“a Contemporary View on Health Care System in Bangladesh.”

CHAPTER 1 Introduction 1. 0 origin and background of the pass over The writing A Contemporary view on wellness Cargon System in Bangladesh is the expiry of Internship Program which is a precondition for acquiring MBA level. Only curriculum activities be not enough for use the real business environment, so it is necessary to get the better k straight off takege astir(predicate) the real scenario. The inform is a requirement of the internship program for my MBA Degree. give experienceion of Internship/ Dissertation started on 20th December two hundred9 and ended on 12th February 2010.My internship supervisor at Inter topic Islamic University Chittagong, Dhaka Campus, Mr. R M Nasrullah Zaidi assigned me the worldation of my report. The reason behind choosing this topic is getting a clear picture of the wellness sector of Bangladesh. works on this topic gives me an opportunity to chthonianstand the Problem and prospect of wellness flush placement in Bangladesh. In t odays orb of globalization Thiland is seeking to encourage wellness tourist to its pastoral down the stairs(a) the banner of Thailand Centre of Excellent Health C are of Asia, India is grammatical construction an e-wellness industry and Singapore is building infirmarys abroad.When scenarios are like that where the health sector of Bangladesh ? Here we try to get a idea more or less what is the real scenario of various tie in issues like regain to health-relate knowledge and technology, the provision of new hospital and aliened health institution and the availableness of health professionals. 1. 1 objectives of the report The objective of my study carve up into deuce instalments 1. 1. 1 Primary Objective The autochthonic objective of this report is to meet the requirements of the course, OCP 5900, Internship. 1. 1. 2 Secondary ObjectiveThe secondary objectives are * To confer a clear picture of matter health senario. * To know well-nigh list and contentedness of existi ng hospital & clinic * To know al intimately manpower supply capacity and requirement * To know about Morbidity and its rate * To know about Available alternative or traditional medical checkup trade system. * To know about health education of mass plurality * To know about governing social structure- health system * To know about demographic structure of population * To know about role of different institution in respect of Health Care 1. methodology I withdraw aforethought(ip) to accomplish the task in quadruplet stages Step 1 readiness of the work Step 2 selective information collection Step 3 Analysis and interpretation of entropy Step 4 Drawing conclusions and recommendations The first-class honours degree stage is the most important stage. I have allocated enormous time for this stage. I am show on thorough and detailed planning. formulation includes detailed methodology and scheduling of the re importanting three stages. I am likewise emphasizing on documen ting detailed planning which would serve as a road map and performance measure for the whole report.The second stage is the info collection stage. I have planned to collect data in three main phases. * Collect data from internet, different books and medical journals. * Conduct interviews with selected re exhibitatives from different take of health professionals. This phase actually concentrates on clarification and elaboration of data peaceful from the first phase. * Conduct interviews and communicate with health providers who are in the front line. This phase actually concentrates on accumulating data for the overall scenario. The third stage is the analysis and interpretation of data.In this stage I would use just about statistical and graphical analysis tools to interpret the relationship among different variables and factors. The fourth stage is the stage for draft copy conclusions and prescribing recommendations. In this stage the results from the previous stage would be u sed to draw conclusions about different aspects of refer matters within the constitution and prescribe some recommendation for future improvement. The project is base on devil prime and secondary information. Primary Source * Informal discussion with employees of UHL. Observation while working in different desks * Interview with health trade providers. Secondary Sources * Official Web Site of UHL * Annual Reports of Ministry of Health * Various Manuals and Brochures of DG Health * Different publications of WHO. 1. 3 scope This report solely deals with the health related information of Bangladesh. Here we try to accumulate information from various topics that have role with the health system of a country. The project is based on both main(a) and secondary information. Health system is a very vast area to work gravitational constants of issues are related here.Here we make some major incision to discuss like national health circumstance, health kick preservation system, fa cility based health assist, leading public health problems and health education. 1. 4 limitations 1. The major limitation faced in preparing this report is the enormous number of parameters that have relationship to the health veneration system of a country. 2. Less availability of data at all tiers of service providing especially in the private sector. 3. Less accessibility to data due to shortage of time and proper arrangement and at the same time the authenticity of data not beyond questions. 4.Health sector requires few specified technical knowhow for better down the stairsstanding. Being a non medical background some time face some problem to understand technical terminology and ofttimes needed explanation and further study. CHAPTER 2 Bangladesh National Health Status 2. 0Location and Geography Bangladesh was emerged as an self-sufficient and sovereign country in 1971 following a nine calendar months war of liberation. The country is wizard of the largest deltas of the wo rld with a total area of 147,570 sq km. Being a low-lying country it stretches latitudinal between 20? 34 and 26? 38 north and hugeitudinally between 88? 01 and 92? 1 east. It is for the most part surrounded by Indian Territory (West Bengal, Tripura, Assam and Meghalaya), except for a small strip in the southeast screen by Myanmar. Bay of Bengal lies on the south. The standard time of the country is GMT +6 hrs. 2. 1History Bangladesh has a superb history and rich heritage. Once it was known as Sonar Bangla or the Golden Bengal. The territory now constituting Bangladesh was under the Muslim blueprint for over five and a fractional centuries from 1201 to 1757 AD. Subsequently, it came under the British rule following the defeat of the sovereign ruler, Nawab Sirajuddaula, at the battle of Plessey on 23 June 1757.The British command over the Indian subcontinent including this land for nearly 190 days from 1757 to 1947. During that extent, Bangladesh was a part of the British In dian provinces of Bengal and Assam. With the termination of British rule in August 1947, the sub-continent was partiti angiotensin- exchangeing enzymed into India and Pakistan. Bangladesh was a part of Pakistan and was called East Pakistan. 2. 2Physiography With about half of its surface below the 10 m contour line, Bangladesh is located at the lowermost reaches of three correctly river systems -the Ganges-Padma river system, Brahmaputra-Jamuna river system and Surma-Meghna river system.Coinciding with the division of the country based on altitude the land can be divided into three major categories of physical units Tertiary hills, Pleistocene uplands and Recent plains (formed in recent epoch). The heavy monsoon pelting coupled with the low altitude of major parts of the country makes floods an annual phenomenon in Bangladesh. Quaternary (began about 2 million years ago and extends to the present) sediments, deposited mainly by the Ganges, Brahmaputra (Jamuna) and Meghna rivers and their numerous distributaries, cover about three-quarters of Bangladesh.The physiography and the drainage pattern of the vast alluvial plains in the central, northern and western regions have g iodine under considerable alterations in recent times. In the context of physiography, Bangladesh may be classified into three perspicuous regions (a) floodplains, (b) terraces and (c) hills, each having distinguishing characteristics of its own. The physiography of the country has been divided into 24 sub-regions and 54 units. 2. 3Climate Bangladesh has a tropical monsoon-type climate, with a bitter and rainy summer and a dry winter.January is the coolest month with temperatures averaging near 260 C (780 F) and April is the w weaponest with temperatures from 330 to 360 C (910 to 960 F). The climate is one of the wettest in the world. or so places receive more than 1,525 mm of rain a year, and areas near the hills receive 5,080 mm). Most rains occur during the monsoon (June-September) an d little in winter ( nary(prenominal)ember-February). Bangladesh has warm temperatures doneout the year, with relatively little variation from month to month. January tends to be the coolest month and may the warmest.In Dhaka, the average January temperature is about 19C (about 66F), and the average May temperature is about 29C (about 84F). 2. 4 face From the administrative point of view, Bangladesh is divided into 6 Divisions, 64 soils, 6 City Corporations, 308 Municipalities, 482 Upazilas and 4498 pairings. The sise administrative divisions are namely, Dhaka, Chittagong, Rajshahi, Khulna, Barisal and Sylhet. The country is governed by the Parliamentary Democracy and it has a unitary National Parliament, nameBangladesh Jatiya Sangsad. on that point are 40 Ministries and 12 Divisions.The Ministry of Health Family Welfare is one of largest ministries in the country. At the national direct, the Ministry oHealth Family Welfare (MOHFW) is responsible for policy, planning and d ecision reservation atmacro level. on a lower floor MOHFW, there are four Directorates, namely , Directorate cosmopolitan of HealthServices, Directorate world-wide of Family Planning, Directorate of Nursing Services and Directorate of dose Administration. Beside, there are a separate National Nutrition Proje(NNP)and Construction, Maintanance and Management unit of measurement (CMMU). . 5Economy Bangladesh has an agrarian economy, although the divide of agriculture to GDP has beendecreasing over the last few years. Yet it dominates the economy accommodating major artless labour force. From foodstuffing point of view, Bangladesh has been following a mixed economy that operates on free market principles. The GDP of Bangladesh is 6. 21% and per capitincome is US$ 599. The principal industries of the country include readymade garments,textiles, chemical fertilizers, pharmaceuticals, tea processing, sugar, leather goods etc.Theprincipal mineral includes Natural gas, Coal, white clay, glass sand etc. 2. 6Communication The transport system of Bangladesh consists of roads, railways, inland waterways, two sea ports, maritime shipping and civil aviation catering for both domestic and world-wide traffic. Presentlythere are about 21,000 km of paved roads 2,706 route-kilometres of railways (BG-884km and MG -1,822 km) 3,800 km of perennial waterways which increases to 6,000 km durinthe monsoon, 2 seaports (Chittagong and Chalna) and 3 international (Dhaka, Chittagong andSylhet) and 8 domestic airports. . 7Religion and Culture The majority (about 88%) of the people are Muslim. Over 98% of the people speak in Bangla. English, however is widely spoken. Bangladesh is heir to a rich cultural legacy. In two thousand or more years of its chequered history, many illustrious dynasties of kings and Sultans ruled the country and have left their mark in the shape of magnificent cities and monuments. The people of Bangladesh are very simple and friendly. A beautiful communal harmony among the different religions has ensured a very congenial atmosphere.More than 75% of the population lives in rural areas. Urbanization has, however, been rapid in the last few decades. 2. 8 universe of discourse and Demography Bangladesh is now Asias fifth and worlds one-eighth populous country with an estimated population of about 146 million. Density of population is around 979 per square kilometer, the highest in the world. farming(prenominal) population comprises about 76% while urban constitutes about 24%. Adult literacy rate is 54% ( two hundred6). Census of 2001 reveals that 43 per cent of the population is below 15 years of age.This young age structure constitutes built-in population momentum. Also urban population is increasing quite fast. Though Bangladesh has made elevate in trim back poverty and per capita income has been creeping up, a substantial number of population are poor. move on made in improving Bangladeshs Human Development Index (HDI) has rigid her among the medium-ranking HDI countries. Strong policy interventions led to persisting reduction in the annual growth rate of population from the level of 2. 33 % in 1981 to 1. 54 in 2001 and further to 1. 48 (2007). The TotalFartility Rate (TFR) also went protrude from 3. 4 in 1993-94 to 2. 2 (2007). The CPR (any method) increased from 44. 6% in 1993-94 to 58. 1% in 2004, but again fell down to 55. 8% in 2007. Life expectancy at birth has continuously been rising, and is now 65 years (2007) from the level of 58 (1994). Reversing past trends, women now live longer than men. The country, however, is over burdened with about two million new faces every year creating extra pressure on food, shelter, education, health, employment, etc. , and thus making the anticipated economic growth difficult. . 9Health Status Since independence Bangladesh has made significant progress in health outcomes. Infant and Child mortality rate rates have been markedly reduced. The underfive mortality r ate in Bangladesh declined from 151 deaths per thousand live births in 1991 to 65 deaths/1000 live births in 2007 and during the same period infant mortality rate reduced from 94 deaths per 1000 live births to 52. EPI coverage extended its reach from 54% in 1991 to 87. 2% in 2006. The MMR reduced from 574/100,000 live births in 1991 to 290 in 2007.Deliveries attended by skilled birth attendants increased from only 5% in 1990 to 20% in 2006. The prevalence of malaria dropped from 42 cases /100,000 in 2001 to 34 in 2005. Bangladesh has also achieved significant success in halting and reversing the break of tuberculosis (TB). Detection of TB by the Directly Observed Treatment Short-course (DOTS) has more than doubled between 2002 and 2007, from 34 to 92%. The boffo handling of tuberculosis has progressed from 84% in 2002 to 91% in 2007. Polio and leprosy are virtually eliminated. human immunodeficiency virus prevalence is even very low.Development of countrywide network of health ca re infrastructure in public sector is remarkable. However, availability of drugs at the health facilities, deployment of adequate health professionals along with maintenance of the health care facilities remain as crucial issues, impacting on optimum economic consumption of public health facilities 2. 10Nutrition Status in that respect has been considerable progress in reducing malnutrition and micro nutrient deficiencies in Bangladesh. According to BDHS, percentage of U5 tightly fitting (6-59 months) has reduced to 46. (2007) from 67 (1990) and that of U5 stunted (24-59 months) from 54. 6 (1996) to 36. 2 (2007). Percentage of children 1-5 years receiving vitamin-A supplements in last six months has increased from 73. 3 (1999-00) to 88. 3 (2007). The rate of night blindness has reduced to 0. 04 per 1000 people (IPHN, HKI 2006). However, in spite of efforts taken by the government, high rates of malnutrition and micronutrient deficiencies along with gender discrimination remain v iridity in Bangladesh. 2. 11Urban Health ServiceThe urban areas provide a contrasting picture of availability of different facilities and service for secondary and tertiary level health care, while primary health care facilities and operate for the urban population at large and the urban poor in particular are inadequate. Rapid influx of migrants and increased numbers of people living in urban slums in large cities are creating continuous pressure on urban health care service delivery. Since the launching of two urban primary health care projects, the work have been delivered by the city corporations and municipalities by contracted nongovernmental organizations in the projects area.Rest of the urban areas and function are being covered by MOHFWs facilities. Moreover, 35 urban dispensaries under the DGHS are providing out-of-door patient services including EPI and MCH to the urban population. 2. 12Organizational Setup of MOHFW The Ministry of Health & Family Welfare is one of largest ministries in the country. At the national level, the ministry of Health & Family Welfare (MOH&FW) is responsible for policy, planning and decision making at macro level. 2. 12. 1Executing Authorities of MOHFWUnder MOHFW, there are four Directorates habitual or Directorates, e. g. , Directorate General of Health Services, Directorate General of Family Planning, Directorate of Nursing Services and Directorate of Drug Administration. 2. 13Directorate General of health Services (DGHS) The Directorate General of Health Services (DGHS) is entrusted for the implementation of the policy decisions of the Ministry of Health and Family Welfare (MOHFW) as regards health service delivery to all the people under the jurisdiction of the Government of the Peoples Republic of Bangladesh.It provides technical guidance to the ministry. DGHS carries out its activities through with(predicate) different directors, line directors, project directors, institution heads, district and upazila healt h managers and union health staffs. 2. 14Health, Nutrition universe of discourse field Program (HNPSP) The constitution Bangladesh mandates for basic health care services for its people as one of the fundamental responsibilities of the state. Towards this goal, the government has taken different endeavors to extend health facilities to the population.The broader policy document of the Government of Bangladesh that shapes rush of health care is the Poverty Reduction Strategy Paper (PRSP) although the current government has indicated that it leave behind go for Five Year Plan. The Government of Bangladesh is running a program through which the health care services are provided to the people from the grass root to the central level. The program is entitled Health, Nutrition and Population Sector Program for the period of July 2003 through June 2010 (HNPSP 2003-2010).The Ministry of Health and Family Welfare (MOHFW) designed the Program Implementation Plan (PIP) in accordance with the PRSP to implement its sector wide program popularly known as Health, Nutrition and Population Sector Program (HNPSP). The HNPSP covers 38 Operational Plans (OP) to be implemented by 38 Line Directors and 14 Projects/Programs. The Government has recently decided to continue HNPSP until 2011. The details of the program are well documented in the form of Program Implementation Plan (PIP) duly endorsed at the highest policy level of the government, the Executive commission for National Economic Council (ECNEC).The Implementing Agency of the program is Ministry of Health and Family Welfare (MOHFW) with its attached departments. The financial involvement is estimated to be around Taka 324,503 million which includes contributions for GOB (Government of Bangladesh) and DPs (Development Partners). 2. 15Priority Objectives and Goal One of the important goals of PRSP and HNPSP is attainment of Millennium Development Goals (MDGs). The health sector is specially striving for attainment of h ealth related MDGs.The priority objectives of HNPSP are (i) reducing MMR (ii) reducing TFR (iii) reducing malnutrition (iv)reducing infant and under-five mortality (v) reducing the burden of TB and other indispositions and (vi) prevention and obligate of nontransmissible diseases including injuries. The commitment of the government targets towards reaching the goal of sustainable improvement in health, nutrition and family planning status of the people by the end of the program period. It may be mentioned here that HNPSP deals with health care service delivery of the public sector.Nevertheless, it strives to maintain a strong co carrying out and coordination with the efforts of the Private Sector as well so as to ensure the overall well-being of every citizen of the country. Of the 38 OPs, 7 are under MOHFW, 19 under Directorate General of Health Services (DGHS), 9 under Directorate General of Family Planning (DGFP), 1 under Directorate of Nursing Services (DNS), 1 under Director ate of Drug Administration (DDA) and 1 under National impart of Population Research and Training (NIPORT) and.Of the 14 projects/programs, 1 is under MOHFW, 9 under DGHS, 1 under DGFP, 2 under DNS and 1 under NIPORT. The Health bulletin 2009 is an attempt of Management Information System (MIS) of DGHS to provide an overview of the current health profiles of Bangladesh. CHAPTER 3 Health care delivery systems of Bangladesh Distribution of public health care services and facilities follows similar pattern of administrative tiers, viz. national (mostly capital-based in Dhaka), regional (in divisions), district, upazila, union and ward. The country has 7 divisions, 64 districts, 482 upazillas and 4,498 unions.As the Ministry of health and family Welfare deploys health workforce according to the older ward system, which divides each union into 3 wards. Therefore, number of MOHFW wards is 13,494. Primary health care (PHC), which includes family planning services in the urban area (city c orporations and municipalities), is provided by Ministry of Local Government and in rest of the country by Ministry of Health and Family Welfare (MOHFW) provides health care service. Provision of secondary and tertiary care, in both urban divisional directorates with necessary staff. and rural areas, is the sole responsibility of MOHFW.The MOHFW delivers its services through two separate executing authorities, viz. Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP). The names explain their functions. PHC services of both DGHS and DGFP begin at the ward level through a set of community health staffs, at least one in each ward (Table). To supervise these field staffs, there is one assistant health tester (for DGHS) and one family planning inspector (for DGFP) at union level. There are several hundred non- rear community facilities to provide outpatient services (1466 for DGHS and 3500 for DGFP).Besides DGFP also operates additional 97 mate rnal and child welfare centers (MCWCs) (union 23 upazila 12 district 62), 471 MCH-FP clinics (upazila 407 district 64), 177 NGO clinics (upazila 68 district 104 national 05), 08 model clinics (national 02 regional 06) and organizes 30,000 makeshift beam clinics per month. The public sector hospital care in Bangladesh is mainly provided by DGHS. Primary level hospital care Secondary level hospital care Tertiary level hospital care Begins through Upazila Health Complex (31 to 50 Bed) existing in 418 upazilas. The district hospitals (50 to 375 neck), one each district, provide secondary level hospital care in several specialty areas. The regional hospital are multidisciplinary tertiary care hospitals (250 to 1700 beds) mostly affiliated with learn bes. At the national level, there are postgraduate and specialized hospitals (100 to 600 beds) 3. 0Divisional level health organization At the divisional level, there is a divisional Director for Health. S/he is the head of a Divisiona l Directors supervise the activities of the civil Surgeons. 3. 1District level health organizationAt the district level, Civil Surgeon is the health manager. S/he has own administrative office supported by various categories of staff. There is either a Sadar Hospital or a General Hospital in each district head quarter. The Hospital provides services under the management of Civil Surgeon with a view to render out-patient, in-patient, emergency, laboratory and image services to the people. The in-patient services internal medicine, general surgery, obstetrics and gynecology and other common specialist clinical services. It is the secondary level referral facility of health services of Bangladesh.Currently there are 59 Sadar district hospitals and 2 General hospitals in the country each having 100-250 bed. 3. 2Upazila level health organization Upazila Health Complex (UHC) is another(prenominal) fixed service delivery point next to district level hospital. It provides the first level r eferral services to the population. In each UHC, there are posts for 9 (nine) doctors including one Upazila Health and Family Planning Officer (UHFPO). UHFPO is the master(prenominal) Health Officer of upazila and also Head of the UHC. Other doctors of UHC are Junior Consultants-4, Resident aesculapian Officer-1, suspensor Surgeons (MO)-2 and Dental Surgeon-1.There are 418 Upazila Health Complexes (UHC) in the country of which 153 are 50bed and rests are 31-bed. UHC provides out-patient, in-patient and emergency services, limited symptomatic and imaging services, emergency obstetric care, contraceptive services and dental care. 3. 3Union level health organization There are four types of static health facilities in the union level. These are Rural Health Centers (RHC, 10-bed hospital), Union Sub-centers (USC), Union Health and Family Welfare Centers (UHFWC) and Community Clinics (CC). There are 22 RHCs, in each of these, there are sanctioned posts of 20 staffs.RHC provides both ou t-patient and inpatient services. In an USC, there is sanctioned posts for one medical officer, one medical assistant, one pharmacist and one MLSS. Number of USC is 1,362 that for UHFWC is 87. Under HPSP, Government planned for establishing one Community Clinic for every 6000 rural populations. Number of CCs so far built is 11,883. But, these were not made functional. of late Government has decided to start the CCs again. The total number of CCs will be clxxx00. The existing UHCs and Union level facilities will also provide services of CCs in the respective communities.So,13,500 additional CCs will be required. The main health workforce in the union level is the domiciliary staff called health assistants. They are placed in each ward, which is the lowest and smallest administrative unit of the health sector. They visit the homes of the local people for providing primary health care services and collection of routine health data. The health assistants routinely organize air clinic s for immunization services. Besides there are other small to large hospitals and special purpose hospitals spread across the country both in rural as well as in urban areas.Under the DGHS, there are altogether 40 teaching/training institutes and 589 small to large hospitals. In Family Planning sector, there are one national inquiry-cum-training institute, two hospital-based training centers, and 32 other training centers (national 12 regional 20). Nearly six hundred health managers under DGHS and a similar number under DGFP, from national to upazila levels, play roles in administering the health and family planning services (1,17). This figure does not include the institute and clinic/hospital heads. CHAPTER 4Facility Based Health Services Hospital service is one of the important activities of health sector, which is the most visible health service also. This chapter of the Health Bulletin 2009 will provide an overview of the hospitals and their bed capacity as well as utilizatio n based on the information from January through December of 2008. 4. 0Hospitals by bed capacity There are 585 hospitals ranging from 10 beds to 1,700 beds under DGHS currently. All of these hospitals provide a total of 37,090 beds. The sidestep below gives a detail profile. No. f hospitals by bed capacity and total beds under DGHS Sl. No. Bed capacity No. of hospitals in this type Total beds 1 1700 beds 1 1700 2 1010 beds 1 1010 3 900 beds 1 900 4 800 beds 1 800 5 600 beds 5 three hundred0 6 500 beds 3 1500 7 414 beds 1 414 8 375 beds 1 375 9 250 beds 19 4750 10 200 beds 2 four hundred 11 150 beds 3 450 12 100 beds 53 5300 13 80 beds 1 80 14 56 beds 1 56 15 50 beds 158 7900 16 31 beds 271 8401 17 30 beds 1 30 8 25 beds 1 25 19 20 beds 43 860 20 10 beds 22 220 Total = 589 3817138171 Type of hospitals Following list gives an overview of the type of hospitals currently in operation under DGHS Type of hospitals No. of hospitals Total bed capacity high institute hospital 7 2014 Dental college hospital 1 20 Hospital for alternative medicine 2 200 medical examination college hospital 14 8685 Mental hospital, Pabna 1 500 Shekh Abu Naser Specialized Hospital 1 250 Narayanganj 200 bed Hospital 1 200 Specialized Health center (Asthma Burn unit) 2 150 Sarkari karmochari hospital 1 100 Chest hospital 12 566 Infectious disease hospital 5 180 Leprosy hospital 3 130 District Level Hospital 60 8100 50 bed hospital(Tongi, Saidpur) 2 100 100 bed hospital (Narsingdi) 1 100 25 bed hospital (Jhenidah) 1 25 Bangladesh korea moitree hospital 1 20 Upazila health complex 421 15958 Health complex (31 bed) 3 93 20 bed hospital 28 560 10 bed hospital 22 220 Postgraduate prove Hospitals all are national level hospitals and are located in Dhaka) Total = 7 No. of beds Total Revenue Develop. Proposed Beds will Increase 1. Nationa l launch of Chest Disease and Hospital (NIDCH) 600 600 0 0 0 2. National appoint of Cardiovascular Disease (NICVD) 414 250 164 0 0 3. National Institute of Traumatology and Rehabilitation (NITOR) 500 500 0 0 0 4 National Institute of Cancer Research and Hospital (NICRH) 50 50 0 250 200 5 National Institute of Ophthalmology (NIO) 250 250 0 0 6.National Institute of Kidney Disease and Hospital (NIKDU) 100 0 100 0 0 7. National Institute of Mental Health (NIMHR) 100 50 50 0 Total = 2014 1700 314 250 200 checkup College Hospitals of Teaching Hospitals of equivalent level (Regional hospitals and are used as undergraduate and postgraduate teaching hospitals). Division District Name of hospital (Total = 17) No. of beds Beds Revenue Develop. Proposed Bed will increase Barisal Barisal Sher-e-Bangla medical College Hospital 00 600 0 1000 400 Chittagong Chittagong Chittagong medical examination College Hospital 1010 10 10 0 0 0 Comilla Comilla aesculapian College Hospital 250 250 0 500 250 Dhaka Dhaka Dhaka Medical College Hospital 1700 1700 0 2000 300 Sir Salimullh Medical College Hospital 600 600 0 0 0 Shahid Suhrawardy Hospital, Dhaka 375 375 0 0 0 Homoeopathic Degree College Hospital 100 100 0 0 0 Unani Ayurvadic College Hospital 100 100 0 0 0 Dental College and Hospital, Dhaka 20 20 0 200 180 Faridpur Faridpur Medical College Hospital 250 250 0 0 0 Mymensingh Mymensingh Medical College Hospital 800 800 0 1000 200 Khulna Khulna Medical College Hospital 250 250 0 500 250 Rajshahi Bogra SZR Medical College Hospital 500 500 0 0 0 Dinajpur Dinajpur Medical College Hospital 250 250 0 500 250 Rajshahi Rajshahi Medical College Hospital 600 600 0 0 0 rangpur lime Rangpur Medical College Hospital 600 600 0 1000 400 Sylhet Sylhet MAG Osmani Medical College Hospital 900 900 0 100 0 100 Total = 8905 8905 0 7700 2330 Specialized Centers under DGHS with bed capacity (Year 2008) Division District Name of hospital (Total = 2) No. of beds Beds Revenue Develop. Proposed Bed will increase Dhaka Dhaka 1. National Asthma Center at NIDCH 100 0 100 0 0 2. Burn Unit 50 0 50 200 150 Total = 150 0 150 200 150 4. 1BSMMU Bangabandhu Sheikh Mujib Medical University (BSMMU) is the premier Postgraduate Medical Institution of the country. It bears the heritage to Institute of Postgraduate Medical Research (IPGMR)which was established in December 1965.In the year 1998 the Government converted IPGMR into a Medical University for expanding the facilities for higher medical education and research in the country. It has an enviable reputation for providing high quality postgraduate education in different specialties. The university has strong link with other professional bodies at home and abroad. The university is expanding cursorily and a t present, the university has many departments fit with modern technology for service, teaching and research. Besides education, the university plays the vital role of promoting research activities in various discipline of medicine. Since its inception, the university has also been delivering general and specialized clinical service as a tertiary level healthcare center.The university provides patient care services on various disciplines like Psychiatry, somatogenetic medicine, Pediatrics, Neonatology, Pediatric neurology, Pediatric surgery, Clinical pathology, Dermatology, Colorectal surgery, Nephrology, Urology, Neurology, Neuro-Surgery, Internal Medicine, Gastroenterology, Hepatology, Ophthalmology, ENT, Obstetrics gynecology, Surgery, Hepatobiliary Surgery, dentistry, and blood transfusion services. It provides different treatment services like Intensive Care, Lithotripsy, Pain management and diagnostic services like radiology, endoscopy, CT stare MRI and a one-stop laborat ory service. BSMMU runs Institute of Nuclear Medicine (INM). INM is a joint project of Bangladesh nuclear Energy Commission and BSMMU. The INM has modern diagnostic and therapeutic facilities including computerized ultrasonography, gamma camera and a well equipped radioimmunoassay (RIA) laboratory.This is considered to be the best center for noninvasive diagnoses. 4. 2SmilingSun libertyProgram (SSFP) The Smiling Sun Franchise Program is a project funded by the United States Agency for International Development (USAID). It is intended to equilibrize the wide network of healthcare facilities set up by the Government of Bangladesh resorting to an innovative approach to health care franchising. SSFP is committed to improve the quality of life of all Bangladeshis by providing superior, friendly and affordable health services in a sustainable manner. To achieve relevant health outcomes, SSFP is jointly working with partnering NGOs to convert the existing network into a viable social heal th system.SSFP objective is to strengthen partnering organizations quality of care while helping them to enhance their financial sustainability, thus enabling them to continue serving an important segment of the Bangladeshi society, including the poorest of the poor. Currently 29 NGOs are providing health care services to women, children and through 319 static and 8,500 satellite clinics in 61 districts of Bangladesh. 34 clinics of this network are providing Emergency Obstetric Care (EmOC) services. This network will continue to expand the volume and types of quality health care under ESD provided to the able-to-pay customers as well as underserved and poor clients. 4. 3Urban Primary Health Care Project (UPHCP-II) About 35 million people representing close to 25 percent of the population of Bangladesh live in urban areas, a large proportion of whom are slum dwellers.The health knowledge of the urban slum dwellers and their access to essential basic health services are low. Children living in urban slums are deprived of education and health care, and vulnerable to violence, revilement and exploitation. On the other hand, high rate of mortality and morbidity exists among women who remain neglected in call of meeting their basic health needs and ensuring their rights. The Government of Bangladesh is committed to put in place strategies to plough the issues of improving the health status of the urban population. This is to be done through improved access to and utilization of efficient, effective and sustainable Primary Health Care Services.The provision of public health services in urban areas is the responsibility of Local Government Bodies by dint of City Corporation Ordinance of 1983 and Pouroshova Ordinance of 1977. For primary health care services delivery, the public sector works in partnership with NGOs and the local government institutions such as the City Corporations and Pouroshovas. The health service delivery mechanism in urban areas involves div ers(prenominal) roles of the government (MOLGRD&C and MOHFW), NGOs and the private sector. CHAPTER 5 Leading Public Health Problems 5. 0Communicable disease The prevention and control of communicable diseases represent a significant challenge to those providing health-care services in Bangladesh.Sound knowledge on the disease epidemiology is a must for the health service providers in various levels. The Bangladesh population is namely affected by diarrheal diseases, cholera, hepatitis A & E, Malaria, Mycobacterial Disease like Tuberculosis and Leprosy, Dengue, Japanese encephalitis, Nipah virus infection, etc. Crowding, poor access to safe water, inadequate hygiene and toilet facilities, and unsafe food preparation and handling practices are associated with transmission. cholera is endemic Bangladesh, between 800 and 1000 cases are usually being recorded daily at the hospital of the ICCDR, B in Dhaka. Hepatitis A and E levels are usually high in the country.Malaria risk exists pas sim the year in Bangladesh. Thirteen out of 64 administrative districts are high malaria endemic areas. 98% of all malaria cases reported are from these districts, which are mainly located in the border areas of India and Myanmar. Tuberculosis still remains as a major public health problem, which ranks Bangladesh fifth among the high-TB burden countries in the world. The present revised National Tuberculosis Programme (NTP) was launched and field implementation of DOTS (Directly Observed Treatment short course) was started in 1993. Kala Azar or Leishmaniasis or is endemic in Bangladesh and has an incidence of 175 per 100,000 per annum.It is caused by a phylum Protozoa which is transmitted from the bite of infected sandfly and may present in cutaneous or splanchnic forms (particularly common in Bangladesh). Filariasis is a mosquito borne parasitic disease causality urogenital organs, breast, etc. with long arm disability. In Bangladesh, it is endemic in 23 districts, mostly the borde ring ones. About 20 million people are already infected, most of whom are incapacitated. Leprosy has been a major health problem in Bangladesh for a long time. Bangladesh was considered a high endemic country and was listed among ten countries with high case load (1992). Leprosy situation has changed globally after 1981 when the Multi Drugs Treatment (MDT) were introduced.Hepatitis A virus infection is common in Bangladesh with a prevalence of about 2% to 7%. Prevalence of hepatitis C virus infection is less than 1%. Sporadic volcanic eruption is often seen caused by hepatitis E virus infection but presence of hepatitis D infection is not exactly known. Polio free status prevailed from 2001 until now (June 2009) except a small window period in 2006 when 18 cases of child polio were seen in boarder areas of Bangladesh. it is assumed that these cases were imported from India. Dengue febrility/Dengue hemorrhagic fever (DF/ DHF) is a viral disease transmitted by the Aedes aegypty mosqu ito. It is on the increase in South East Asia. Bangladesh reported 100, 000 cases in 2005.However case fatality rate (CFR) remained