. Although these local area plans are
regularly submitted to the Ministry, they are rarely considered when developing holistic health sector
plans. It is clear that most of them remain a waste-related exercise.

6. Misuse or misuse of resources:

Drugs or drugs that should be available for free (or with minimal fees) often "disappear" from the UHC
and finding a way to sell at a hefty price in the local market is a common complaint from consumers. X-
ray films are not regularly available at UHC and the patient has to buy from the local market. About 65%
of ambulances given to sub-district health complexes are reported to be "asleep" or inactive at any time
due to abuse or improper use. It is becoming clear that patients are suffering severely due to the
deteriorating health system.

7. Lack of community empowerment at the local level:

Due to government regulations, community management committees are often set up at the sub-district
level to oversee UHCs. However, these committees rarely represent their communities or have the
power to demand accountability from health authorities. The UHC is dominated by bureaucrats who do
not have meaningful community participation in the planning and provision of health care services at
the local level.

8. Lack of public health and management skills at district and sub-district levels:

Civil surgeons are responsible for overseeing the district health system, with the Sub-District Health and
Family Control Officer (UHFPO) leading the sub-district health complexes. There are also civil surgeons,
doctors and many UHFPOs. In many cases these physicians have little knowledge or expertise in public
health or management. Although they are good doctors, they have no expertise in management.
Consequently, the health system at the district and sub-district levels suffers from a lack of knowledge of
public health and management skills.

9. Inadequate financial resources:

In Bangladesh, about 3.4% of GDP is spent on health, of which government contribution is about 1.1%.
In dollar terms, the total health expenditure in the country is US $ 12 per person per year, of which
public health expenditure is only US $ 4. More than two-thirds of total health care spending is provided
privately through out-of-pocket payments.

10. Weak Health Information System:

Reliable and up-to-date health information is essential for the development of an effective health
system. The WHO therefore emphasizes it as one of the building blocks of any health system (WHO,
2008). It is not enough to just collect raw data; That data should be systematically managed, analyzed
and distributed to appropriate authorities to facilitate decision making and prompt action. Over the
years, many small-scale surveys, monitoring and research have been conducted across the country
“Rural” areas where proper training of development of the employees are not enough right now.

There may be poor health outcomes in “rural” and remote areas due to lifestyle differences and the
level of risk associated with education and employment opportunities, as well as access to health
services.

Rural residents face a variety of access barriers. Rural residents often face barriers to health care that
limit their ability to receive the care they need. Necessary and appropriate health services must be
available in a timely manner and be made available for adequate access to rural residents.

Ideally, residents should be able to easily and confidently access services such as basic care, dental care,
behavioral health, emergency care and public health services. According to Healthy People 2020, access
to health care is important:

 Overall physical, social, and mental health status

 Disease prevention
 Detection, diagnosis, and treatment of illness
 Quality of life
 Avoiding preventable deaths
 Life expectancy

Poor health is a component of the outcome of a poor health system. The WHO ranked the Bangladesh
health care system 131st out of 191 countries (and 181st in terms of the system's delivery response, a
measure of social exclusion). But access is not the only problem: the quality of health care is also low.
Those who can afford it are being treated abroad especially for large operations. The poor do not have
that choice, often relying on less qualified or unqualified medical practitioners such as pharmacy and
dispensary owners and traditional healers.

In its first analysis of the health care system in 2004. It is important to have a good understanding of the
situation of the poor and the nature of their exclusion. Key results - based on studies by other
organizations - have concluded that access to health services in Bangladesh is low and where there is
access to the public, the quality of services is a serious concern. According to the WHO rankings, large
sections of the population - especially in rural areas - have little or no access to proper health care.
What are barriers to healthcare access in “Rural” areas?

1. Distance and transport:

The rural population is more likely to travel long distances to access health services, especially sub-
specialty services. This can be a significant burden in terms of travel time, cost and time away from the
office. In addition, the lack of reliable transportation is an obstacle to care. In urban areas, public
transportation is usually an option for patients to go to medical appointments; However, these transport
services are not often available in rural areas.

2. Manpower shortage:

Shortage of healthcare workforce affects access to health care in rural communities. One criterion of
access to health care is the general source of care, depending on whether adequate health care is
available to the workforce. Some health care researchers argue that evaluating health care access by
measuring provider availability alone is not sufficient to fully understand health care access.

3.Health Insurance Coverage:

People without health insurance have less access to health services. According to infants without health
insurance: racial / ethnic and rural / urban disparities in infant family insurance coverage, 2011-2015
data show that 19.9% of infants in rural households have no health insurance, which is more than
16.8%. Babies. In uninsured urban families.

4. Broadband access:

While the use of telehealth services has already become more widespread and widespread in early
2020, measures taken in response to the COVID-19 epidemic have accelerated this growth.
Unfortunately, many areas do not have access to broadband internet and are experiencing slow internet
speeds, both of which are barriers to accessing telehealth services. Compared to their urban
counterparts, rural people are almost twice as likely to have no broadband access.

5. Poor Health Literacy:

Health literacy can also be a barrier to accessing health care. Health literacy affects patient ability to
understand health information and instructions from their health care providers. This is especially true
of rural communities where low levels of education and high incidence of poverty often affect residents.

6.Social stigma and privacy issues:

In rural areas, where anonymity is low, social stigma and privacy concerns are likely to act as barriers to
health care. Rural residents may have concerns seeking care due to mental health, drug abuse, health,
pregnancy or general chronic illnesses or privacy concerns.
That organization can benefit from proper training of development of the employees in those “Rural”
areas:

Closing rural health facilities or shutting down services can have a negative impact on access to health
care in rural areas.

Local rural health care systems are fragile; When a facility is closed or the provider exits, it affects care
and access throughout the community. For example, if a surgeon is fired, C-section use is reduced and
maternity care is at risk. If the hospital is closed, it will be difficult to hire doctors.

There are multiple “Training” strategies being used to improve access to healthcare in rural areas:

1. Distribution Sample Training:

After hospital closure: Adoption of a high-performance rural health system without patient care. The
three rural communities have moved to a new model of care, which includes freestanding emergency
department services, increased telemedicine capacity and specialized care. The report also outlines a
range of different delivery options for communities without inpatient in-hospital care.

2. Affiliation with large systems or network training:

Local rural health facilities may choose to join a health care network or associate themselves with larger
health systems as a strategic move to maintain or improve health care in their communities. The
hospital system affiliation in the report includes some of the benefits that rural hospitals can enjoy,
including access to:

 Technology
 Staff recruitment and retention
 Group purchasing
 Increased access to healthcare and operational services
3.Telifitness training:

Telehealth is considered to be a major tool for addressing rural health care issues. Through telehealth,
rural patients can see specialists from time to time from their home facility or local facilities. However,
temporary changes to telehealth policy in response to the COVID-19 epidemic have led to unequal
access to these services due to the lack of broadband internet in some rural areas.

4. Further enhancement of other functions in the training system:

Policy guidelines and curricula are only one component of a functional training system. Other aspects
required for the effective functioning of the training system are: Coordination between the Ministry of
Education (BTEB) and Health (SMF); Teacher training; Curriculum development as a permanent duty;
Quality assurance; Social marketing; Private Sector Law.

“Yes”, proper training and development can revolutionize the healthcare sector in Bangladesh.
Importance of Training:

Training of employees and managers is absolutely essential in this changing environment. It is an

important activity of human resource development that helps in improving the efficiency of the
employees. Training brings many benefits to employees such as improving efficiency and effectiveness,
boosting self-confidence and helping everyone in self-management.

The stability and progress of the organization always depends on the training given to the employees.
Training becomes mandatory at every stage of expansion and diversification. Only training can improve
quality and reduce waste. Training and development to adapt to the changing climate is also very much
needed.

The Training Development Process:

 Expected Organizational Performance (EOP) is the targeted performance that the firm aims to
achieve.
 Actual Organizational Performance (AOP) is the performance that actually occurs.
 The need for training arises when AOP<EOP.