Why government hospital maintenance in a mess

Suppose a light bulb in your house burns out all of a sudden and you are not allowed to replace it. The landlord will do it for you but it could take a while. As painful as it may sound, this is how broken things in government hospitals are taken care of.

When an LED light bulb in a ward or balcony or bathroom of a government hospital burns out, the hospital authorities do not have the jurisdiction to install new lights, even though the cost of a new bulb is only Tk250-300.

The hospital authorities have to write to the Health Engineering Department (HED) for new lights. Upon request, the HED will call a tender for installing lights and if they do not have the funds, fixing the issue will be delayed.

Let's take the case of the Sheikh Hasina National Institute of Burn and Plastic Surgery. This building has a lot of glass structures. But five-six pieces of glass were broken due to a storm a year ago. When the authorities contacted the HED for replacement glass, the agency said it does not have funds for the repair work. Hence, the glass has remained broken for a year while water is entering the hospital during rains.

The Public Works Department (PWD) or Health Engineering Department (HED) is responsible for fixing any broken or damaged physical objects or structures, such as plumbing, bathroom fittings, lights, fan and electrical wirings in government hospitals. 

Brigadier General Nazmul Haque, director of Dhaka Medical College and Hospital (DMCH), told The Business Standard, "We do not have the power to fix anything broken in the hospital. The PWD or HED solves emergency problems, but perennial problems are a little more difficult to solve. This makes it difficult for us to provide the services that people want."

Big government hospitals have HED or PWD branch offices to solve only emergency problems right away. But the hospitals and health complexes at the district and upazila levels do not even have that scope, which increases the sufferings of patients, doctors and health workers.

Officials and directors of several government hospitals told The Business Standard that fixing any broken or damaged structures or objects is a hassle. There is a coordination problem between the hospitals and the repair agencies. Besides, these agencies often take a long time to fix some problems due to funding and tendering delays.

"The PWD deals with a lot of problems, ours is a part of it. They often plan on doing the work we asked for but it is not always approved by the higher authorities. Besides, we often cannot always explain our needs to them properly," DMCH Director Nazmul Haque said.

The situation is worse in the districts and upazilas. As there is no security guard in hospitals at the upazila level, lights and water faucets in most hospitals get stolen, and every time something gets stolen, a letter has to be sent to the HED or PWD. 

Dhamrai Upazila Health Complex is experiencing the same problem. Some of its lights and faucets are missing. The bathrooms are untidy with broken water pipes and sinks.

Dhamrai Upazila Health and Family Planning Officer Dr Noor Riffat Ara told TBS, "Since the toilet of the government hospital is for public use, there will be some problems every week. To solve these problems, we have to ask the HED and it will do the work once a year."

My house, but not my rules

Hospital directors and healthcare officials said if the responsibility of managing the facility had been given to the director or head of the hospital, such problems would have been solved quickly and people's sufferings could be reduced to a great extent.

"If something gets broken in the hospital and the director has some authority to fix it then it will be solved quickly and people's sufferings will also be reduced," said DMCH Director Nazmul Haque.

Dr Hossain Imam, assistant director of the Sheikh Hasina National Institute of Burn and Plastic Surgery, told the Business Standard, "It is our house but its maintenance is someone else's responsibility. If the hospital authorities had some financial power, they could have done the work themselves, the same way they maintain vehicles."

When asked, Prof Dr ABM Khurshid Alam, director general of the Directorate General of Health Services, told TBS, "There is no plan yet on whether the maintenance responsibility can be given to the hospital director."

However, Brig Gen Kazi Rashid-un-Nabi, director of Mitford Hospital, told TBS that these issues could be resolved quickly if the hospital directors could communicate better with the PWD or HED.

Professor Liaquat Ali, an educationist and former vice chancellor of Bangladesh University of Health Sciences, told TBS, "The infrastructure and equipment of our government hospitals have improved greatly. But problems remain with hospital maintenance plans." 

"Civil, electrical, and mechanical issues are looked after by the HED, which is under the Ministry of Health but its capacity is low. The PWD is not under the Ministry of Health. Installations of bigger structures are made by the PWD but their maintenance is not easy. These powers should be decentralised," he said.

The National Electro-Medical Equipment Maintenance Workshop and Training Centre (NEMEMW) fixes any machine, including MRI, CT scan, and ultrasound in government hospitals. Equipment cannot be fixed or replaced by the director or the hospital authority at will. 

Professor Liaquat Ali said the capacity of the National Electro-Medical Equipment Maintenance Workshop has not increased at the rate in which government hospitals have expanded. 

The government should plan on entering into an agreement with the people from whom the equipment will be purchased so that if it gets broken, they can fix it under the supervision of the National Electro-Medical Equipment Maintenance Workshop, he added.