New manpower structure devised for govt hospitals

The Ministry of Public Administration has devised a new manpower structure for the country's hospitals, defining the number of doctors, nurses, and other staff categories required based on bed capacity.

The ministry, which refers to it as the "standard setup" of hospital manpower, announced the structure on 27 February. The last such structure was devised 15 years ago.

According to the Directorate General of Health Services (DGHS), the hospitals are currently being managed based on the standard setup formulated in 2008. Back then, government hospitals had 38,171 beds, whereas currently, the number of beds stands at around 72,000.

The DGHS requested a new manpower setup in 2020 due to the increasing number of patients and beds in hospitals. While the new structure has been announced after four years, it still requires approval from the Cabinet Division, the Health Services Division, the Prime Minister's Office, and the Ministry of Finance before implementation. Therefore, it will not be immediately operational.

Health Minister Samanta Lal Sen, in response to a question from TBS at a deputy commissioners' conference on 3 March, said that the standard setup has been established, but it will take time for the recruitment and deployment of personnel according to the plan.

DGHS Director General Abul Bashar Mohammed Khurshid Alam told TBS recently that due to the need for approval from various authorities and the recruitment and promotion processes, the implementation of the new setup will not occur immediately.

"It is a matter of time. However, there is hope as Prime Minister Sheikh Hasina has already directed the authorities concerned to expedite the approval process for the manpower structure in healthcare development. Accordingly, if the parties concerned fulfil their responsibilities, it may be possible to recruit some personnel within a year," he said.

The DGHS director general said a new manpower structure for hospitals is formulated by considering factors such as bed occupancy, expected number of healthcare seekers, and disease burden at regular intervals. "The Ministry of Public Administration has announced a new staffing structure based on such observations."

Implementing the structure will result in changes to the healthcare system, as despite numerous establishments in the country, there is a lack of necessary manpower, he said. "Now, by fulfilling these requirements, services can be delivered."

What's in the new manpower structure?

On 27 February, in a circular, the public administration ministry announced the standard manpower setup for 10-bed, 20-bed, 20-bed (trauma), 31-bed, 50-bed, 100-bed (upazila), 100-bed (district), 250-bed (district), and 600-bed (specialised) hospitals, as well as for Medical Assistant Training Schools, Institute of Health Technology, and Institute of Health Technology (BSc and Diploma) positions.

According to the circular, in hospitals with 10 beds, there will be a total of 25 staff, including 6 doctors. In hospitals with 20 beds, there will be 41 staff, including 11 doctors. In trauma hospitals with 20 beds, there will be 27 staff, including 10 doctors. In upazila hospitals with 31 beds, there will be 89 staff, including 34 doctors. In upazila hospitals with 50 beds, there will be 105 staff, including 40 doctors.

In hospitals with 100 beds, there will be 70 doctors. Additionally, there will be one Ayurvedic medical officer and a nutritionist in such hospitals. In all, there will be 153 staff, including 40 nurses.

In district hospitals with 100 beds, there will be 100 doctors, one Ayurvedic medical officer, and one nutritionist. In all, there will be 185 staff, including 40 nurses.

In district hospitals with 250 beds, there will be 138 doctors. There will be 10 anaesthetists, 3 pathologists, and 3 radiologists. Additionally, there will be 20 assistant registrars and 2 assistant dental surgeons. There will be 388 staff, including 100 senior staff nurses, at various levels.

In hospitals with 600 beds, there will be 192 specialist doctors, 174 medical officers, 10 registrars, 2 senior clinical pathologists, 4 sonologists, 12 emergency medical officers, 12 assistant dental surgeons, and 44 assistant registrars. Altogether, there will be 947 staff in such hospitals.

Outside of this, standard staffing setups have been defined for Medical Assistant Training Schools, Institute of Health Technology, and Institute of Health Technology (BSc and Diploma).

Twice the current workforce may be required

DGHS Director (Administration) Md Harun-Or-Rashid told TBS that according to the new standard setup, approximately twice the current workforce may be required.

On 29 February, the health minister, in response to a question from lawmaker ABM Anisul Islam of Mymensingh-7 constituency, informed the parliament that there is one bed available for every 990 people in both government and private hospitals combined. For every 50 people, the government hospitals have 0.0211 beds available, he said.

The health minister further said there are currently 29,561 graduate doctors in the government hospitals. The number of graduate nurses is 6,650, among whom 3,904 have a BSc in nursing, 1,597 have a BSc in public health nursing (post-basic), and 1,149 have a BSc in nursing (post-basic).

According to the DGHS, there are 660 government hospitals in the country. The total number of beds in these hospitals is approximately 72,000. According to data from the Society for Nurses Safety and Rights, the number of employed nurses in government hospitals is only 42,330.

There is a shortage of staff in both doctors and nurses according to the hospital bed ratio. Among them, the shortage of nurses is much higher. According to the World Health Organization's guidelines, there should be three nurses for every doctor.

DGHS data shows that there are currently 35,503 approved positions for doctors in various categories in government hospitals.

For a long time, the country's healthcare system has been challenged by an inadequate ratio of beds, doctors, nurses, and other relevant staff members in proportion to the population. Public health experts say that the scope of services provided by each hospital or healthcare institution primarily depends on the number of beds available.

In Bangladesh, hospitals often admit more patients than their bed capacity can accommodate. As a result, patients are frequently observed lying in hospital corridors due to a shortage of beds.