Messy wards, dirty toilets, and poor quality of services for patients are among the most undesirable elements of the country's public hospitals and healthcare centres.
According to healthcare insiders, almost all government healthcare centres, from upazila health complexes to medical colleges and hospitals, are in desperate need of support staff (cleaners, sweepers and ayahs) not only to ensure quality service but also to keep the wards, corridors, and toilets clean.
The staff shortage has grown severe over time due to an extended hiatus in the recruitment of third and fourth class government employees. Meanwhile, most hospitals have been conducting their daily business by outsourcing part-time workers on a contractual basis.
These poorly paid part-time workers know little and care less about maintaining hygienic environments, and demand money directly from patients for their work, people say.
When Rajshahi Medical College and Hospital was established in 1958, it had 434 third and fourth class employees. The hospital now only has 180 such employees due to lack of recruitment. The 1,200-bed hospital accommodates 2,500-3,000 patients a day, with about 3,000 outpatients. More than 10,000 people visit the hospital every day.
Brigadier General Shamim Yazdani, director of Rajshahi Medical College and Hospital, told The Business Standard (TBS), "Our hospital needs at least 1,000 support staff for indoor and outdoor services combined. Since government recruitment stopped, we are outsourcing 300 workers daily, besides depending on our 180 such permanent staff."
"The salary of an irregular worker is a meagre Tk4,500 per month which is why they expect and demand money from patients, often harassing them for any inconvenience. Providing quality services with a massive staff shortage is nearly impossible," the hospital director said.
The 50-bed Upazila Health Complex in Dhamrai accommodates an average of about 70 patients per day and about 800 patients seeking outdoor services, but the hospital has only one sweeper for cleaning.
From ward boys to ticket counter staff, the hospital is running short on third and fourth class staff. The hospital authorities have temporarily hired a few locals for cleaning who get paid from the salaries of hospital staff.
Dhamrai Upazila Health and Family Planning Officer Dr Noor Riffat Ara told TBS, "With just one cleaner, it is very difficult for us to keep the hospital clean and tidy. We don't have staff to sit at the ticket counter. Out of necessity, we had to hire temporary staff and hospital staff pay them from their own salaries. However, due to rising commodity prices, it is becoming difficult to find workers."
Brigadier General Nazmul Haque, director of Dhaka Medical College and Hospital, told TBS, "We have to serve patients in the face of difficult challenges. Although hygiene is moderately good, patient management is the biggest problem."
"Nannies or other staff of the hospital are supposed to take care of patients, but in reality, personal attendants or relatives of patients are doing the job," Nazmul Haque said.
Currently, the 2,600-bed Dhaka Medical College and Hospital admits 3,000-4,000 patients daily and about 5,000 patients are treated outdoors.
Nazmul Haque said the hospital has less than 800 third and fourth class government employees.
"With a separate budget, I am managing with about 500 workers, each hired for Tk650 per day. However, informal discussions are underway to recruit more third and fourth class staff when the hospital is upgraded to 5,000 beds," he said.
Md Salzar Rahman, secretary general of the Bangladesh Class-III Govt Employees Association, told TBS, "The government hospitals need about 40,000 third and fourth class employees but most of them have not hired employees since 1990. That is why they are outsourcing staff."
"Outsourced employees have no obligation to the organisation. They squeeze money from patients holding them hostage with no fear of being fired or any other consequences. That's why official recruitment is so necessary," Salzar Rahman said.
According to experts, doctors and nurses are appointed in hospitals when there is a shortage of manpower, but doctors and nurses are not enough. Without an adequate number of support staff, service will be disrupted and patients will pay the price.
Dr Md Abdul Aziz, lawmaker and member of the Parliamentary Standing Committee on Health and Family Welfare, told TBS, "A hospital needs enough doctors, nurses, ward boys, OT boys, and ayahs to provide quality services to patients. Just a good physician is not enough, but the OT boy has to clean the operation theatre properly. If not, no matter how well the surgeon operates, the patient will catch an infection."
"Hospital-acquired infection occurs due to unclean wards and toilets. Patients with an impaired immune system can come to the hospital and become infected due to the unhygienic environment," the lawmaker said.
"Our health budget is already low but even that budget is not spent properly. It is necessary to make proper use of the low budget with planned decisions so that people get better service, Abdul Aziz added.
Professor Dr Shamiul Islam, director (Administration) of the Directorate General of Health Services, told TBS, "Outsourcing workers is also a part of government policy. Recruitment of government employees is an ongoing process and there will be a circular soon for recruiting third and fourth class employees."