The excessive focus of country’s public hospitals on infrastructure development and medical equipment procurement, while neglecting severe staff shortages, has become a longstanding structural problem undermining healthcare services. Almost all public hospitals suffer from unhygienic environments, filthy toilets and inadequate maintenance. Patients and their attendants often have to endure unbearable conditions even inside hospital wards. Medical associations and public health experts have long demanded a shift from procurement-driven development towards workforce reform and coordinated recruitment.
Doctors identify the acute shortage of support staff, particularly fourth-class employees, as a major reason for this deterioration. Although public hospitals have 65,230 approved positions for third- and fourth-class employees, 34,205 remain vacant, representing 52.44 per cent of the total. Some positions have remained unfilled for nearly two decades. According to the Directorate General of Health Services (DGHS), 20,816 positions in grades 11-16 and 13,389 in grades 17-20 are vacant. Recruitment of these employees is currently suspended, with hospital authorities instructed to hire workers through outsourcing.
Doctors also complain that some employees become difficult to manage after establishing connections with local political leaders. Several physicians have told Daily TIMES of Bangladesh that their frustration has reached the point where they are considering leaving their jobs. Meanwhile, patients and their relatives allege that some nurses and cleaners behave rudely and remain occupied with mobile phones instead of attending to patients.
A public health expert has criticised the government’s misplaced priorities, arguing that it has concentrated on constructing buildings and purchasing equipment while neglecting the human resources needed to deliver healthcare. Large procurement projects create opportunities for financial irregularities and commissions, whereas staff recruitment offers no comparable incentives. As a result, doctors are left to face public anger when patients fail to receive essential services.
The problem has been aggravated by expanding hospital infrastructure without proportionately increasing support staff. Upazila hospitals have been upgraded from 31 to 50 beds, while district hospitals have expanded from 50 to 100 beds and from 100 to 250 beds. Although doctors’ positions have sometimes increased, cleaners and other essential workers have not been recruited accordingly. The deteriorating conditions have become so alarming that Prime Minister Tarique Rahman recently expressed displeasure after finding filthy toilets during an unannounced hospital visit in the capital.
The procurement-oriented approach has also left expensive medical equipment unused. Hospitals purchase ICU beds, CT scanners and MRI machines without recruiting sufficient trained technologists and engineers to operate them. Consequently, costly equipment remains idle or deteriorates in storage. Meanwhile, understaffing increases the workload on existing healthcare professionals, contributing to service deficiencies, long queues and the deterioration of rural primary healthcare.
Against this backdrop, we recall that the BNP pledged in its election manifesto to reform the healthcare system along the lines of the UK’s National Health Service (NHS). It also promised to recruit 100,000 healthcare workers within three years, 80 per cent of whom would be women. This is encouraging, but recruitment alone will not resolve the crisis. Transparent appointments, adequate training, effective supervision and accountability must accompany the initiative.
We believe healthcare reform must prioritise people over buildings and machinery. Modern infrastructure and equipment are essential, but without sufficient and skilled personnel, they cannot ensure quality treatment. The government must fill vacant positions, reform workforce management and ensure proper maintenance of public hospitals.
