Short supply of medicines, syndicates rock DMCH

Dhaka Medical College Hospital (DMCH), a cornerstone of Bangladesh's public healthcare system, now struggles with 'widespread' irregularities, including a severe shortage of medicines, leaving poor and middle-class patients without the proper care they desperately need.

The hospital, consistently exceeding its bed capacity, is grappling with overcrowded wards and an overwhelming patient load, severely compromising its ability to provide proper medical care.

Reports from various departments highlight a grim picture: unclean environments, low-quality food, inadequate staffing, and patients often forced to lie on the floors of overcrowded corridors and wards.

Hospital Director Brigadier General Asaduzzaman Khan acknowledged the increasing number of patient complaints, admitting the gravity of the situation. "We are aware of these issues, and steps are being taken to address them," he said.

However, the situation seems to have worsened, with one of the most concerning issues being the chronic shortage of medicines.

A patient, who chose to remain anonymous, spoke about the difficulties of getting essential drugs from the hospital's pharmacy.

"Most of the necessary medicines are unavailable here. We often have no choice but to purchase them at higher prices from pharmacies outside," the patient said.

The stark contrast between the hospital's shortages and the full stock of nearby pharmacies has raised suspicions about the management of medicine supplies within the facility.

In one instance, a woman from a rural village was seen heading to a nearby pharmacy, escorted by a man. When asked about their destination, the woman confirmed that she was going to buy medicine.

However, when questioned about the man's identity or whether he was receiving a commission for directing patients to the pharmacy, he quickly avoided answering.

Brigadier General Asaduzzaman Khan, when confronted about the shortages, explained that the problem lay in the supply chain. "What can we do if the government does not supply the required medicines? There are many items we need that are simply not being supplied," he said.

In addition to the medicine shortages, some patients have reported receiving only one type of medication over several days due to the lack of necessary supplies. Families have frequently had to buy medications from outside sources, adding an extra financial burden on already struggling patients.

One hospital staff member pointed to budgetary constraints as the primary reason behind the shortages. "We don't have government supply. We can't always provide every medicine due to budget shortfalls. To offer complete services, we need to double our budget," the staff member explained, though they declined to provide further details on the specifics of the hospital's current budget allocation.

Allegations of syndicate and bribery practices

Further complicating matters are widespread allegations of bribery and corrupt practices within the hospital.

Several patients have claimed that hospital staff and ward aides are demanding bribes ranging from Tk50 to Tk100 for basic services such as providing wheelchairs and facilitating medical tests. These practices have added to the already heavy financial burden placed on families who are seeking essential medical care.

One unregistered worker, seen assisting a patient, admitted to accepting tips for his services. "We don't force anyone to give us money, but if they do, it helps with our expenses," he said.

Brigadier General Asaduzzaman Khan has acknowledged the existence of such practices, stating that the hospital is actively working to address these issues. "Both sides share the blame. We have dismissed several people based on these complaints and are working to dismantle such practices, though complete eradication has yet to be achieved."

Earlier this year, in February, the High Court weighed in on the pervasive influence of syndicates in the healthcare sector.

The court described the syndicates as playing "games of ducks and drakes" with people's lives, accusing them of supplying expired drugs and medical equipment for profit.

The court urged all concerned parties to remain vigilant and take action to protect vulnerable patients from such exploitative practices.

Struggling medical supply chain

Medicine supply has long been a challenge in Bangladesh's public healthcare system.

A 2020 survey revealed that 72% of public hospitals face regular shortages of medicines, exacerbating the difficulties for patients who rely on these facilities for care.

Several factors contribute to these shortages, including inadequate budget allocation, limited healthcare insurance, and an overwhelming number of outpatients.

The public healthcare sector has historically received less than 1% of the country's GDP over the past 12 years, which is insufficient to meet the demands of the growing population. Without health insurance, many patients are required to pay for outpatient services, further compounding the strain on public hospitals.

Despite these challenges, some efforts have been made to improve the situation.

The World Bank provided critical assistance, including supplying vaccines, syringes, and medical equipment to help Bangladesh manage the Covid crisis.

Besides, the government heavily subsidises public healthcare, though these subsidies are often insufficient to meet the growing demands of the system.

A study conducted in 2013 at Dhaka Medical College Hospital highlighted further issues in the hospital's medical supply chain.

The study, which surveyed hospital shop employees, revealed that over half of the drugs were purchased through open tender, while a significant portion came through direct purchases and donations.

However, the hospital's pharmacy suffers from a lack of proper storage facilities, with no air-conditioning or refrigeration available in the store.

The management has called for improvements in quality control, storage facilities, and training to improve the system.

Looking ahead

The situation at Dhaka Medical College Hospital paints a worrying picture of the state of public healthcare in Bangladesh.

From the lack of basic medicines to the widespread practice of bribery and corruption, the hospital's problems are a microcosm of the systemic issues that plague the broader healthcare system.

While efforts to improve the situation are ongoing, patients and healthcare workers alike are calling for more substantial reforms, increased funding, and greater transparency to ensure that Bangladesh's public healthcare system can truly meet the needs of its people.