The health services policy in Upazila Health Complex:

A Case Study of Chandpur Sadar Hospital

1. The health services policy in Upazila
Health Complex:
A Case Study of Chandpur Sadar Hospital.
SUBMITTED TO :
Mr. Sayeedul Huq
Course InstructorPolicy Analysis SOC-422
Dept. of Applied Sociology
Presented By:
K. M. Asaduzzaman; 12-1-20-0023
Farjana Akter Eti; 111-20-0010
Yeanur Hossain Khan; 12-3-20-0004
Aklima Akter; 12-3-20-0005
Umme Salma; 12-3-20-0009
Antora Saha; 12-3-20-0015
Uday Kumar Shil; 12-3-20-0025
Sohaly Akter; 12-3-20-0031
Khing Khing May; 12-3-20-0036
Rasel patuary; 12-3-20-0044
Rakiba Rahman; 12-3-20-0045
Date of Submission: 26-12-2015

2. INTRODUCTION:
Bangladesh is a mostly rural, developing country of South Asia, located on the northern shore of
the Bay of Bengal, covering 147,570 square km. People of this country are known as
hardworking, with proven capability to preserve mental strength in the event of unexpected
extensive loss due to natural calamities, such as floods, cyclones, epidemics, etc. But, their basic
needs have remained unfulfilled.
Health is a basic requirement to improve the quality of life. National economic and social
development depends on the status of a country’s health facilities. A health care system reflects
the socio-economic and technological development of a country and is also a measure of the
responsibilities a community or government assumes for its people’s health care. The
effectiveness of a health system depends on the availability and accessibility of services in a
form which the people are able to understand, accept and utilize. The Government of Bangladesh
is constitutionally committed to “the supply of basic medical requirements to all levels of the
people in the society” and the “improvement of nutrition status of the people and public health
status” (Bangladesh Constitution, Article-18).
The study explores people’s participation in health services through personal interview as well
as case studies for which
Chandpur Sadar Upazila health complexhad been provided through
govt.
.

3. LITERATURE REVIEW:
Mohammad Shafiqul Islam and Mohammad Woli Ullah
*( Respectively, Assistant Professor,
Department of Public Administration, Shahjalal University of Science & Technology (SUST),
Sylhet-3114, Bangladesh; and M.S. in Public Administration, Department of Public
Administration, Shahjalal University of Science & Technology (SUST), Sylhet-3114,
Bangladesh.) studied about “
People’s Participation in Health Services: A Study of
Bangladesh’s Rural Health Complex”
in the Muradnagar Upazilla under the Comilla District.
According to this case study health services based on primary health services have been
expanding gradually in Bangladesh to improve the health status of the people, especially in rural
areas and maternal health where more than 85 percent of the people are living and are
underserved and underprivileged groups. The study focused on the degree of people’s getting the
public health services of Bangladesh. It suggests that the people’s getting the health services is
not satisfactory.
Salahuddin, Ali, Alam and Ali (1988) stated that Bangladesh, being a poor country with scarce
resources, cannot afford to provide sophisticated medical care to the entire population. Emphasis
is therefore given to primary health care covering the unnerved and undeserved population with
the minimum cost in the shortest time.
Mahmud (2004) explored people’s perceptions and reality about participation in newly opened
spaces within the Bangladesh public health care delivery system. The empirical findings suggest
that the effectiveness and ability of community groups to function as spaces for participation and
provide the means for developing capabilities to participate is limited, being constrained by
poverty, social inequality and dependency relationships, invisibility, low self-esteem and absence
of political clout.
HEALTH INDICATORS:
CDR – 5.2 /1000
Annual Growth rate – 1.48%
MMR – 1.94 /1000 live births (BMMS 2010)
IMR – 43 /1000 live births
Under 5 MR – 83 /1000 live births
Total Fertility Rate – 2.9
CPR – 53.8%
Life expectancy at birth – 68 (m) and 69 (f)
Fully immunized children – 52%
TB (smear positive new) detection rate – 31.2%

4. HEALTH CARE INFRASTRUCTURE:
UHFWC – 3375
31–50 bed UHC – 397
Various types o district level hospitals – 80
Government medical college hospitals – 13
Postgraduate hospitals – 6
Specialised hospitals – 25
Doctor to population ratio – 1:4,3660
Nurse to population ratio – 1:8,226
Hospital beds – 40,773 (over 29,000 in GOB)
PROCESS FOR FORMULATION
The Ministry of Health and Family Welfare
[3]
assembled a Committee in 1996 for the purpose of
preparing a health policy, with members drawn from civil society and professional bodies,
including technocrats and bureaucrats.
A further five sub-committees were formed to:
Evaluate the existing health services and determining the goals
Formulate policies to ensure essential services
Formulate policies to ensure hospital-based services
Design Strategies for HRD
Integrate NGOs and the Private Sector and plan for resources and utilisation of funds
The sub-committees worked for more than a year and submitted their efforts/recommendations.
A working group was formed and entrusted with the responsibilities for compiling the
recommendations contained in the reports. The working group also organised workshops in all
six Divisions to elicit opinions of cross-section of the society on these reports. Finally the
working group presented the proposals and recommendations to the National Health Policy
Formulation Committee. A report on the health policy was thus formulated on the basis of
consensus. The Cabinet on 14 Aug 2000 approved the National Health Policy.

5. HEALTH CARE SYSTEM:
The health care are designated to meet the health needs of the community through the use of
available knowledge and resources. The services provided should be comprehensive and
community based. The resources must be distributed according to the needs of the community.
The final outcome of good health care system is the changed health status or improve health
status of the community which is expressed in terms of lives saved, death averted, disease
prevented, disease treated, prolongation of life etc.
Health care delivery system in Bangladesh based on PHC concept has got various Level of
service delivery:
Home and community level.
Union level,
Union sub centre (USC) or Health and family welfare centre; This is the first health
facility level.
Thana level, Thana Health Complex (THC): This is the first referral level.
District Hospital: This is the secondary referral level.
National Level: This is the tertiary referral level.
A) Primary level health care is delivered though USC or HFWC with one in each union
domiciliary level, integrated health and family planning services through field workers for every
3000–4000 population and 31 bed capacities in hospitals.
B) The secondary level health care is provided through 100 bed capacities in district hospital.
Facilities provide specialist services in internal medicine, general surgery, gynecology,
paediatrics and obstetrics, eye clinical, pathology, blood transfusion and public health
laboratories.
C) Tertiary Level health care is available at the medical college hospital, public health and
medical institutes and other specialist hospitals at the national level where a mass wide range of
specialised as well as better laboratory facilities are available.
The referral system will be developed keeping in view the following.
1. A clearly spent-out linkage between the specialised national institutes, medical college and
district hospitals to ensure proper care and treatment of patients from the rural areas served by
lower level facilities.
2. Patients from the rural areas referred by lower level facilities to district and Medical College
hospitals and specialised institutions should get preferential treatment after admission.

6. IMPROVEMENT OF HEALTH CARE SYSTEM IN BANGLADESH:
Among countries that provide free medical services to the people at the community level through
various public health facilities, Bangladesh has a top-ranking position in this regard. The primary
healthcare is provided through an
extensive network of health
facilities extended down to the
community level with upward
referral linkage and a set of
government funded permanent
community healthcare workers.The
community clinics are the lowest-
level static health facilities located
at the ward level. These have
upward referral linkages with
health facilities located at the union
and upazila levels. There are 467
government hospitals at the upazila
level and below, which altogether
have 18,791 hospital beds. At the
upazila level, there are 436
hospitals with 18,301 beds. At the
union level, there are 31 hospitals
with 490 beds and 1,362 health
facilities for outpatient services
only. So, at the union level, there are 1,393 health facilities. At the ward level, there are 12,584
community clinics in operation till date.
HEALTH CARE SYSTEM IN BANGLADESH:
The public healthcare network of Bangladesh is an intricate web of public health departments,
NGOs, and private institutions constitutes. Responsibilities and functions range from policy
planning, regulation, implementation, and healthcare delivery to medical education. The Ministry
of Health and Family Welfare (MOHFW) is responsible for formulating national-level policy,
planning, and decision-making in the provision of healthcare and education. The healthcare
infrastructure under the DGHS comprises six tiers: national, divisional, district, upazila (sub
district), union, and ward.

7. NATIONAL HEALTH POLICY OF BANGLADESH:
The Health Policy has 15 goals and objectives, 10 policy principles and 32 strategies.
Goal and objectives of the national health policy
First: To make necessary basic medical utilities reach people of all upazillaas per Section 15
(A) of the Bangladesh constitution and develop the health and nutrition status of the peoples as
per Section 18 (1) of the Bangladesh Constitution
Second: To develop system to ensure easy and sustained availability of health servicesfor the
people, especially the poor communities in both rural and urban areas
Third: To ensure optimum quality, acceptance and availability of primary health care and
governmental medical services at the upazilla and union levels
Fourth: To reduce the intensity of malnutrition among people, especially children and mothers;
and implement effective and integrated programs for improving nutrition status of all segments
of the population
Fifth: To undertake programs for reducing the rates of child and maternal mortality within the
next 5 years and reduce these rates to an acceptable level

8. Sixth: To adopt satisfactory measures for ensuring improved maternal and child health at the
union level, and install facilities for safe and hygienic child delivery in each village
Seventh: To improve overall reproductive health resources and services
Eighth: To ensure the presence of full-time doctors, nurses and other officers/staff, provide and
maintain necessary equipment and supplies at each of the upazilla health complexes and Union
Health and Family Welfare Centers (UHFWCs)
Ninth: To devise necessary ways and means for the people to make optimum usage of available
opportunities in government hospitals and the health service system, and ensure satisfactory
quality management, cleanliness of service delivery at the hospitals
Tenth: To formulate specific policies for medical colleges and private clinics, and to introduce
laws and regulation for the control and management of such institutions including maintenance
of service quality
Eleventh: To strengthen and expedite the family planning program with the objective of
attaining the target of Replacement Level of Fertility
Twelfth: To explore ways to make the family planning program more acceptable, easily
available and effective among the extremely poor and low-income communities
Thirteenth: To arrange special health services for the mentally retarded, the physically disabled
and elderly populations
Fourteenth: To determine ways to make family planning and health management more
accountable and cost-effective by equipping it with more skilled manpower
Fifteenth: To introduce systems for treatment of all types of complicated diseases in the country,
and minimize the need for foreign travel for medical treatment ab Road.
POLICY PRINCIPLES:
The following policy principles have been adopted in order to attain the foregoing goals and
objectives:
i.To create awareness among the enable every citizen of Bangladesh irrespective of caste, creed,
religion, income and gender, and especially children and women, in any geographical region of
the country, through media publicity, to obtain health, nutrition and reproductive health services
on the basis of social justice and equality through ensuring everyone’s constitutional rights;
ii.To make the essential primary health care services reach every citizen in all geographical
regions within Bangladesh;
iii.Toensure equal distribution and optimum usage of the available resources to solve urgent
health-related problems with focus on the disadvantaged, poor and unemployed persons.
iv.Toinvolve the people in various processes like planning, management, local fund raising,
spending, monitoring and review of the procedure of health service delivery etc. with the aim of
decentralizing the health management system and establishing people’s right and responsibilities
in this system

9. v.To tacilitate and assist in the collaborative efforts between the government and the non-
government agencies to ensure effective provision of health services to all
vi.Toensure availability of birth control supplies through integration, expansion and
strengthening of the family planning activities
vii.Tocarry out appropriate administrative restructuring, decentralization of the service delivery
procedure and the supply system, and to adopt strategies for priority-based human resource
development aimed at overall improvement and quality-enhancement of health service, and to
create access of all citizens to such services
viii.To encourage adoption and application of effective and efficient technology, operational
development and research activities in order to ensure further strengthening and usage of health,
nutrition and reproductive health services
ix.Toprovide legal support with regard to the rights, opportunities, responsibilities, obligations
and restrictions of the service providers, service receivers and other citizens, in connection with
matters related to health service; and
x.To establish self-reliance and self-sufficiency in the health sector by implementing the primary
health care and essential services programs, in order to fulfill the aspirations of the people for
their overall sound health and access to reproductive health care.
POLICY STRATEGIES:
In keeping with the purported goals, objectives and principles, the following policy strategies
will be adopted
i.An appropriate implementation of the Health Policy needs mass-scale consensus and
commitment that will facilitate socio-economic, social and political development
ii.Preventionof disease and health promotion will be emphasized to achieve the basic objective
of Health for All”. The Health Policy focuses on provision of the best possible health facilities to
as many people as possible using cost-effective methods, and will thus ensure effective
application of the available curative and rehabilitative services.
iii.A primary health care is the universally recognized methodology to provide health services;
this will be adopted as the major component of the National Health Policyin order to ensure
delivery of cost-effective health services
iv.The Drug Policy will be liberalized and improved in keeping with the Health Policy to fulfill
the overall needs for health services. There is need to ensure smooth availability of essential
medicines focusing on the current needs for such medicines and their efficacy, including their
affordability by all people. Necessary steps will be taken to maintain quality standards of the
marketed medicines and raw materials used therein, and to rationalize the usage of medicines. In
this line, the required number ofskilled manpower will be acquired in the drug administration of
the country.
The health policy will ensure distribution of birth control supplies and make improvements in the

10. management of the domestic sources of the same, including encouragement of the domestic
sources of the same, including encouragement of the domestic entrepreneurs for production of
such commodities.
v.Epidemiologicalsurveillance method will be integrated with the disease control programs. A
specific institution will be entrusted with the responsibility of such surveillance.
vi.The basic principles for ensuring quality standards in health care at various health centers will
be adhered to. Standard quality assurance guideline including monitoring and evaluation will be
provided to every health center
vii.A Health Services Reforms Body will be formed based on the Health and Population Sector
Strategy aiming at meeting the current demand. The role of the Health Services Reforms Body
will be the render the following services
Infrastructure reforms
Acquisition of human resources,

Planning and implementation of programs for development of human resources related
to the health sector,
Career planning of the staff,
Inspection of supplies and logistics,

Consultations on how to effect overall development of health services including its
management styles etc

Recommendations will be implemented in phases based on the availability of necessary
resources
viii.An appropriate and need-based approach to develop human resources will be designed in
order to maximize the utilization of the knowledge and skills of health-related personnel. A
number of posts will be created with a view to promoting the eligible staff at the grassroots level
on the basis of their seniority and skills acquired. Special care will be taken to ensure that no
staffs promotion is held up.
While a staff is sent for training outside his/her own organization, necessary replacement will be
put in place for the term of the training, that is, no training leave may be allowed without
replacement
ix.The people and the local government will be integrated with the health service system at all
levels
x.AnIntegrated Management Information System (IMIS) and a computerized communication
system will be installed countrywide, to facilitate implementation, action planning and
monitoring. The existing information system will be further strengthened by recruitingmore
efficient and eligible incumbents. To this purpose, extensive and appropriate training will be
arranged, and the available manpower will be expanded and their skills enhanced.
xi.The Bangladesh Medical and Dental Council (BMDC) and the BangladeshNursing Council
(BNC) will be restructured and strengthened in order to ensure strict supervision of medical
practitioners registration, their quality of skills, and related ethical issues. With a view to
maintaining the required quality standards of the performance, education and training of the
pharmacists, medical technologists and other paramedics, the Pharmacy Council and the State
Medical Faculty will be restructured and organized.

11. xii.Various professional organizations, such as, Bangladesh Medical Association (BMA),
Bangladesh Private Medical Practitioners Association (BPMPA), and the unani, ayurvedic and
homeopathic societies etc. will be integrated with the country’s health service system.
xiii.Need-based medical education and training will be made more people-oriented and updated.
xiv.Arrangements will be mode for institutional training, on such issues as management and
administration, for improving the doctors’ management capabilities.
xv.Regular training will be provided to the medical practitioners, teachers, nurses, paramedics
and other staff at all levels in both public and private sectors through a specific institution. The
following types of courses will be offered from here:
-Reoriented Course,
-Continuing Medical Education Program,
-Administrative and Management Courses etc.
In order to create the required facilities for offering such training, a National Training Institute
will be established.
xvi.Toensure efficient health services, the management of the medical colleges/institutions and
related hospitals will be improved, and higher levels of financial and administrative power will
be delegated to them.
xvii.Nutrition and health education will be emphasized, as these are the major driving forces of
health and family planning activities. There will be one nutrition education unit and one health
education unit in each upazilla, so that they can reach every village of Bangladesh.
Information on health education will be disseminated the people through incorporating the
community leaders and other departments or organizations of the government in the health
service system. One of the goals of the health service system will be to improve the nutrition
status of the people.
xviii.The government hospitals and clinics will charge a minimum fee from the patients, but
there will also be provision for cost-free medical treatment to the poor and the disabled.
xix.NGOsand other private organizations will be encouraged to perform a role complementary
to those of the government in the light of the governmental rules and policy.
xx.Infrastructure and transportation will be developed to minimize the disparity in accessto
health services between rural and urban populations. In order to ensure presence of every officer
and staff of the health service system at their respective workplaces and their efficient services,
development of education facilities and improvement ofthe social environment in those
neighborhoods will be made.
xxi.Arrangements will be made to pay non-practicing allowances to the government
doctors/trainee doctors who act as full-time and resident doctor thus making them refrain from
private medical practice.
Doctors working at a government medical college, hospital or health center opting for private
medical practice using the facilities at the medical college, hospital or health center, will be

12. allowed to do so only under a clear policy.
xxii.Accountability of all concerned in the health service system will be ensured. An adequate
procedure will soon be designed to strengthen accountability and ensure quick and strict legal
disposal of cases relating to negligence of duties.
xxiii.A national level health-and-population council will be formed under the leadership of the
Head of the Government. This council will provide support and advice on the implementation of
the National Health Policy and will ensure effectiveness and accountability of the health service
system. The local and regional councils will monitor the health-related activities in their
respective areas, including review of composition, application and supervision of the primary
health care provided to the people
xxiv.Inter-sectoral coordination and linkages will be strengthened way of utilizing the resources
at the disposal of concerned sectors for quick solution of the health-related problems.
xxv.Research on various management styles and their effectiveness, clinical services, approach
to diagnoses, social and behavioral aspects of human beings, epidemics etc. will be encouraged
by the government.
Information dissemination system will be strengthened, especially by involving the private
organizations, in order to make IEC (information, education and communication) reach the
grassroots level.
A sound referral system will be designed and installed, and its usage will be strictly supervised,
so that a linkage can be established among primary health care activities at various tiers
ultimately increasing the efficacy of this system.
xxv1.Duplicationof activities from different projects, programs and activities will be avoided. In
this connection, a policy-planning cell will be established in the Ministry of Health and Family
Welfare, through which effective and sustainable coordination may be ensured.
xxvii.To goal of the Health Policy will be to provide personal or client-centered health and
reproductive health service, so that an individual can have the opportunity to select services
according to his/her personal needs. This pattern of services-delivery will be considered an
important approach of the National Health Policy and will contribute to a reduction in the rate of
unwanted pregnancies.
xxviii..Governmental allocation of expenditure budget for health centers from the districts to the
community level may be redistributed within reasonable flexibility. This redistribution of
expenditure budget will provide increased benefits to the poor and destitute communities. As a
result, expenses will be optimized and health service will be easily available.
xxix.Alternative health service systems, such as ayurvedic, unani and homeopathic practices will
be incorporated into the National Policy. Encouragement will be given to the principle of making
these three
disciplines of medical science more scientific and time-worthy towards enabling the practitioners
in these disciplines to contribute to the country’s health service. Government will provide
appropriate support to these systems through enhancing grants and arranging proper training in
these areas, and ensure monitoring of the quality of services rendered through these systems.

13. xxx.The arrangement for delivery of Essential Services Package (ESP) among the people from a
single one-stop health service center will be considered the appropriate strategy for provision of
primary health care. This will be introduced throughout the country. For this purpose, well-
planned and useful training will also be arranged at the upazilla health complexes.
xxxi.All development activities in the health sector will be conducted through a sector-wide
management system.
xxxii.. In order to bring every citizen of the country under coverage of his health service system,
one community clinic will be established to serve every 6,000 persons. An MBBS-doctor will be
deployed in each Union Health and Family Welfare Center, and each ofthese centers will also
equip with residence facilities for the doctor.
Multi-dimensional problems at various tiers of the physical and technical infrastructures of the
health service system and among the manpower employed have been creating bottlenecks
towards effective provision of health services. These colossal problems accumulated over a long
period of time and cannot be solved in a day. Therefore, a comprehensive plan for efficient
solution of the existing problems must be formulated urgently after elaborate consideration of the
issues involved. Only way to an effective health service system lies in timely modification,
reform and correction of the country’s traditional health service through adoption and
implementation of a transparent health policy.
A CASE STUDY OF CHANDPUR SADAR POURASHAVA:
Organization at a Glance:
Name of the Institution :Chandpur SadarHealth complex, Chandpur
Location :Chandpur
Type of organization :Government
Date of establishment :1897
Date of visit :01.12.15

14. ACTIVITIES OF THE ORGANIZATION:
Existing health facilities in the Upazila
Facility Type
Upazila Health Complex
No. of Union Sub-Centres
No. of Union Health and Family Welfare Centres
No. of Rural Dispensaries
No. of Community Clinics
No of Trauma Centres
No. of MCWC
No. of Chest Disease Clinic (TB clinic)
No. of Private Clinics
No. of NGO Clinics
FOLLOWING SERVICES REGARDING FAMILY PLANNING ARE PROVIDE AT
HOSPITAL AND FIELD LEVEL:
Free distribution of family planning maternal like oral pill and condom.
Insertion of Cu.T.
Tubectomy and vasectomy
MR
Motivating people to take family planning methods antenatal services including
referring high risk mothers.
STUDY AREA:
Chandpur sadar pourashava (in Chandpur district)
was selected as the study area. It was established in
1897. It has an area of 8.77 sq km and bounded by
Tarpur Chandi union on the north, Ishali union on
the south, Baghadi union on the east and Meghna
Riveron the west. The town has a population of
94821 where male are 50.77% and female are
49.23%. Literacy rate of the town people is 66.4%
(BBS, 2011). Main rivers are lower Meghna and
Dakatia. There are substantial numbers of health
care centers in Chandpur sadar pourashava provided
by the government, non-government, private and
other organization. The number of doctors, nurses,
medical assistants, beds and staffs available during
the study in Chandpur sadar pourashava were 80,
ACTIVITIES OF THE ORGANIZATION:
Existing health facilities in the Upazila
Total No. of Beds
1 0
1 0
No. of Union Health and Family Welfare Centres12 0
0 0
40 0
0 0
1 20
No. of Chest Disease Clinic (TB clinic) 1 0
19 210
3 30
FOLLOWING SERVICES REGARDING FAMILY PLANNING ARE PROVIDE AT
FIELD LEVEL:
Free distribution of family planning maternal like oral pill and condom.
Tubectomy and vasectomy
Motivating people to take family planning methods antenatal services including
referring high risk mothers.
Chandpur sadar pourashava (in Chandpur district)
was selected as the study area. It was established in
1897. It has an area of 8.77 sq km and bounded by
Tarpur Chandi union on the north, Ishali union on
the south, Baghadi union on the east and Meghna
on the west. The town has a population of
94821 where male are 50.77% and female are
49.23%. Literacy rate of the town people is 66.4%
(BBS, 2011). Main rivers are lower Meghna and
Dakatia. There are substantial numbers of health
sadar pourashava provided
government, private and
other organization. The number of doctors, nurses,
medical assistants, beds and staffs available during
the study in Chandpur sadar pourashava were 80,
No. of Beds
20
210
30
FOLLOWING SERVICES REGARDING FAMILY PLANNING ARE PROVIDE AT
Motivating people to take family planning methods antenatal services including

15. 162, 35, 392 and 725 respectively
OBJECTIVES:
The main objectives of this research are as follows:
To find-out the location pattern of health care facilities in the study area;
To determine the health care facilities provided by the study centers;
To find-out the utilization pattern of health care facilities in the study area;
Service provided by the health care centre in the study area are given below:
FIELD SERVICES:
This section is headed by UHFPO. Under his supervision there are health Inspector (HI),
Assistant Health Inspector (AHI) and health Assistant (HA).
Provided services are-
Health education
Control of communicable disease
Distribution of Vitamin-A capsule
Distribution of oral contraceptive pill (Shukhi) and condom.
Sanitation: Provided by a sanitary Inspector whose function is to supervise the hygienic
condition of food and drink, to send suspicious samples to the Institute of Public Health
(IPH), Dhaka.
Co-ordination with NGOs and other health related sector
Registration of births and deaths
Immunization of static clinics and outreach centers
Collection of blood sample from pt’s suffering from prolonged fever to detect material
parasite.
STATUS OF HUMAN RESOURCES (CATEGORY WISE):
Manpower
Community
Clinic
USC/UHFWC/RD UHC Others
IMCI
trained
Basic
EOC
trained
Sanctioned
Filled-
up
Sanctioned
Filled-
up
Sanctioned
Filled-
up
Sanctioned
Filled-
up
Physician 0 0 14 12 3 2 0 0 0 0
Nurse 0 0 0 0 0 0 0 0 0 0

16. Medical
Assistant
0 0 1 1 13 130 0 0 0
SERVICE PROVIDED BY THE HEALTH CARE CENTRE IN THE STUDY AREA:
The hospitals of this area deal with comparatively more complicated diseases, which is beyond
the scope and capacity of the primary level. Most of the hospitals in the study area are curative in
nature. These hospitals are assigned to provide some specialist services particularly in internal
medicine, general surgery, obstetrics and gynecology and pediatrics.
SERVICE PROVIDED BY THE HEALTH CARE CENTRE IN THE STUDY AREA IS
GIVEN BELOW:
Type of Available
diagnostics
Services provided
by the hospital
Hospital and other facilities
1.
Government
CT angiogram, USG.
stress
Child disease, General Surgery,
Gout, Fever,
Anemia,
Hospitals thaleum test,
Measles, Elderly disease, Circumcision,
Hypertension,
X-Ray,
Gastric, Diabetes, Chest pain, Tuberculosis,
Influenza,
Alta sonogram, E.C.G,
Diarrhoea, Hepatitis, ENI problem, Stroke,
Eyes
CT Scan, Therapy,
proble
m,
Gynecology& obstetric
problem
,
Pathologicallab(Urine,
Headache, Skin problem, Accident
& injuries
disease,
stool, cough, blood etc.)
Cytica, Rheumatic fever, Immunization,
Dental
disease etc.
2.
Organizatio
nal
Computer to determine
the
Eye disease & injuries, Antenatal &
postnatal care to
Hospitals eyes problem, Different
mother
s,
Child
disease,
General
surgery,
types of instruments
Gynecological
problem,
Immunization
etc.
related with eyes. Alta
sonogram, E.C.G,

17. Pathologicallab(Urine,
stool, cough, blood etc.),
3.
Private
Altra sonogram
Surgery, Child disease, Delivery, Gout,
Fever,
Clinic/Hospi
tals
E.C.G, Pathological lab
Scabies, Anaemia Measles, Elderly disease,
Asthma
(Urine, stool, cough,
blood
Circumcision, Hypertension, Gastric,
Diabetes, Chest
etc.)
pain, Influenza, Diarrhoea, Hepatitis, ENT
problem,
Stroke, Appendicitis, Headache,
Dysentery,
Chicken
pox, Cardiovascular disease etc
Chandpur sadar hospital arrange the Expanded Programme on Immunization (EPI) with the help
of Canadian International Development Agency (CIDA), United Nations Children’s Fund
(UNICEF), United States Agency for International Development (USAID), World Health
Organization (WHO), Government of Japan, Rotary International (RI). Some medicine is
provided free of charge. Food is also provided free for indoor patients. Matrimongol hospital
provides services for pregnant women (during Antenatal & postnatal period). It provides services
under Emergency Operation Camp (EOC). Chandpur Tuberculosis (TB) Hospital provides
services only for Tuberculosis patients.
The diagnostic facilities provide services only for outpatients for laboratory (Urine, stool, cough,
blood, E.C.G, Alta sonogram, X-Ray, Therapy etc) tests. They have no surgical or bed facilities.
The diagnostic centers provide services under the supervision of Chandpur sadar hospital. After
the introduction of modern system of medicine the traditional system of health care has been
gradually decreasing. Now-a-days the old and comparatively less educated patients avail of the
traditional health care facilities.
HEALTH CARE UTILIZATION PATTERN IN THE STUDY AREA
Present study observed that 30.8 percent patients availed government hospitals for their
treatment due to its being free of cost and easy excess. Only 13.5 percent patients avail private
clinics / hospitals due the availability of expert and good behavior. About 25 percent patients
avail Allopathic pharmacy, 5.8 percent patients availed homeopathic Allopathic pharmacy and
kabiraj whereas only 1.9 percent patients used Unani. Occupations of the cases also have
influence in utilization of health care facilities. Among the Rikshaw-pullers 33.3 percent used
government facilities, kabiraj and homeopathic medicines. 100 percent driver/ transport labour,
fishermen and hotel boy usages government facilities whereas 20 percent service holder use it.
60 percent students availed government facilities whereas 75 percent housewives, 40 percent

18. advocates, 50 percent hawker and 16.7 percent day labourers use government facilities. 100
percent small business men /women, 60 percent government service holders, 60 percent private
employees, 66.7 percent teachers, 20 percent students and 25 percent housewives met private
doctors during the last 6 months, (all data given from Chandpur sadar hospital report book)
CONCLUSIONS:
There seems to be a distinct spatial variation in the patterns of attendance between low and high
income people, between low and high education level. The low income peoples mostly avail of
public health care facilities and they are experiencing much longer travel to primary care services
than other respondents. The high income people mostly use the private doctor’s facilities. The
poorer households have no choice to undertake frequently lengthy journey often to crowded
hospitals or public clinics. In the study area most of the respondents use Rikshaw as mode of
transportation. There are some high income respondents with private vehicles at their disposal.
Long waiting at the health centers discourages the people who consider it as potential loss of
wages or work hours. Many of the respondents did not be use the nearest facility due to reason
not explained. This is understandable in the context of Bangladesh, in mixed health care system,
spatial proximity does not necessarily equate with social or economic access. The reasons given
by respondents for not using the nearest facility are varied. If the poor class of patients do not use
public health facility nearby , they need to travel a long distance to get treatment which is many
case become impossible. The high income respondents traveled to doctors with whom a good
relationship is already established and who are situated either in the study area or outside the
study area.

19. Reference:
"Frequently asked questions". World Health Organization. 2012. Retrieved 21
March 2012.
Jump up^Staff (2011)."Health Policy 2011"(PDF). Ministry of Health & Family
Welfare, Government of the People's Republic of Bangladesh (in Bengali). Ministry of
Health & Family Welfare, Government of the People's Republic of Bangladesh.
Retrieved 7 June 2012.
Jump up^Staff (2007–2008)."Home". Ministry of Health & Family Welfare, Government
of the People's Republic of Bangladesh (in Bengali and English). Ministry of Health &
Family Welfare, Government of the People's Republic of Bangladesh. Retrieved 7
June 2012.