Bangladesh health network

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Bangladesh health network

  1. 1. Health Care Network of Bangladesh under the Ministry of Health & Family Welfare Hierarchies in Ministry of Health & Family Welfare The Ministry of Health & Family Welfare (MOHFW) is one of largest ministries under the Government of Bangladesh. It is responsible for national level policy, planning and decision making at macro level, which are then implemented by different executing and regulatory authorities. The ministry is headed by the Honorable Minister for Health & Family Welfare, who is assisted by the Honorable State Minister for Health & Family Welfare. The principal executing staff of the ministry is the Secretary who works with a set of bureaucrats under him, viz. Additional Secretary, Joint Secretaries/Joint Chiefs, Deputy Secretaries/Deputy Chiefs, Senior Assistant Secretaries/Senior Assistant Chiefs, etc. Minister State Minister Secretary Additional Secretary Joint Secretary (Administration) Joint Secretary (Hospital) (Public Health & WHO) Joint Secretary Joint Secretary (Finance) Joint Secretary (Coordination) Joint Chief (Planning) Joint Chief (Health Economics Unit) Deputy Secretary Deputy Secretary Deputy Secretary Deputy Secretary Deputy Secretary Deputy Chief Deputy Chief Senior Assistant Secretary Senior Assistant Secretary Senior Assistant Secretary Senior Assistant Secretary Senior Assistant Secretary Senior Assistant Chief Senior Assistant Chief Figure-1.1. Hierarchy of Ministry of Health & Family Welfare Executing authorities under the Ministry of Health & Family Welfare Under the MOHFW, there are several executing authorities and regulatory bodies. The executing authorities are Directorate General of Health Services (DGHS), Directorate General of Family Planning, Directorate General of Drug Administration (DGDA), Directorate of Nursing Services (DNS), Health Engineering Department (HED), National Nutrition Program (NNP), Transport & Equipment Maintenance Organization (TEMO), National Electro-medical & Engineering Workshop (NEMEW) and Essential Drugs Company Limited (EDCL). 1 | Health Care Network of Bangladesh
  2. 2. MOHFW Directorate General of Health Services (DGHS) Directorate General of Family Planning (DGFP) Directorate General of Drug Administration (DGDA) Directorate of Nursing Services (DNS) Construction Management & Maintenance Unit (CMMU) National Nutrition Program (NNP) Transport & Equipment Maintenance Organization (TEMO) National Electromedical Maintenance Workshop (NEMEW) Essential Drugs Company Limited (EDCL) Figure-1.2. Executing authorities under the Ministry of Health & Family Welfare Regulatory bodies under the Ministry of Health & Family Welfare The Regulatory bodies are Bangladesh Medical & Dental Council (BMDC), Bangladesh Nursing Council (BNC), State Medical Faculty (SMF), Homeo, Unani & Ayurvedic Board & Bangladesh Pharmacy Council. MOHFW Bangladesh Medical & Dental Council (BMDC) Bangladesh Nursing Council (BNC) State Medical Faculty (SMF) Homeo, Unani & Ayurvedic Board Bangladesh Pharmacy Council (BPC) Figure-1.3. Regulatory bodies under MOHFW Directorate General of health Services (DGHS) The Directorate General of Health Services (DGHS) is the largest executing authority under the Ministry of Health & Family Welfare. Having over one hundred thousand officers and staffs, it operates the health care delivery system for the ministry all over the country extending as low as up to village level. DGHS also provides technical guidance to the ministry. The activities of the DGHS are implemented both through the regular revenue set ups as well as under the development programs. The MOHFW undertakes sector-wide multi-year approach to draw the development programs. The sector-wide multi-year development program is popularly known as Health, Nutrition and Population Program (HNPSP), which has been begun in 2003 and will be completed in June 2011. The ministry is now planning the new sector program to be started from July 2011. 2 | Health Care Network of Bangladesh
  3. 3. Director General of Health Services Additional Director General (Administratio n) Additional Director General (Planning) Director, Planning, Research & Development Director, Administration Director, Central Medical Stores & Depot Director, Finance Director, Homeo, Unani & Ayurvedic Medicine Director, Management Information System Director, Medical Education & Health Manpower Development Director, Myco-bacterial Disease Control Deputy Directors Deputy Directors Deputy Directors Deputy Directors Deputy Directors Deputy Directors Deputy Directors Deputy Directors Assistant Directors Assistant Directors Assistant Directors Assistant Directors Assistant Directors Assistant Directors Assistant Directors Assistant Directors Figure-1.4. Administrative set up of DGHS Health, Nutrition & Population Program (HNPSP 2003-2011) The development programs of the Ministry of Health & Family Welfare have been implemented under a sector-wide program called Health, Nutrition & Population Sector Program (HNPSP). The ongoing HNPSP has been launched in July 2003 and is expected to be completed in June 2011, when a new sector-wide program will take the course. Currently the MOHFW is preparing the next sector-wide program. Under HNPSP (2003-2011), there are 38 Operational Plans (OPs), of which the DGHS implements 19 OPs. The remaining 19 OPs are implemented by MOHFW itself (5 OPs), Directorate General of Family Planning (9 OPs), Directorate General of Drug Administration (1 OP), Construction Management & Maintenance Unit (CMMU) (1 OP), Directorate of Nursing Services (1 OP), National Nutrition Program (1 OP) and National Institute of Population, Research & Training (NIPORT) (1 OP). The chief executive officer responsible for implementation of each OP is called Line Director. Line Directors are brought on deputation or given additional responsibility beyond his or her regular tasks. Under each Line Director, there are few to several Program Managers and Deputy Program Managers depending upon the number of programs under specific OPs. Like the Line Directors, the Program Managers and Deputy Program Managers are also brought on deputation or given additional responsibility. The list of the Operational Plans under DGHS is given below: 3 | Health Care Network of Bangladesh
  4. 4. List of Operational Plans (OPs) under DGHS 1. 2. 3. 4. 5. 6. 7. Alternative Medical Care (AMC) Communicable Disease Control (CDC) Essential Service Delivery (ESD) Health Education and Promotion (HEP) Human Resource Management (HRM) Improved Financial Management (IFM) Improved Hospital Services Management (IHSM) 8. In-Service Training (IST) 9. Management Information System (MIS) 10. Micronutrient Supplementation (MS) 11. Mycobacterial Disease (Tuberculosis & Leprosy) Control 12. National AIDS/STD Program (NASP) and Safe Blood Transfusion Program (SBTP) 13. National Eye Care (NEC) 14. Non-communicable Diseases and Other Public Health Interventions (NCD&PHI) 15. Pre-service Education (PSE) 16. Procurement, Logistics & Supplies Management (CMSD) 17. Quality Assurance (QA) 18. Research & Development (Health) 19. Sector-wise Program Management (SWPM) Management structure and type of health facilities beyond DGHS The distribution of health infrastructures under the DGHS can be divided into different tiers, viz. national, divisional, district, upazila (sub-district), union, ward and village levels. At the national level, there are institutes, both for public health functions as well as for postgraduate medical teaching/training and specialized treatment for patients. In each division, there is one divisional director for health and under him/her are deputy directors and assistant directors. In each divisional head quarter, there is one infectious disease hospital and one or more medical college(s). Each medical college has an attached medical college hospital. Some divisional head quarters also possess general hospital and institutes of health technologies. The district health manager is called civil surgeon (CS). In each district, there is a district hospital. Some district hospitals have Superintendent to look after the hospital management. In others, civil surgeons look after the district hospitals. Some of the district head quarters have medical colleges and attached medical college hospitals. There are also medical assistant training schools and nursing training institutes in some districts. In the upazila, upazila health & family planning officer (UHFPO) is the Health Manager. He manages all public health programs in the upazila and also looks after the upazila hospital (31- to 50-bed). In the union level, one or other of the three kinds of health facilities may exist, viz. rural health center, union sub-center or union health & family welfare center (UHFWC). In a union health facility, there is a post of medical doctor. All union facilities possess medical assistants to provide health service to the people. In the ward level, community clinics (CC), one for every 6,000 population are being established. So far 9,525 independent community clinics have been established as of May 2010. The existing union and upazila facilities (4,500) also provide community clinic services. Therefore, about 14,000 community clinics are already in operation. The Government estimates that 18,000 community clinics will be required to cover all the rural population. There remaining community clinics will be constructed and added in next 2 to 3 years. In the ward or village levels, there are domiciliary workers, one for every 5 to 6 thousand population. There are 26,436 sanctioned posts of domiciliary workers under DGHS, of which 20,841 are for health assistants (HA), 4,196 for assistant health inspectors (AHI) and 1,399 4 | Health Care Network of Bangladesh
  5. 5. for health inspectors (HI). The Directorate General of Family Planning (DGFP) also has domiciliary family planning staffs to work in the village levels. Currently, the domiciliary staffs both from DGHS and DGFP share the responsibility of running the independent community clinics. However, the ministry will soon recruit 13,500 full time community health care providers (CHCP) to run the community clinics. DGHS Divisional Level National Level District Level Upazila Level Union Level Ward Level Director of Institute Principal of Medical College Divisional Director, Health Civil Surgeon Superintendent Upazila Health & Family Planning Officer Medical Officer Health Inspector Deputy Director Vice Principal Deputy Director Medical Officer Consultant / Medical Officer Jr consultant / Medical Officer Medical Assistant Assistant Health Inspector Assistant Director Assistant Director Health Assistant Figure-1.5. Managerial hierarchies from national to the lowest level under DGHS National Table-1.1. Type of health facilities under DGHS in different administrative tiers Divisional District Upazila Union • Public Health Institute • Postgraduate Medical Institute & Hospital with nursing institute • Specialized Health Center • Medical College & Hospital with nursing institute • General hospital with nursing institute • Infectious Disease Hospital • Institute of Health Technology • District Hospital with nursing institute • General Hospital with nursing Institute (in some) • Medical College & Hospital with nursing institute (in some) • Chest Clinic (in some) • Leprosy Hospital (in some) • Medical Assistants’ Training School 5 | Health Care Network of Bangladesh • Upazila Health Complex • TB Clinic (in some) • Rural Health Center (in some) • Union subcenter in some) • Union Health & Family Welfare Center (in some) Ward • Community Clinic (in some)
  6. 6. Managerial structure and health facilities under Directorate General of Family Planning (DGFP) The primary intention of Health Bulletin 2010 is to capture the health information pertaining to Directorate General of Health Services. However, to give the readers an impression of the family planning services under the public sector, a brief mention about the latter is pertinent. The DGFP also has more or less similar type of managerial structure from the national down to ward levels, viz. director general, directors, deputy directors and assistant directors at the head office, divisional director, deputy director and assistant director at the division, district family planning officer (DFPO) at the district and upazila family planning officer (UFPO) in the upazila. DGFP has limited number of medical doctors, viz. one medical officer for maternal and child health (MO, MCH) in each upazila, one sub-assistant medical officer (SACMO – a medical assistant by background) in union health facility. For performing family planning procedures, DGFP also has FWV (family welfare visitor) in the upazila and union facility. The domiciliary staffs of DGFP to work in the ward level are called family planning inspector (FPI), assistant family planning inspector (AFPI) and family welfare assistant (FWA). The DGFP run union facility which is equivalent to that of union health & family welfare center of DGHS is called family welfare center (FWC). There are 3,719 HFWCs at the union level. Besides, DGFP operates 97 MCWCs (maternal and child welfare centers: 24 in union level, 12 in upazila level and 61 in district level), 471 MCH-FP clinics (407 in upazila level and 64 in district level) and 8 model clinics (2 at national level and 6 at regional levels). DGFP organizes 30,000 makeshift satellite clinics each month. It also supports operation of 179 NGO clinics (27 in union level, 86 in upazila level, 44 in district level and 22 in national level). ________________________________ Source of information: DGHS and DGFP (2010) 6 | Health Care Network of Bangladesh

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