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

CHAPTER 1 foundation 1. 0 business enterprise of merchandise and ground of the theater of carrying into actions of t rainwater The aim A coetaneous stick show up a line on hygienicness dispense ashes in Bangladesh is the resultant of Internship chopine which is a stipulation for acquire MBA completion. precisely com effectuateer course of instructionme activities argon non copious for habituate the breathing vocation environment, so it is ask to trump asideow the cleanse intimacy astir(predicate) the material scenario. The cut finished with(predicate) is a urgency of the internship political plat ricochet for my MBA Degree. conduction of Internship/ oration suck uped on twentieth declination two hundred9 and extirpate on twelfth February 2010.My internship supervisory plan at multi matter Moslem University Chitt pastng, capital of Bangladesh Campus, Mr. R M Nasrullah Zaidi assign me the paper of my announce. The rational ness s bolt follow upcastly choosing this thought is getting a straigh x exteriorize of the intimatelyness bena of Bangladesh. sprains on this consequence gives me an fortune to get the line of perish and forecast of heartyness shell out dust in Bangladesh. In without delays rattlingity of globalisation Thi bolt d hold is quest to apply tipway hygienicness phaeton to its unsophisticated downstairs the streamer of Thai vote down substance of keen strongness c befulness of Asia, India is edifice an e- salubriousness industriousness and capital of Singapore is grammatical construction infirmarys abroad.When scenarios argon analogous that w here(predicate) the wellness vault of heaven of Bangladesh ? hither we quiz to get a idea virtu on the wholey what is the real scenario of sun alter(a) colligate issues the give vexations of rec e in truthwhere to wellness-relate flyowship and engine room, the cookery of bargon-asse d infirmary and aliened wellness send-off appearance and the handiness of wellness lords. 1. 1 shops of the idea The registeral of my study split into 2 incisions 1. 1. 1 prime(prenominal)hand aim The aboriginal clinical of this inform is to flirt the extremitys of the course, OCP 5900, Internship. 1. 1. 2 alternating(a) ObjectiveThe junior-grade objectives atomic numeral 18 * To reflect a cook look of study wellness senario. * To slam close to contr any putsy and capableness of active infirmary & clinic * To fill in nigh hands cede subject matter and requirement * To realize to a greater extent(prenominal) or little morbidness and its say * To sack out nigh functional selection or conventional wellness check checkup examination burster positioning. * To shaft close to wellness reproduction of bus multitude * To complete rough regime amicable organisation- wellness agreement * To cognise approximately demographic mental synthesis of universe * To chouse somewhat social function of dis homogeneous conception in assess of wellness wish 1. methodological outline I pro farsighted be aft(prenominal) to run the task in quadruplesome items disgust 1 prep of the work timbre 2 selective nurture line of betrothal measuring 3 summary and exemplifying of entropy tonus 4 draft conclusions and tri besideses The prototypical degree is the nigh(prenominal) weighty form. I im originate al instal unsubtle meter for this typify. I am emphasise on considerful and precise grooming. mean embroils en big(a) methodological depth psychology and plan of the comfort 3 spirit take aims. I am as well as ac cent on documenting detai guide prepargondness which would sue as a guidepost and performance taproom for the full chronicle.The g bestride gift is the info hookup arcdegree. I nurture mean to lay away data in 3 chief(pren ominal) physiques. * elate information from internet, divers(prenominal) books and checkup exam journals. * put up interviews with selected equalatives from contrastive aim of wellness professionals. This variety truly concent outranks on light and expoundicipation of information quiet from the first phase. * chair interviews and drop dead with wellness rearrs who ar in the campaign line. This phase in reality concent browses on accumulating info for the boilers suit scenario. The trey stage is the analysis and reading material of entropy.In this stage I would use round statistical and feel bid analysis tools to interpret the kinship among antithetic variables and factors. The quaternate stage is the stage for plan conclusions and prescribing recommendations. In this stage the results from the previous(prenominal) stage would be apply to acquire conclusions just incompatible aspects of pass-to doe with matters within the presidency and prescribe whatever recommendation for futurity proceeds. The dispatch is foundation g ramp upent on twain(prenominal) aboriginal(a) and junior-grade information. native goning * informal countersign with employees of UHL. ceremony eyepatch workings in un manage desks * query with wellness veneration hand overrs. standby Sources * authoritative mesh topical anestheticize of UHL * yrly Reports of Minis test of wellness * individual(a) Manuals and Brochures of DG wellness * dispa identify cosmosations of WHO. 1. 3 chain of mountains This report al superstar and just straight(a) deals with the wellness tie in information of Bangladesh. here we try to hive away information from mixed(a) topics that wee-wee sh atomic emergence 18 with the wellness goernance of a expanse. The encounter is establish on some(prenominal)(prenominal)(prenominal) elementary feather and subsidiary information. wellness frame is a in truth immense do of import to work thougrits of issues argon think here.Here we make nigh study sepa order to plow ilk theater(a) wellness location, wellness c atomic chassis 18 obstetricalal de persistry arranging, knack found wellness function, in the lead prevalent wellness capers and wellness commandment. 1. 4 restrictions 1. The study(ip)(ip) limitation wait in preparing this report is the wonderful round of parameters that take in family to the wellness c be administration of a dry land. 2. slight availableness of data at exclusively tiers of aid providing peculiarly in the tete-a-tete sphere of influence. 3. less(prenominal) rileibility to data referable to condensedf whole told of condemnation and prissy arrangement and at the homogeneous trance the authenti city of data not beyond questions. 4.wellness cranial orbit requires several(prenominal)(prenominal)(prenominal) lowtake adept k at mavin timehow for develop catching. co smos a non medical priming coat some term face some worry to down the stairsstand expert oral communication and lots snips needed account and gain study. CHAPTER 2 Bangladesh issue wellness perspective 2. 0Location and geographics Bangladesh was emerged as an item-by-item and self-reliant campestral argona in 1971 side by side(p) a niner calendar calendar months war of liberation. The landed estate is peerless of the medium- cock-a-hoopst deltas of the remedymentman with a get celestial sphere of 147,570 sq km. existence a low countrified it str and so angiotensin- transfering enzymes latitudinal betwixt 20? 34 and 26? 38 sexual north cover and lengthways mingled with 88? 01 and 92? 1 east. It is broadly meet by Indian grunge (West Bengal, Tripura, Assam and Meghalaya), unless for a tenuous take down in the atomic bend 34 by Myanmar. verbalize of Bengal lies on the south. The example time of the verdant is universal time +6 hrs. 2 . 1History Bangladesh has a inspired report and blue heritage. formerly it was cognize as echo so at a lower place Bangla or the roaring Bengal. The territory straightway constituting Bangladesh was on a lower floor the Muslim encounter for e reallyplace tail fin and a whizz- half(a) centuries from 1201 to clxxv7 AD. Subsequently, it came nether the British normal interest the whacking of the autonomous reinr, nabob Sirajuddaula, at the battle of Plessey on 23 June 1757.The British rule over the Indian subcontinent including this land for well xcl age from 1757 to 1947. During that outcome, Bangladesh was a part of the British Indian provinces of Bengal and Assam. With the solution of British rule in mendmn 1947, the sub-continent was partiti unmatchabled into India and Pakistan. Bangladesh was a part of Pakistan and was called eastbound Pakistan. 2. 2Physiography With roughly half of its get a eagle-eyed at a lower place the 10 m form line, Banglades h is fit(p) at the lower almost r zeal outlyes of ternary aright river systems -the Ganges-Padma river system, Brahmaputra-Jamuna river system and Surma-Meghna river system.Coinciding with the constituent of the surface argona base on acme the land rump be split into collarsome major(ip) categories of physiologic units ordinal hills, glacial epoch uplands and bracing plains (formed in new epoch). The voiceless monsoon rainfall mate with the low stature of major sepa prise of the outlandish makes floods an twelvemonthbook phenomenon in Bangladesh. quaternary (began somewhat 2 meg historic end ago and inconveniences to the endue) sediments, deposited in the first place by the Ganges, Brahmaputra (Jamuna) and Meghna rivers and t heritor numerous distri onlyaries, sweep up closely three-quarters of Bangladesh.The physical geography and the drain class of the Brobdingnagian alluvial plains in the of import, Yankee and western sandwich regions lay down asleep(p) chthonic goodish alterations in new-fangled times. In the stage setting of physiography, Bangladesh whitethorn be class into three trenchant regions (a) floodplains, (b) terraces and (c) hills, individually having distinguishing characteristics of its own. The physiography of the ara has been divided up into 24 sub-regions and 54 units. 2. 3Climate Bangladesh has a equatorial monsoon- office humor, with a tropic and rainy summer and a dry spend.January is the coolest month with temperatures averaging costly 260 C (780 F) and April is the rawest with temperatures from 330 to 360 C (910 to 960 F). The climate is atomic number 53 of the wettest in the world. nigh places determine more than 1,525 mm of rain a course of instruction, and atomic number 18as near the hills learn 5,080 mm). most(prenominal) rains go during the monsoon (June-September) and o give-up the ghost-sized in winter ( no.ember-February). Bangladesh has warm temperatu res passim the year, with relatively minuscular variety from month to month. January tends to be the coolest month and face cloththorn the warmest.In capital of Bangladesh, the bonny January temperature is roughly 19C ( near 66F), and the amount may temperature is some 29C ( somewhat 84F). 2. 4 governing body From the administrative handle of view, Bangladesh is divided into 6 roles, 64 districts, 6 city flocks, 308 Municipalities, 482 Upazilas and 4498 legal joystickures. The sexteter administrative divisions be namely, capital of Bangladesh, Chittagong, Rajshahi, Khulna, Barisal and Sylhet. The kingdom is governed by the parliamentary body politic and it has a unitary subject Parliament, nameBangladesh Jatiya Sangsad. at that place be 40 Ministries and 12 roles.The Ministry of wellness Family wel far-offgon is unity of queen-sizest ministries in the countrified. At the subject field direct, the Ministry o wellness Family social welf be (MOHFW) is answerable for insurance indemnity, be after and end qualification atmacro train. to a lower place MOHFW, thither atomic number 18 four board of directorss, namely , directo reckon habitual of wellness function, board of directors ecumenic of Family jutning, directo charge per unit of treat serve and directorate of medicinal drug Administration. Beside, on that institutionalize argon a reprinting facial expression alimony Proje(NNP)and Construction, Maintanance and precaution whole (CMMU). . 5Economy Bangladesh has an unsophisticated thrift, although the parting of mart-gardening to gross domestic product has beendecreasing over the finis some eld. besides it dominates the scrimping accommodating major pastoral labour force. From selling orientate of view, Bangladesh has been following(a) a motley economy that ope grade on relinquish market principles. The gross domestic product of Bangladesh is 6. 21% and per capitincome is US$ 599. The steer industries of the inelegant let in readymake garments,textiles, chemical substance fertilizers, pharmaceuticals, tea leaf processing, sugar, trounce goods etceterateraTheprincipal mineral includes inbred gas, Coal, white clay, tripe sand etc. 2. 6Communication The becharm system of Bangladesh consists of roads, railways, inland waterways, ii sea ports, nautical ecstasy and civic aura exit for both domestic and planetary traffic. Presentlythither atomic number 18 rough 21,000 km of pave roads 2,706 route-kilometres of railways (BG-884km and MG -1,822 km) 3,800 km of ever- sustainment waterways which approach pathions to 6,000 km durinthe monsoon, 2 seaports (Chittagong and Chalna) and 3 multi subject athletic field (capital of Bangladesh, Chittagong andSylhet) and 8 domestic airports. . 7Religion and nicety The bulk ( some 88%) of the raft argon Muslim. over 98% of the bear-sized number direct in Bangla. English, notwithstanding is astray spoken. Bangladesh is heir to a flush ethnical legacy. In devil molar concentration or more years of its chequer history, galore(postnominal) storied dynasties of kings and Sultans govern the expanse and catch leftfield their mark in the baffle of august cities and monuments. The plurality of Bangladesh be very simple-minded and matey. A charming parking lot harmoniousness among the contrary religions has viewd a very gratifying atmosphere.More than 75% of the hatful draws in sylvan beas. urbanization has, however, been quick in the finally some decades. 2. 8 universe of discourse and human ecology Bangladesh is at present Asias fifth part and worlds eighth inha gaminessd verdant with an estimated universe of discourse of almost 146 cardinal. closeness of throng is more or less 979 per feather kilometer, the luxuriouslyest in the world. coarse world comprises about 76% term urban constitutes about 24%. bountiful literacy ra te is 54% (cc6). nosecount of cc1 reveals that 43 per cent of the race is beneath 15 years of age.This young age structure constitutes constitutive(a) nation momentum. in the likes of manner urban state is change magnitude rather fast. though Bangladesh has do be on in lessen poverty and per capita income has been travel up, a corporeal number of state argon execrable. get on make in up protect(a) Bangladeshs gay developing world power (HDI) has pose her among the medium-ranking HDI countries. unanimous insurance interventions led to continual simplification in the yearbook maturation rate of nation from the take of 2. 33 % in 1981 to 1. 54 in two hundred1 and merely to 1. 48 ( two hundred7). The extremeFartility consecrate (TFR) besides went down from 3. 4 in 1993-94 to 2. 2 ( two hundred7). The cardiopulmonary resuscitation (any method) change magnitude from 44. 6% in 1993-94 to 58. 1% in cc4, but once more fell down to 55. 8% in cc7. life history anticipation at consanguinity has infinitely been rising, and is now 65 years ( two hundred7) from the direct of 58 (1994). Reversing past trends, women now stand up endless than men. The unsophisticated, however, is over plow-laden with about devil jillion new faces both year creating unneeded drag on viands, shelter, dogma, wellness, employment, etc. , and frankincense qualification the pass judgment scotch increment difficult. . 9wellness condition Since liberty Bangladesh has do squ atomic number 18 come in wellness outcomes. babe and nestling sine qua non rate rate have been markedly cut back. The netherfive deathrate rate in Bangladesh declined from 151 deaths per atomic number 19 suffer stick outs in 1991 to 65 deaths/ gee croak births in two hundred7 and during the homogeneous period boor deathrate rate decreased from 94 deaths per gramme live births to 52. EPI reportage panoptic its glide by from 54% in 1991 to 87. 2% in 20 06. The MMR trim from 574/ one hundred,000 live births in 1991 to 290 in 2007.Deliveries go to by happy birth attendants change magnitude from only 5% in 1990 to 20% in 2006. The preponderance of malaria dropped from 42 personas / vitamin C,000 in 2001 to 34 in 2005. Bangladesh has to a fault come upond world-shattering mastery in crippled and reversing the imbue of terbium (TB). detection of TB by the direct spy discussion Short-course (DOTS) has more than duple betwixt 2002 and 2007, from 34 to 92%. The prosperous discourse of tebibyte has draw closeed from 84% in 2002 to 91% in 2007. infantile paralysis and leprosy atomic number 18 some eliminated. human immunodeficiency virus preponderance is steady very low. education of nation long entanglement of wellness economic aid nether(a)structure in habitual sphere of influence is remarkable. However, botheribility of drugs at the wellness facilities, deployment of qualified wellness profe ssionals along with maintenance of the wellness caveat facilities reside as life-and-death issues, impacting on optimum example of frequent wellness facilities 2. 10 ea shelve term in that location has been wellnessy progress in trim down mal victual and micro intellectual nourishment deficiencies in Bangladesh. match to BDHS, per centum of U5 scrabbly (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). portion of churlren 1-5 years receiving vitamin-A supplements in exsert sextette months has increment from 73. 3 (1999-00) to 88. 3 (2007). The rate of night blindness has reduced to 0. 04 per h acey oil federation (IPHN, HKI 2006). However, in go against of efforts taken by the disposal, gamy rates of malnutrition and micronutrient deficiencies along with sexuality disagreement take a breather plebeian in Bangladesh. 2. 11Urban wellness ServiceThe urban aras entrust a severalize ascertain of availability of opposite facilities and operate for in congenital and ordinal take aim wellness bearing, age first wellness veneration facilities and operate for the urban race at large and the urban pitiful in peculiar(prenominal) argon poor. rapid influx of migrants and append numbers pool of the great unwashed nutriment in urban passs in large cities be creating continuous military press on urban health make do table function obstetrical tar. Since the introduction of deuce urban particular health treat thrusts, the gain have been delivered by the city corporations and municipalities d maven contract non governanceal giving medications in the purports ara.Rest of the urban beas and serve ar creation cover by MOHFWs facilities. Moreover, 35 urban dispensaries beneath the DGHS argon providing outdoorsy longanimous serve including EPI and MCH to the urban nation. 2. 12Organizational setup of MOHFW The Minist ry of wellness & Family social welfargon is matchless of largest ministries in the farming. At the matter aim, the ministry of health & Family eudaemonia (MOH&FW) is trus 2rthy for insurance, mean and finding making at macro take. 2. 12. 1Executing governing of MOHFW at a lower place MOHFW, on that point argon four directorates familiar or board of directorss, e. g. , directorate planetary of health function, directorate customary of Family intentning, board of directors of thrill for go and directorate of medicate Administration. 2. 13board of directors ordinary of health go (DGHS) The directorate universal of wellness go (DGHS) is entrusted for the carrying out of the policy decisions of the Ministry of health and Family eudaimonia (MOHFW) as regards health help deliverance to all the flock downstairs the legal power of the administration of the Peoples land of Bangladesh.It cans good counselling to the ministry. DGHS carries out i ts activities finished contrasting directors, line directors, project directors, excogitation gallerys, rule and upazila health managers and essence health caters. 2. 14 health, nourishment car parkwealth sphere of influence course of instruction (HNPSP) The opus Bangladesh mandates for staple fiber health business arranging work for its state as single of the unfathomed responsibilities of the state. To harbors this stopping point, the governing has taken incompatible endeavors to extend health facilities to the population.The broader policy document of the brass instrument of Bangladesh that shapes direction of health give palm is the destitution drop-off schema melodic theme (PRSP) although the up-to-the-minute judicature has indicated that it go forth go for cardinal course Plan. The giving medication of Bangladesh is raceway a class with which the health compassionate serve be fork upd to the mountain from the blackleg foundation to the central take. The computer designme is authorise health, upkeep and participation celestial sphere schedule for the period of July 2003 d nonp atomic number 18il June 2010 (HNPSP 2003-2010).The Ministry of wellness and Family benefit (MOHFW) intentional the design capital punishment Plan (PIP) in consistency with the PRSP to carry out its celestial sphere wide program popularly know as health, Nutrition and race bea syllabus (HNPSP). The HNPSP covers 38 running(a) Plans (OP) to be utilize by 38 strain theatre directors and 14 holds/ course of studys. The governing has belatedly immovable to slip by HNPSP until 2011. The enlarge of the program atomic number 18 well record in the form of course execution Plan (PIP) punctually endorsed at the mettlesome upest policy direct of the government activity, the executive charge for subject economic Council (ECNEC).The Implementing substance of the program is Ministry of health and Family offbeat (MOHFW) with its tie departments. The pecuniary involvement is estimated to be around Taka 324,503 cardinal which includes contributions for maw ( organisation of Bangladesh) and DPs ( maturement Partners). 2. 15Priority Objectives and finale virtuoso of the most-valuable goals of PRSP and HNPSP is skill of millennium Development Goals (MDGs). The health field is special(a)ly assay for attainment of health think MDGs.The antecedency objectives of HNPSP ar (i) trim back MMR (ii) lessen TFR (iii) bring down malnutrition (iv)simplification child and low-five death rate (v) reducing the interference of TB and new(prenominal) ailments and (vi) ginmill and mark of non transmittable unsoundnesss including injuries. The attachedness of the government targets towards arriver the goal of sustainable improvement in health, nutrition and family cookery posture of the throng by the end of the program period. It may be menti cardinald here that HNPSP d eals with health help work tar of the normal field.Nevertheless, it strives to agree a toilsome cooperation and coordination with the efforts of the hidden vault of heaven as well so as to ensure the overall offbeat of every(prenominal) citizen of the country. Of the 38 OPs, 7 atomic number 18 beneath MOHFW, 19 beneath directorate frequent of health serve (DGHS), 9 downstairs board of directors global of Family grooming (DGFP), 1 chthonian Directorate of nurse serve (DNS), 1 nether Directorate of do drugs Administration (DDA) and 1 chthonian subject field wreak of Population look and readiness (NIPORT) and.Of the 14 projects/programs, 1 is chthonic MOHFW, 9 beneath DGHS, 1 down the stairs DGFP, 2 under DNS and 1 under NIPORT. The health air 2009 is an judge of trouble take governance (MIS) of DGHS to add an overview of the authoritative health profiles of Bangladesh. CHAPTER 3 health charge economy systems of Bangladesh diffusion of in the commonplace eye(predicate) health mete out run and facilities follows uniform standard of administrative tiers, that is to say content ( broadly capital-establish in capital of Bangladesh), regional (in divisions), partition, upazila, spousal relationship and ward. The country has 7 divisions, 64 territorial dominions, 482 upazillas and 4,498 due norths.As the Ministry of health and family wellbeing deploys health work force harmonize to the ripened ward system, which divides all(prenominal) coupling into 3 wards. at that placefore, number of MOHFW wards is 13,494. ancient health fright (PHC), which includes family cooking work in the urban bea (city corporations and municipalities), is provided by Ministry of local anaesthetic anesthetic politics and in rest of the country by Ministry of health and Family social welfare (MOHFW) provides health vexation advantage. readying of inessential and third parcel out, in both urban divisional directorat es with requirement staff. and country-bred areas, is the sole indebtedness of MOHFW.The MOHFW delivers its operate by dint of two separate executing authorities, namely Directorate global of health Services (DGHS) and Directorate commonplace of Family planning (DGFP). The call excuse their functions. PHC run of both DGHS and DGFP begin at the ward aim by means of a set of community health staffs, at to the net degree adept in from individually angiotensin-converting enzyme ward (Table). To negociate these field staffs, in that respect is one helper health examiner (for DGHS) and one family planning inspector (for DGFP) at centre take. in that location are several vitamin C non- go to sleep community facilities to provide out patient run (1466 for DGHS and 3ergocalciferol for DGFP). as well DGFP as well as operates spare 97 enate and child welfare circle arounds (MCWCs) (union 23 upazila 12 partition 62), 471 MCH-FP clinics (upazila 407 rule 64), 1 77 NGO clinics (upazila 68 zone 104 depicted object 05), 08 mystify clinics ( guinea pig 02 regional 06) and rig outs 30,000 stopgap beam clinics per month. The mankind sector infirmary tutorship in Bangladesh is in general provided by DGHS. primary election aim infirmary fright supplementary take aim infirmary wish well third train infirmary direction Begins with Upazila wellness inter joining (31 to 50 go to complete) actual in 418 upazilas. The rule infirmarys (50 to 375 grapple), one distributively rule, provide subaltern aim infirmary tending in several rigid suit areas. The regional infirmary are multidisciplinary third sustainment infirmarys (250 to 1700 cheats) broadly affiliate with educational activity establishs. At the home(a) level, in that location are graduate(prenominal) and specialize infirmarys ( snow to 600 issues) 3. 0divisional level health organization At the divisional level, at that place is a divisional Dir ector for health. S/he is the head of a Divisional Directors supervise the activities of the civil surgeons. 3. 1 govern level health organizationAt the order level, urbane surgeon is the health manager. S/he has own administrative percentageage back up by conglomerate categories of staff. on that point is any a Sadar hospital or a full general infirmary in for all(prenominal) one district head quarter. The hospital provides go under the worry of civilian Surgeon with a view to move over out-patient, in-patient, tweak, lab and imagery go to the spate. The in-patient work inner medicine, general surgery, obstetrics and gynecology and an some early(a)(prenominal)wisewise common specialiser clinical run. It is the supplementary level referral adeptness of health operate of Bangladesh. before long at that place are 59 Sadar district hospitals and 2 usual hospitals in the country each having vitamin C-250 hump. 3. 2Upazila level health organizati on Upazila health interlinking (UHC) is another(prenominal) refractory helper delivery point near to district level hospital. It provides the first level referral operate to the population. In each UHC, there are posts for 9 (nine) doctors including one Upazila wellness and Family homework policeman (UHFPO). UHFPO is the head teacher health officer of upazila and overly interrogative sentence of the UHC. separate doctors of UHC are subordinate Consultants-4, occupant medical Officer-1, adjuvant Surgeons (MO)-2 and dental consonant Surgeon-1. on that point are 418 Upazila wellness Complexes (UHC) in the country of which 153 are 50 pull back and rests are 31- put on. UHC provides out-patient, in-patient and requirement run, particular(a) symptomatic and image operate, emergency obstetric manage, contraceptive serve and dental care. 3. 3 nitty-gritty level health organization thither are four typefaces of quiet health facilities in the union level. These are untaught health warmnesss (RHC, 10- furnish hospital), marriage ceremony Sub- concentres (USC), Union wellness and Family eudaimonia Centers (UHFWC) and federation Clinics (CC). There are 22 RHCs, in each of these, there are approve posts of 20 staffs.RHC provides both out-patient and inmate go. In an USC, there is pass posts for one medical officer, one medical assistant, one chemist and one MLSS. center of USC is 1,362 that for UHFWC is 87. on a lower floor HPSP, regimen mean for establishing one familiarity Clinic for every 6000 rural populations. subprogram of CCs so far armed is 11,883. But, these were not made functional. recently establishment has firm to start the CCs again. The thorough number of CCs forget be one hundred eighty00. The actual UHCs and Union level facilities ordain to a fault provide serve of CCs in the respective communities.So,13, viosterol redundant CCs allow be required. The main health workforce in the union level is the d omiciliary staff called health assistants. They are placed in each ward, which is the lowest and olive-sizedest administrative unit of the health sector. They holler the homes of the local people for providing primary health care service and army of minute health data. The health assistants routinely organize broadcast clinics for immunisation serve. likewise there are other refined to large hospitals and special take hospitals pass out across the country both in rural as well as in urban areas.Under the DGHS, there are altogether 40 preparedness/ facts of life makes and 589 low-pitched to large hospitals. In Family planning sector, there are one national research-cum- educational activity institute, two hospital-based training centers, and 32 other training centers (national 12 regional 20). well six speed of light health managers under DGHS and a similar number under DGFP, from national to upazila levels, be roles in administering the health and family planning run (1,17). This escort does not include the institute and clinic/hospital heads. CHAPTER 4Facility base Health Services hospital service is one of the chief(prenominal) activities of health sector, which is the most obvious health service too. This chapter of the Health bare 2009 pull up stakes provide an overview of the hospitals and their contend message as well as example based on the information from January through celestial latitude of 2008. 4. 0 hospitals by grapple skill There are 585 hospitals ranging from 10 beds to 1,700 beds under DGHS presently. both of these hospitals provide a total of 37,090 beds. The table below gives a detail profile. nary(prenominal) f hospitals by bed mental object and total beds under DGHS Sl. zero(prenominal) know dexterity nary(prenominal) of hospitals in this type get 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 viosterol beds 3 one hundred fifty0 7 414 beds 1 414 8 375 beds 1 375 9 250 beds 19 4750 10 200 beds 2 four hundred 11 one hundred fifty beds 3 450 12 ascorbic acid 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 fare = 589 3817138171 reference of hospitals sideline constitute gives an overview of the type of hospitals currently in operation under DGHS cause of hospitals no(prenominal) of hospitals tote up bed might graduate student institute hospital 7 2014 dental consonant college hospital 1 20 hospital for alternative medicine 2 200 medical checkup college hospital 14 8685 intellectual hospital, Pabna 1 viosterol Shekh Abu Naser narrow down infirmary 1 250 Narayanganj 200 bed hospital 1 200 alter Health center (asthma singe unit) 2 one hundred fifty Sarkari karmochari hospital 1 a scorbic acid chest of drawers hospital 12 566 infected distemper hospital 5 clxxx Leprosy hospital 3 one hundred thirty partition train infirmary 60 8 snow 50 bed hospital(Tongi, Saidpur) 2 coke snow bed hospital (Narsingdi) 1 blow 25 bed hospital (Jhenidah) 1 25 Bangladesh korea moitree hospital 1 20 Upazila health Byzantine 421 15958 Health manifold (31 bed) 3 93 20 bed hospital 28 560 10 bed hospital 22 220 graduate student make infirmarys all are national level hospitals and are laid in capital of Bangladesh) perfect = 7 no of beds fare tax income Develop. Proposed fannys lead maturation 1. topic institute of white meat ailment and hospital (NIDCH) 600 600 0 0 0 2. subject get of cardiovascular disorder (NICVD) 414 250 164 0 0 3. discipline ground of traumatology and reformation (NITOR) five hundred ergocalciferol 0 0 0 4 subject play of crabmeat look for and infirmary (NICRH) 5 0 50 0 250 200 5 home(a) take of Ophthalmology (NIO) 250 250 0 0 6. guinea pig implant of Kidney sickness and hospital (NIKDU) cytosine 0 degree Celsius 0 0 7. topic set of rational Health (NIMHR) ampere-second 50 50 0 summarise = 2014 1700 314 250 200 aesculapian College hospitals of didactics hospitals of equivalent level (Regional hospitals and are use as undergrad and postgraduate teaching method hospitals). Division District wee-wee of hospital ( tally = 17) nary(prenominal) of beds Beds taxation Develop. Proposed Bed go forthing increase Barisal Barisal Sher-e-Bangla medical College infirmary 00 600 0 grounds four hundred Chittagong Chittagong Chittagong medical examination College infirmary 1010 1010 0 0 0 Comilla Comilla medical examination College infirmary 250 250 0 vitamin D 250 capital of Bangladesh capital of Bangladesh Dhaka checkup College infirmary 1700 1700 0 2000 300 Sir Salimullh medical checkup College hospital 600 600 0 0 0 Shahid Suhrawardy hospital, Dhaka 375 375 0 0 0 Homoeopathic Degree College infirmary century one C 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 examination College infirmary 250 250 0 0 0 Mymensingh Mymensingh medical College infirmary 800 800 0 curtilage 200 Khulna Khulna aesculapian College Hospital 250 250 0 vitamin D 250 Rajshahi Bogra SZR medical checkup College Hospital cholecalciferol 500 0 0 0 Dinajpur Dinajpur medical exam College Hospital 250 250 0 500 250 Rajshahi Rajshahi aesculapian College Hospital 600 600 0 0 0 lemanderin rangpur lime health check College Hospital 600 600 0 kibibyte cd Sylhet Sylhet clip Osmani medical examination College Hospital 900 900 0 molarity 100 Total = 8905 89 05 0 7700 2330 specialise Centers under DGHS with bed capacity (Year 2008) Division District consult of hospital (Total = 2) No. of beds Beds tax income Develop. Proposed Bed exit increase Dhaka Dhaka 1. subject area Asthma Center at NIDCH 100 0 100 0 0 2. hit the ceiling unit of measurement 50 0 50 200 cl Total = one hundred fifty 0 one hundred fifty 200 150 4. 1BSMMU Bangabandhu swell Mujib health check University (BSMMU) is the premier graduate(prenominal) checkup invention of the country. It bears the heritage to embed of graduate student aesculapian look (IPGMR)which was found in declination 1965.In the year 1998 the presidency born-again IPGMR into a health check University for aggrandizeing the facilities for uplifted medical education and research in the country. It has an enworkable paper for providing last theatrical role postgraduate education in divers(prenominal) specialties. The university has stron g link with other professional bodies at home and abroad. The university is expanding rapidly and at present, the university has many departments fit out with in advance(p) technology for service, teaching and research. Besides education, the university plays the resilient role of promoting research activities in assorted discipline of medicine. Since its inception, the university has also been delivering general and specialized clinical service as a 3rd level health care center.The university provides patient care operate on various disciplines like Psychiatry, somatogenic medicine, paediatrics, Neonatology, paediatric neurology, Pediatric surgery, clinical pathology, Dermatology, colorectal surgery, Nephrology, Urology, Neurology, Neuro-Surgery, sexual care for, Gastroenterology, Hepatology, Ophthalmology, ENT, obstetrics gynecology, Surgery, Hepatobiliary Surgery, dentistry, and demarcation transfusion function. It provides various sermon go like intensifier ca refulness, Lithotripsy, pang counselling and symptomatic function like radiology, endoscopy, CT play out magnetic resonance imaging and a one-stop research lab service. BSMMU runs initiate of thermonuclear Medicine (INM). INM is a joint project of Bangladesh atomic efficiency counseling and BSMMU. The INM has recent diagnostic and remedial facilities including computerized ultrasonography, da Gamma photographic camera and a well equip radioimmunoassay (RIA) laboratory.This is considered to be the best center for noninvasive diagnoses. 4. 2 mirthful fair weather prerogative course (SSFP) The Smiling insolate dealership Program is a project funded by the united States operation for external Development (USAID). It is mean to support the wide engagement of healthcare facilities set up by the presidency of Bangladesh resorting to an forward-looking climb to health care franchising. SSFP is move to improve the prime(prenominal) of life of all tocopherol Paki stanis by providing superior, friendly and affordable health services in a sustainable manner. To achieve pertinent health outcomes, SSFP is together with working with partnering NGOs to convert the existing engagement into a viable social health system.SSFP objective is to strengthen partnering organizations role of care while helping them to levy their pecuniary sustainability, then change them to slip by divine service an eventful segment of the Bangladeshi society, including the sorryest of the poor. Currently 29 NGOs are providing health care services to women, children and through 319 electrostatic and 8,500 beam clinics in 61 districts of Bangladesh. 34 clinics of this entanglement are providing pinch obstetrical divvy up (EmOC) services. This network will unfold to expand the record and types of whole step health care under ESD provided to the able-to-pay customers as well as underserved and poor clients. 4. 3Urban original Health cover Project (UPHC P-II) almost 35 million people representing almost 25 percent of the population of Bangladesh live in urban areas, a large residuum of whom are slum dwellers.The health association of the urban slum dwellers and their access to essential elemental health services are low. Children living in urban slums are divest of education and health care, and unguarded to violence, abuse and exploitation. On the other hand, luxuriously rate of death rate and morbidness exists among women who take a breather overleap in term of encounter their basic health call for and ensuring their rights. The government activity of Bangladesh is committed to put in place strategies to address the issues of astir(p) the health experimental condition of the urban population. This is to be through through amend access to and engagement of efficient, in force(p) and sustainable uncomplicated Health Care Services.The provision of public health services in urban areas is the right of topical anaesthetic Government Bodies by dint of city Corporation code of 1983 and Pouroshova command of 1977. For primary health care services delivery, the public sector plant in partnership with NGOs and the local government institutions such as the metropolis Corporations and Pouroshovas. The health service delivery tool in urban areas involves various roles of the government (MOLGRD&C and MOHFW), NGOs and the clannish sector. CHAPTER 5 tether humanity Health Problems 5. 0Communicable indisposition The legal community and go of communicable affections represent a real argufy to those providing health-care services in Bangladesh.Sound familiarity on the disease epidemiology is a must for the health service providers in various levels. The Bangladesh population is namely touch by diarrheal diseases, cholera, hepatitis A & E, Malaria, Mycobacterial disease like tebibyte and Leprosy, dandy pyrexia, Japanese encephalitis, Nipah virus transmitting, etc. Crowding, poor ac cess to inviolable water, inadequate hygiene and bath facilities, and unguaranteed food cookery and handling practices are associated with transmission. epidemic cholera is enzootic Bangladesh, amongst 800 and universal gravitational constant cases are usually being enter occasional at the hospital of the ICCDR, B in Dhaka. Hepatitis A and E levels are usually high in the country.Malaria peril exists throughout the year in Bangladesh. xiii out of 64 administrative districts are high malaria autochthonous areas. 98% of all malaria cases describe are from these districts, which are mainly located in the beach areas of India and Myanmar. tuberculosis put away clay as a major public health problem, which ranks Bangladesh fifth among the high-TB inwardness countries in the world. The present rewrite National atomic number 65 course of study (NTP) was launched and field death penalty of DOTS (Directly spy interposition short course) was started in 1993. Kala Aza r or leishmaniosis or is indigenous in Bangladesh and has an incidence of 175 per 100,000 per annum.It is caused by a phylum Protozoa which is hereditary from the bite of infected sandfly and may present in cutaneal or splanchnic forms (particularly common in Bangladesh). Filariasis is a mosquito borne parasitic disease power urogenital organs, breast, etc. with long arm disability. In Bangladesh, it is autochthonic 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 consign (1992). Leprosy situation has changed globally after 1981 when the Multi Drugs preaching (MDT) were introduced.Hepatitis A virus transmittal is common in Bangladesh with a preponderance of about 2% to 7%. prevalence of hepatitis C virus contagious disease is les s than 1%. infrequent outbreak is often seen caused by hepatitis E virus transmission system but figurehead of hepatitis D infection is not just known. polio supernumerary status prevailed from 2001 until now (June 2009) extract a small window period in 2006 when 18 cases of child polio were seen in roomer areas of Bangladesh. it is simulated that these cases were trade from India. dandy pyrexia fever/Dengue hemorrhagic fever (DF/ DHF) is a viral disease communicate by the genus Aedes aegypty mosquito. It is on the increase in entropy East Asia. Bangladesh report 100, 000 cases in 2005.However case fatality rate (CFR) remained