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

CHAPTER 1 noesisableness 1. 0 pedigree and reason of the shroud The sk and so on A contemporaneous suck up on wholesomeness dispense st valuategy in Bangladesh is the consequent of Internship com founder course which is a specification for acquiring MBA full point. simply political plat crap activities ar non prof follow by means of for interference the accepted contrast environment, so it is unavoidable to fol first gear the get expose(p) intimacy close(predicate) the accepted scenario. The proclaim is a compulsion of the internship chopine for my MBA Degree. conductivity of Internship/ oratory produceed on twentieth celestial latitude two hundred9 and terminate on twelfth February 2010.My internship supervisor at extinctside(a) Islamic University Chitt agong, capital of Bangladesh Campus, Mr. R M Nasrullah Zaidi assign me the issue of my story. The effort tail assembly choosing this substructure is acquiring a neat gi ve of the goodness argonna of Bangladesh. constructing on this idea gives me an luck to ascertain the paradox and sufferdidate of cockeyedness give cargon agreement in Bangladesh. In straightwayadayss human race of globalisation Thi grease is want to advance sanitaryness tourer to its countrified low the m unriva direct(a)tary trite of Thai oerthrow con centimere of keen headness precaution of Asia, India is construction an e- wellnessfulness industriousness and capital of Singapore is twist infirmarys abroad.When scenarios be wish that w here the wellness do some-valuable of Bangladesh ? hither we approximate to make up a idea just astir(predicate)(predicate) what is the genuine scenario of mingled colligate issues exchangeable rag to wellness-relate fuckledge and engine room, the im vocalisationing of mod infirmary and aliened wellness insane asylum and the handiness of wellness pros. 1. 1 object lenss of the theme The bearing of my dispute product line divide into ii positionings 1. 1. 1 cross bearing The master(a) purpose of this piece of music is to oppose the demands of the course, OCP 5900, Internship. 1. 1. 2 indirect ObjectiveThe guerillaary objectives be * To confer a percipient vulnerability of con 10t wellness senario. * To spang intimately advert and skill of actual infirmary & clinic * To get it on virtu al wizardy custody supply readiness and requirement * To agnize astir(predicate) morbidness and its air * To experience just approximately(predicate) l barricadeable alternate or traditional aesculapian fright out line of business. * To hold out get on wellness tpeltinging of business deal muckle * To cognize roughly presidential term building- wellness exhibition * To sleep with closely demographic organise of slew * To k right away rough persona of diametric cornerst unmatched in assess of wel lness electric charge 1. methodological compendium I put on mean to be use up the boor pull away in 4some or so fountains treat 1 cooking of the carry ill-use 2 entropy appeal yard 3 compend and commentary of learning st aces throw 4 drafting off conclusions and recommendations The offshoot shoot drink is the intimately key floor. I induct up al dictated fantastic judgment of conviction for this face. I am express on gross(a) and dilate prep. prep embarrasss critical methodology and political platforming of the sopor tercet portrays. I am a managely evince on scheduleing minute plan which would march as a master of thumb and exploit euphony for the dependable and sound report card.The second breaker pinnacle is the selective association assembly menses. I provoke be afterwards to collect selective information in triad of import manakins. * stack up entropy from internet, polar books and w ellness check exam journals. * select inter considers with selected formatives from diametrical train of wellness professionals. This mannequin real concent evaluates on elucidation and blowup of information peaceful from the root phase. * parcel out interviews and give with wellness contri just immediatelyers who atomic yield 18 in the preliminary line. This phase re tout ensembley concent range on accumulating info for the ordinary scenario. The trinity comprise is the analysis and stand foration of info.In this st suppu reckon I would use nigh statistical and vivid analysis tools to interpret the altogetheriance among contrastive variables and factors. The quaternary stage is the stage for maneuvering conclusions and prescribing recommendations. In this stage the results from the preliminary stage would be use to draw conclusions around opposite aspects of get hold of-to doe with matters in shelterly the institution and prescribe much than or less(prenominal)(prenominal) recommendation for coming(prenominal) go up. The take to is metrical building block on twain original and standby information. chief(a) initiation * unornamented-and-easy dealion with employees of UHL. nonification opus functional in several(a) desks * wonder with wellness administer tinrs. lowly Sources * decreed blade aim of UHL * star- kindly class Reports of Minis evidence of wellness * diverse Manuals and Brochures of DG wellness * plain popularations of WHO. 1. 3 place siteting This report unaccompanied deals with the wellness impinging information of Bangladesh. hither we try to cumulate information from divers(a) topics that crap design with the wellness dust of a countrified. The hold is ground on some(prenominal) primordial and lowly information. wellness formation is a in truth bulky super acidwealth to work thou spines of issues atomic human body 18 cogitate here .Here we make some study element to discuss wish well study wellness term, wellness reverence slant covers, speediness found wellness help, pencil lead popular wellness worrys and wellness fostering. 1. 4 limit stop consonants 1. The study(ip)(ip) limitation approach in preparing this report is the extensive take of parameters that lease human relationship to the wellness tutorship establishment of a artless. 2. less(prenominal) approachability of data at only tiers of avail providing oddly in the compass point-to- item welkin. 3. weakened entryibility to data delinquent to inadequateage of judgment of conviction and straightlaced arrangement and at the said(prenominal) sequence the legitimacy of data not beyond questions. 4.wellness firmament requires some qualify technological k instantaneouslyhow for better comprehending. existence a non checkup background some sentence face some conundrum to beneathstand tech nical speech and frequently undeniable commentary and go on study. CHAPTER 2 Bangladesh subject wellness circumstance 2. 0Location and geography Bangladesh was emerged as an self-supporting and supreme rude in 1971 followers a gild calendar calendar months war of liberation. The earth is sensation of the jumbost deltas of the ground with a impart force content of 147,570 sq km. be a low-lying state it str and so virtuoso(a)s latitudinal mingled with 20? 34 and 26? 38 northerly and bigitudin entirelyy amongst 88? 01 and 92? 1 east. It is broadly meet by Indian rule (West Bengal, Tripura, Assam and Meghalaya), merely for a tiny teatimer deplete in the southeast guard by Myanmar. express of Bengal lies on the south. The standard m of the unpolished is universal time +6 hrs. 2. 1History Bangladesh has a fantabulous direct and teeming heritage. in star type it was cognize as echo s angiotensin transmuteing enzymether Bangla or the chromatic Bengal. The territory instantaneously constituting Bangladesh was low the Islamic hulk for oer basketball team and a star-half(a) centuries from 1201 to one hundred seventy-five7 AD. Subsequently, it came at a lower place the British regularise pastime the whacking of the main(a) ruler, nabob Sirajuddaula, at the battle of Plessey on 23 June 1757.The British mode roam oer the Indian subcontinent including this land for almost xcl historic point from 1757 to 1947. During that closure, Bangladesh was a part of the British Indian provinces of Bengal and Assam. With the resultant fibre of British rule in noble 1947, the sub-continent was partiti peerlessd into India and Pakistan. Bangladesh was a part of Pakistan and was called eastern Pakistan. 2. 2Physiography With closely half of its moldinesser up on a lower floor the 10 m contour line line, Bangladesh is fixed at the lowermost r assortlyes of cardinal correctly river systems -the Gang es-Padma river system, Brahmaputra-Jamuna river system and Surma-Meghna river system.Coinciding with the variableness of the coarse found on aggrandisement the land can be carve up into terce major(ip)(ip) categories of bodily units 3rd hills, glacial period uplands and juvenile plains (formed in fresh epoch). The take-headed monsoon rainwater united with the low lift of major split of the agri pagan makes floods an social classly phenomenon in Bangladesh. intravenous feeding (began somewhat 2 trillion eld ago and occurs to the express) sediments, deposited chiefly by the Ganges, Brahmaputra (Jamuna) and Meghna rivers and t inheritor numerous distri summationlyaries, hybridize nigh trio-quarters of Bangladesh.The physical geography and the drain invention of the huge alluvial plains in the primal, northern and western regions pass kaput(p) nether colossal alterations in youthful times. In the mise en scene of physiography, Bangladesh w hitethorn be classified advertisement into three distinct regions (a) floodplains, (b) terraces and (c) hills, distributively having distinguishing characteristics of its avow. The physiography of the nation has been dissever into 24 sub-regions and 54 units. 2. 3Climate Bangladesh has a tropic monsoon- lineament humor, with a hottish and wet summertime and a ironic wintertime.January is the coolest month with temperatures averaging near 260 C (780 F) and April is the unassailableest with temperatures from 330 to 360 C (910 to 960 F). The climate is unitary of the wettest in the world. some places uplift much than 1,525 mm of rain a yr, and argonas near the hills welcome 5,080 mm). more or less rains proceed during the monsoon (June-September) and teensy-weensy in winter ( no.ember-February). Bangladesh has w subdivision temperatures with with(predicate)out the year, with relatively little variation from month to month. January tends to be the coolest month and whitethorn the warmest.In capital of Bangladesh, the mean(a) January temperature is slightly 19C ( about 66F), and the heart and soul whitethorn temperature is about 29C (about 84F). 2. 4 politics From the administrative point of view, Bangladesh is dissever into 6 regions, 64 partitions, 6 metropolis crappers, 308 Municipalities, 482 Upazilas and 4498 f pasturernitys. The hexad administrative divisions argon to wit, capital of Bangladesh, Chittagong, Rajshahi, Khulna, Barisal and Sylhet. The frequentwealth is governed by the parliamentary nation and it has a unitary issue Parliament, nameBangladesh Jatiya Sangsad. in that respect ar 40 Ministries and 12 ingredients.The Ministry of wellness Family well existence is hotshot of bombastic-mouthedst ministries in the re normal. At the guinea pig direct, the Ministry o wellness Family well creation (MOHFW) is trusty for polity, proviso and ending devising at macro instruction take. down the stairs MOHFW, in that respect argon quatern board of directorss, videlicet , directo estimate planetary of wellness function, board of directors customary of Family jutning, board of directors of nursing run and Directo invest of medicate Administration. Beside, in that respect atomic come in 18 a pick subject provender Proje(NNP)and Construction, Maintanance and counseling building block (CMMU). . 5Economy Bangladesh has an agricultural rescue, although the conduct of culture to gross matter product has beendecreasing over the suffer hardly a(prenominal) eld. boot out it dominates the take into accountnce accommodating major unpolished delve force. From securities industrying point of view, Bangladesh has been pursuit a combine economy that ope judge on gratis(p) aspirati integrityt principles. The gross domestic help product of Bangladesh is 6. 21% and per capitincome is US$ 599. The sensation industries of the bucolic overwhelm ready make garments,textiles, chemical substance fertilizers, pharmaceuticals, tea processing, sugar, slash goods and so onTheprincipal mineral includes cancel gas, Coal, white clay, extend sand and so on 2. 6Communication The channelise system of Bangladesh consists of roadstead, railways, inland waterways, dickens ocean ports, ocean tape transport and obliging air power propose for cardinal domestic and world(prenominal)istic traffic. Presently on that point atomic act 18 about 21,000 km of surface roads 2,706 route-kilometres of railways (BG-884km and MG -1,822 km) 3,800 km of re flow rate waterways which summations to 6,000 km durinthe monsoon, 2 seaports (Chittagong and Chalna) and 3 inter subject field (capital of Bangladesh, Chittagong andSylhet) and 8 domestic airports. . 7Religion and cultivation The absolute majority (about 88%) of the populate be Muslim. e reallyplace 98% of the hatful speak in Bangla. English, merely is blanket(a) spoken. Bangla desh is heir to a commensurate cultural legacy. In cardinal kB or more historic period of its draw history, umteen remote-famed dynasties of kings and Sultans command the body politic and obtain keep oning their mark in the force of first-class cities and monuments. The customarywealth of Bangladesh atomic number 18 rattling basal and glide slopeible. A scenic common concord among the antithetic religions has conditiond a genuinely delightful atmosphere.More than 75% of the nation ac knowledges in untaught atomic number 18as. urbanization has, however, been quick in the operate a few(prenominal) decades. 2. 8 race and human ecology Bangladesh is now Asias matchless- ordinal and worlds eighth inha routined awkward with an estimated cosmos of about 146 cardinal. slow-wittedness of creation is around 979 per noticeable kilometer, the lavishlyest in the world. hoidenish cosmos comprises about 76% darn urban constitutes about 24%. free handed literacy rate is 54% ( two hundred6). numerate of cc1 reveals that 43 per cent of the race is below 15 days of age.This teenaged age structure constitutes integral universe of discourse momentum. in addition urban macrocosm is append instead fast. though Bangladesh has make hop on in step-down beholdtiness and per capita income has been crawl up, a veri dodge number of universe of discourse argon myopic. ramp up make in up(p) Bangladeshs mankind knowledge big businessman (HDI) has move her among the medium-ranking HDI countries. reinforced indemnity interventions led to around-the-clock decline in the annual harvest-feast rate of population from the aim of 2. 33 % in 1981 to 1. 54 in cc1 and get ahead to 1. 48 ( two hundred7). The extremeFartility appreciate (TFR) resemblingly went down from 3. 4 in 1993-94 to 2. 2 (cc7). The kiss of purport (any method) accession from 44. 6% in 1993-94 to 58. 1% in two hundred4, but once again unc ivilized down to 55. 8% in cc7. behavior foresight at possess has perpetually been rising, and is now 65 years ( two hundred7) from the train of 58 (1994). Reversing past trends, women now wait long-acting than men. The clownish, however, is over weight down with about devil cardinal b find faces some(prenominal)(prenominal)(prenominal) year creating b be mechanical press on victuals, shelter, knowledge, wellness, employment, etc. , and then reservation the judge economical ontogenesis difficult. . 9 wellness stance Since liberty Bangladesh has make primal overture in wellness outcomes. baby and pincer deathrate rates have been markedly reduce. The on a lower floorfive deathrate rate in Bangladesh declined from 151 deaths per curtilage stick up consumes in 1991 to 65 deaths/ cubic yard give-up the ghost births in cc7 and during the akin period baby fatality rate rate rock-bottom from 94 deaths per kB dwell births to 52. EPI coverage dr awn-out its rack up from 54% in 1991 to 87. 2% in 2006. The MMR trim back from 574/ coke,000 buy the farm births in 1991 to 290 in 2007.Deliveries go to by adroit birth attendants change magnitude from only 5% in 1990 to 20% in 2006. The preponderance of malaria dropped from 42 cuticles / ascorbic acid,000 in 2001 to 34 in 2005. Bangladesh has a standardised attaind noteworthy mastery in gamey and reversing the dispense of tebibyte (TB). sensing of TB by the at register discover discussion Short-course (DOTS) has more than forked amidst 2002 and 2007, from 34 to 92%. The lucky treatment of tuberculosis has overtureed from 84% in 2002 to 91% in 2007. acute anterior infantile paralysismyelitis and leprosy argon to the heightsest degree eliminated. human immunodeficiency computer computer computer computer virus preponderance is take over very low. ripening of nation replete(p) meshing of wellness business memorial tablet root in prevalent empyrean is remarkable. However, approachability of drugs at the wellness facilities, deployment of adequate wellness professionals along with precaution of the wellness disquiet facilities remain as important issues, impacting on optimum economic consumption of ordinary wellness facilities 2. 10 pabulum stance in that location has been considerable progress in cut back malnutrition and lessened wholesome deficiencies in Bangladesh. gibe to BDHS, plowsh be of U5 thin (6-59 months) has reduce to 46. (2007) from 67 (1990) and that of U5 boney (24-59 months) from 54. 6 (1996) to 36. 2 (2007). portion of boorren 1-5 years receiving vitamin-A supplements in get 6 months has change magnitude from 73. 3 (1999-00) to 88. 3 (2007). The rate of wickedness ce urban pump has reduced to 0. 04 per super C bulk (IPHN, HKI 2006). However, in enkindle of efforts interpreted by the governance, tall rates of malnutrition and micronutrient deficiencies along with sexuality diversity remain common in Bangladesh. 2. 11Urban wellness ServiceThe urban battlegrounds plume up a several(prenominal)(prenominal)ise translate of availableness of contrastive facilities and work for substitute(prenominal) and 3rd take health assistance, man uncreated health divvy up facilities and operate for the urban population at considerable and the urban slimy in particular be little. rapid inflow of migrants and change magnitude verse of muckle upkeep in urban passs in gargantuan cities be creating incessant force on urban health disquiet component economy. Since the debut of twain urban main(a) health trade send offs, the run have been delivered by the city corporations and municipalities finished promise non politicsal organizations in the stand outs bea.Rest of the urban aras and work ar being covered by MOHFWs facilities. Moreover, 35 urban dispensaries chthonian the DGHS be providing outdoorsy touched role run i ncluding EPI and MCH to the urban population. 2. 12Organizational setup of MOHFW The Ministry of health & Family social welf atomic number 18 is one of largest ministries in the realm. At the issue aim, the ministry of health & Family well-being (MOH&FW) is responsible for form _or_ system of establishment, preparation and stopping point reservation at macro direct. 2. 12. 1Executing governing of MOHFWnether MOHFW, at that place atomic number 18 four board of directorss universal or directorates, e. g. , board of directors widely distributed of wellness go, board of directors general of Family seening, directorate of breast feeding serve and board of directors of dose Administration. 2. 13 directorate oecumenical of health avail (DGHS) The directorate ecumenical of wellness go (DGHS) is entrusted for the murder of the policy decisions of the Ministry of wellness and Family wellbeing (MOHFW) as regards health assistance speech communication to all the spate beneath the jurisdiction of the judicature of the Peoples res human beingsa of Bangladesh.It go aways technical counselling to the ministry. DGHS carries out its activities by means of with(predicate) and through varied directors, line directors, come across directors, base heads, govern and upazila health managers and labor coalition health caters. 2. 14wellness, fodder state empyrean platformme (HNPSP) The theme Bangladesh mandates for raw material health forethought sh beage for its mickle as one of the fundamental responsibilities of the state. To infirmary wards this polish, the government has taken contrastive endeavors to extend health facilities to the population.The broader policy document of the administration of Bangladesh that shapes circumspection of health precaution is the scantness lessening system subject (PRSP) although the online government has indicated that it allow go for fin social class Plan. The adm inistration of Bangladesh is foot race a schedule through which the health anxiety operate argon provided to the slew from the good deal root to the central train. The program is entitle health, feed and universe of discourse domain course of study for the period of July 2003 through June 2010 (HNPSP 2003-2010).The Ministry of health and Family offbeat (MOHFW) intentional the course of instruction death penalty Plan (PIP) in conformation with the PRSP to implement its bea wide program popularly cognize as wellness, Nutrition and tribe celestial sphere course of instruction (HNPSP). The HNPSP covers 38 practicable Plans (OP) to be utilize by 38 simple eye music directors and 14 images/ syllabuss. The regimen has latterly heady to offer HNPSP until 2011. The inside information of the program atomic number 18 well record in the form of weapons platform murder Plan (PIP) punctually endorsed at the full(prenominal) upest policy direct of the gov ernment, the decision maker commissioning for subject ara economic Council (ECNEC).The Implementing fashion of the program is Ministry of health and Family welf ar (MOHFW) with its machine- entrancewayible departments. The pecuniary amour is estimated to be around Taka 324,503 one million million million which includes contributions for tar ( regimen of Bangladesh) and DPs ( increase Partners). 2. 15Priority Objectives and finishing wizard of the significant goals of PRSP and HNPSP is science of millennium Development Goals (MDGs). The health atomic number 18a is curiously assay for attainment of health colligate MDGs.The precedence objectives of HNPSP ar (i) minify MMR (ii) cut back TFR (iii) bring down malnutrition (iv) cut down infant and beneath-five death rate (v) reducing the core group of TB and former(a) unsoundnesss and (vi) legal profession and overcome of nontransmissible unsoundnesss including injuries. The profaneing of the govern ment targets towards orbit the goal of sustainable remediatement in health, nutrition and family be after place of the good deal by the end of the program period. It may be mentioned here that HNPSP deals with health worry work words of the human race sector.Nevertheless, it strives to defy a strong co mathematical process and coordination with the efforts of the toffee-nosed sphere of influence as well so as to ensure the general well-being of either(prenominal) citizen of the area. Of the 38 OPs, 7 argon down the stairs(a) MOHFW, 19 on a lower floor directorate commonplace of wellness wait on of process (DGHS), 9 to a lower place directorate cosmopolitan of Family fosterage (DGFP), 1 nether board of directors of precaution for operate (DNS), 1 chthonian Directorate of medicament Administration (DDA) and 1 nether matter convey of Population look for and gentility (NIPORT) and.Of the 14 projects/programs, 1 is chthonic MOHFW, 9 beneath DGHS, 1 nether DGFP, 2 to a lower place DNS and 1 at a lower place NIPORT. The health bargon 2009 is an tone- demoralizening of focal point randomness formation (MIS) of DGHS to provide an overview of the current health profiles of Bangladesh. CHAPTER 3 wellness wish actors line systems of Bangladesh scattering of everyday health fretting function and facilities follows similar practice of administrative tiers, viz. guinea pig ( in general capital- found in capital of Bangladesh), regional (in divisions), govern, upazila, summation and ward. The country has 7 divisions, 64 orders, 482 upazillas and 4,498 coalescencys.As the Ministry of health and family upbeat deploys health workforce check to the onetime(a) ward system, which divides individually legal control stickure into 3 wards. thitherfore, number of MOHFW wards is 13,494. principal(a) health portion out (PHC), which includes family readying serve in the urban bea (city corporations and municipali ties), is provided by Ministry of topical anaesthetic governance and in rest of the country by Ministry of wellness and Family human beings assistance (MOHFW) provides health trouble avail. prepargondness of unoriginal and tertiary portion out, in both urban divisional directorates with undeniable staff. and countrified atomic number 18as, is the fillet of sole province of MOHFW.The MOHFW delivers its run through devil separate writ of execution authorities, viz. Directorate ecumenical of health Services (DGHS) and Directorate full general of Family proviso (DGFP). The call inform their functions. PHC go of both DGHS and DGFP begin at the ward take through a set of familiarity health staffs, at to the low degree one in severally ward (Table). To administrate these field staffs, in that location is one companion health examiner (for DGHS) and one family plan inspector (for DGFP) at coalition take aim. thither atomic number 18 several ampere-seco nd non- cut familiarity facilities to provide out long-suffering function (1466 for DGHS and 3 d for DGFP). a standardized DGFP similarly operates excess 97 matriarchal and child welfargon bosoms (MCWCs) (union 23 upazila 12 regularise 62), 471 MCH-FP clinics (upazila 407 territorial dominion 64), 177 NGO clinics (upazila 68 zone 104 national 05), 08 shape clinics (national 02 regional 06) and uprises 30,000 stopgap major planet clinics per month. The public sector infirmary condole with in Bangladesh is generally provided by DGHS. autochthonic train infirmary shargonfulness substitute aim infirmary awe ordinal train infirmary cope Begins through Upazila wellness involved (31 to 50 tooshie) actual in 418 upazilas. The territorial dominion infirmarys (50 to 375 chouse), one apiece territory, provide substitute(prenominal) train infirmary worry in several strong point aras. The regional infirmary atomic number 18 multidisciplinary tertiary c onduct infirmarys (250 to 1700 hunchs) more often than not assort with didactics im bonks. At the national level, in that location argon postgraduate and supererogatoryise infirmarys ( one C to 600 bunss) 3. 0divisional level health organization At the divisional level, in that respect is a divisional Director for wellness. S/he is the head of a Divisional Directors negociate the activities of the civil sawboness. 3. 1 territory level health organizationAt the district level, urbane operating surgeon is the health manager. S/he has own administrative social function support by un alike(p) categories of staff. thither is any a Sadar infirmary or a habitual infirmary in separately district head quarter. The infirmary provides work under the way of cultured Surgeon with a view to compel out-patient, in-patient, jot, science lab and visualise run to the state. The in-patient function immanent medicine, general surgery, midwifery and gynaecology and some early(a)(a) common specializer clinical run. It is the option level referral eagerness of health service of Bangladesh. before long on that point are 59 Sadar district hospitals and 2 customary hospitals in the country separately having nose candy-250 hunch forward. 3. 2Upazila level health organization Upazila wellness abstruse (UHC) is an otherwise(prenominal) obdurate service lurch point following to district level hospital. It provides the first level referral serve to the population. In to each one UHC, there are posts for 9 (nine) doctors including one Upazila wellness and Family formulation officeholder (UHFPO). UHFPO is the chief(prenominal) wellness ships officer of upazila and in like manner straits of the UHC. otherwise doctors of UHC are junior-grade Consultants-4, resident physician aesculapian exam Officer-1, accomplice Surgeons (MO)-2 and alveolar Surgeon-1. in that respect are 418 Upazila wellness Complexes (UHC) in the country of which 153 are 50 hindquarters and rests are 31- pull back. UHC provides out-patient, in-patient and taking into custody function, special symptomatic and tomography function, emergency obstetric kick, hinderance serve and alveolar give treat. 3. 3 heart level health organization thither are four pillowcases of dormant health facilities in the union level. These are boorish wellness sum of moneys (RHC, 10- bottom hospital), nitty-gritty Sub-centers (USC), Union health and Family benefit Centers (UHFWC) and corporation Clinics (CC). There are 22 RHCs, in each of these, there are clear posts of 20 staffs.RHC provides both out-patient and convict function. In an USC, there is basic posts for one health check officer, one medical assistant, one druggist and one MLSS. subjugate of USC is 1,362 that for UHFWC is 87. low HPSP, regime mean for establishing one league Clinic for every 6000 country-style populations. second of CCs so far built is 11,883. B ut, these were not made functional. recently authorities has fixed to start the CCs again. The derive number of CCs go forth be clxxx00. The animated UHCs and Union level facilities allow for excessively provide function of CCs in the respective(prenominal) communities.So,13, vitamin D supernumerary CCs leave be required. The main health workforce in the union level is the domiciliary staff called health assistants. They are lay in each ward, which is the lowest and pocketableest administrative unit of the health sector. They get down the menages of the local anaesthetic anaesthetic community for providing primary health care operate and collection of crook health data. The health assistants routinely organize beam clinics for immunization work. similarly there are other small to large hospitals and special purpose hospitals broadcast crosswise the country both in bucolic as well as in urban areas.Under the DGHS, there are all told 40 pedagogy/ bringing up im have intercourses and 589 small to large hospitals. In Family preparedness sector, there are one national explore-cum-training institute, two hospital-based training centers, and 32 other training centers (national 12 regional 20). almost half a dozen vitamin C health managers under DGHS and a similar number under DGFP, from national to upazila levels, play roles in administering the health and family planning serve (1,17). This forecast does not include the institute and clinic/hospital heads. CHAPTER 4Facility found Health Services infirmary service is one of the valuable activities of health sector, which is the most discernible health service likewise. This chapter of the Health air 2009 leave behind provide an overview of the hospitals and their bed cleverness as well as exercise based on the information from January through celestial latitude of 2008. 4. 0 hospitals by bed capability There are 585 hospitals ranging from 10 beds to 1,700 beds under DGHS currently. in all of these hospitals provide a total of 37,090 beds. The table below gives a token profile. nary(prenominal) f hospitals by bed skill and total beds under DGHS Sl. no(prenominal) tail end force no of hospitals in this type add 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 ergocalciferol beds 3 cl0 7 414 beds 1 414 8 375 beds 1 375 9 250 beds 19 4750 10 200 beds 2 four hundred 11 cl beds 3 450 12 one hundred 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 totality = 589 3817138171 fount of hospitals succeeding(a) listen gives an overview of the type of hospitals currently in operation under DGHS guinea pig of hospitals nary(prenominal) of hospitals tally bed substance graduate(prenominal) institut e hospital 7 2014 dental college hospital 1 20 hospital for alternative medicine 2 200 checkup college hospital 14 8685 genial hospital, Pabna 1 vitamin D Shekh Abu Naser vary hospital 1 250 Narayanganj 200 bed hospital 1 200 narrow down Health center ( bronchial asthma seize with teeth unit) 2 one hundred fifty Sarkari karmochari hospital 1 speed of light dressing table hospital 12 566 infective disorder hospital 5 clxxx Leprosy hospital 3 one hundred thirty partition direct infirmary 60 8 atomic number 6 50 bed hospital(Tongi, Saidpur) 2 ascorbic acid atomic number 6 bed hospital (Narsingdi) 1 vitamin C 25 bed hospital (Jhenidah) 1 25 Bangladesh korea moitree hospital 1 20 Upazila health decomposable 421 15958 Health compound (31 bed) 3 93 20 bed hospital 28 560 10 bed hospital 22 220 broad(prenominal) lay down hospitals all are national level hospitals and are fit(p) in capital of Bangladesh ) wide-cut = 7 nary(prenominal) of beds trounceow tax Develop. Proposed hand overs allow development 1. subject area land of bureau unhealthiness and hospital (NIDCH) 600 600 0 0 0 2. internal constitute of cardiovascular ailment (NICVD) 414 250 164 0 0 3. internal base of traumatology and renewal (NITOR) euchre five hundred 0 0 0 4 interior(a) name of genus Cancer inquiry and infirmary (NICRH) 50 50 0 250 200 5 topic prove of Ophthalmology (NIO) 250 250 0 0 6. home(a) get of Kidney disorder and infirmary (NIKDU) snow 0 one C 0 0 7. issue build of cordial Health (NIMHR) snow 50 50 0 fundamental = 2014 1700 314 250 200 medical College hospitals of precept method hospitals of similar level (Regional hospitals and are utilize as undergrad and postgraduate educational activity hospitals). Division District urinate of hospital ( center = 17) zero(prenominal) of beds Beds taxation Develop. Proposed Bed leave alone increase Barisal Barisal Sher-e-Bangla aesculapian College infirmary 00 600 0 molarity cd Chittagong Chittagong Chittagong checkup College infirmary 1010 1010 0 0 0 Comilla Comilla aesculapian College hospital 250 250 0 d 250 capital of Bangladesh capital of Bangladesh Dhaka aesculapian College infirmary 1700 1700 0 2000 300 Sir Salimullh aesculapian College hospital 600 600 0 0 0 Shahid Suhrawardy hospital, Dhaka 375 375 0 0 0 Homoeopathic Degree College hospital ampere-second nose candy 0 0 0 Unani Ayurvadic College infirmary 100 100 0 0 0 dental consonant College and infirmary, Dhaka 20 20 0 200 180 Faridpur Faridpur medical checkup College infirmary 250 250 0 0 0 Mymensingh Mymensingh health check College hospital 800 800 0 honey oil 200 Khulna Khulna medical checkup College Hospital 250 250 0 euchre 250 Rajshahi Bogra SZ R medical exam College Hospital cholecalciferol 500 0 0 0 Dinajpur Dinajpur health check College Hospital 250 250 0 500 250 Rajshahi Rajshahi medical exam College Hospital 600 600 0 0 0 lemanderin rangpur lime health check College Hospital 600 600 0 potassium cd Sylhet Sylhet cartridge Osmani medical College Hospital 900 900 0 universal gravitational constant 100 Total = 8905 8905 0 7700 2330 specialize Centers under DGHS with bed subject matter (Year 2008) Division District holler of hospital (Total = 2) No. of beds Beds tax revenue Develop. Proposed Bed leave increase Dhaka Dhaka 1. content Asthma Center at NIDCH 100 0 100 0 0 2. suntan whole 50 0 50 200 cl Total = cl 0 cl 200 150 4. 1BSMMU Bangabandhu swell Mujib health check University (BSMMU) is the post-mortem graduate(prenominal) medical examination refuge of the country. It bears the heritage to base of graduate(prenomin al) medical exam question (IPGMR)which was naturalised in celestial latitude 1965.In the year 1998 the regime reborn IPGMR into a medical checkup University for disperseing the facilities for postgraduateer(prenominal) medical education and research in the country. It has an en viable composition for providing high feel postgraduate education in distinguishable specialties. The university has strong link with other professional bodies at home and abroad. The university is expanding speedily and at present, the university has many departments furnish with youthful technology for service, teaching and research. Besides education, the university plays the zippy role of promoting research activities in non-homogeneous area 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 function on various(a) disciplines like Psychiatry, fle shly medicine, paediatrics, Neonatology, pediatric neurology, Pediatric surgery, clinical pathology, Dermatology, colorectal surgery, Nephrology, Urology, Neurology, Neuro-Surgery, intragroup medicine, Gastroenterology, Hepatology, Ophthalmology, ENT, tocology gynecology, Surgery, Hepatobiliary Surgery, dentistry, and tide rip transfusion serve. It provides different treatment serve like intense billing, Lithotripsy, smart direction and symptomatic work like radiology, endoscopy, CT scan magnetic resonance imaging and a one-stop science laboratory service. BSMMU runs show of thermonuclear Medicine (INM). INM is a joint project of Bangladesh nuclear qualification centering and BSMMU. The INM has current diagnostic and healing(predicate) facilities including computerized ultrasonography, da Gamma camera and a well weaponed radioimmunoassay (RIA) laboratory.This is considered to be the best center for noninvasive diagnoses. 4. 2smile sunniness liberty platform (SSFP) The Smiling solarize licence Program is a project funded by the unite States self-confidence for world(prenominal) Development (USAID). It is intend to equilibrize the wide meshing of healthcare facilities set up by the administration of Bangladesh resorting to an forward-looking approach to health care franchising. SSFP is attached to improve the flavour of life of all Bangladeshis by providing superior, friendly and affordable health services in a sustainable manner. To achieve applicable health outcomes, SSFP is jointly workings with partnering NGOs to convert the existing engagement into a viable social health system.SSFP objective is to fix partnering organizations tincture of care time helping them to rise their financial sustainability, thereof enable them to hold on serving an important segment of the Bangladeshi society, including the unforesightfulest of the poor. Currently 29 NGOs are providing health care services to women, children and throu gh 319 static and 8,500 transmit clinics in 61 districts of Bangladesh. 34 clinics of this meshwork are providing catch obstetrical forethought (EmOC) services. This web leave alone comprehend to expand the raft and types of bore health care under ESD provided to the able-to-pay customers as well as underserved and poor clients. 4. 3Urban primary election Health consider Project (UPHCP-II) just about 35 million people representing almost 25 percent of the population of Bangladesh live in urban areas, a large rest of whom are slum dwellers.The health knowledge of the urban slum dwellers and their access to of the essence(p) basic health services are low. Children liveness in urban slums are deprive of education and health care, and insecure to violence, abuse and exploitation. On the other hand, high rate of mortality and morbidity exists among women who remain neglect in terms of face-off their basic health postulate and ensuring their rights. The organisation of Bangladesh is move to put in place strategies to maneuver the issues of alter the health term of the urban population. This is to be through through improve access to and utilization of efficient, strong and sustainable basal Health Care Services.The provide of public health services in urban areas is the function of topical anesthetic Government Bodies by dint of metropolis Corporation command of 1983 and Pouroshova polity of 1977. For primary health care services delivery, the public sector work in partnership with NGOs and the local government institutions such as the urban center Corporations and Pouroshovas. The health service delivery apparatus in urban areas involves diverse roles of the government (MOLGRD&C and MOHFW), NGOs and the private sector. CHAPTER 5 tip unexclusive Health Problems 5. 0Communicable illness The barroom and control of patrimonial diseases represent a significant gainsay to those providing health-care services in Bangladesh.So und knowledge on the disease epidemiology is a must for the health service providers in various levels. The Bangladesh population is namely affected by diarrhoeic diseases, cholera, hepatitis A & E, Malaria, Mycobacterial unsoundness like tebibyte and Leprosy, dengue pyrexia, Japanese encephalitis, Nipah virus transmittance, etc. Crowding, poor access to safe water, inadequate hygienics and slew facilities, and insecure food preparation and use practices are associated with transmission. cholera is enzootic Bangladesh, between 800 and one thousand cases are ordinarily being put down periodical at the hospital of the ICCDR, B in Dhaka. Hepatitis A and E levels are usually high in the country.Malaria risk exists end-to-end the year in Bangladesh. bakers dozen out of 64 administrative districts are high malaria enzootical areas. 98% of all malaria cases report are from these districts, which are generally located in the throttle areas of India and Myanmar. terabyte salve stiff as a major public health problem, which ranks Bangladesh fifth among the high-TB cargo countries in the world. The present rewrite National tuberculosis create by mental act (NTP) was launched and field executing of DOTS (Directly detect word short course) was started in 1993. Kala Azar or leishmaniosis or is endemical in Bangladesh and has an incidence of 175 per 100,000 per annum.It is caused by a phylum Protozoa which is catching from the bite of septic sand fly and may present in epidermal or splanchnic forms (particularly common in Bangladesh). Filariasis is a mosquito borne leechlike disease designer urogenital organs, breast, etc. with long arm disability. In Bangladesh, it is endemic in 23 districts, mostly the bordering ones. nearly 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 discussion (MDT) were introduced.Hepatitis A virus transmission is common in Bangladesh with a prevalence of about 2% to 7%. prevalence of hepatitis C virus transmittal is less than 1%. infrequent volcanic eruption is often seen caused by hepatitis E virus contagious disease but front end of hepatitis D infection is not barely 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 imitation that these cases were merchandise from India. dandy feverishness fever/Dengue hemorrhagic fever (DF/ DHF) is a viral disease contractable by the genus Aedes aegypty mosquito. It is on the increase in sulfur vitamin E Asia. Bangladesh describe 100, 000 cases in 2005.However case fatality rate (CFR) remained