A review of data from a social audit conducted on health services in 2010 found that problems in the health sector include manpower crisis, lack of adequate equipment and supplies for medical services, lack of infrastructure, regional disparities, inadequate budget allocation and above all lack of transparency, accountability and management. There are. After the audit report, considering the overall aspect of Satkhira region, an initiative was taken in August 2013 to prepare the survey report again in the health service. The issues that are specifically identified in the audit are-
Satkhira Sadar Hospital and Kaliganj Upazila with the objective of identifying the limitations of the government health care providers, determining the efficiency and effectiveness of the service providers and making effective recommendations to ensure the health rights of the poor and marginalized people. The Health Complex, Khalishkhali Union Family Welfare Center and Bayardanga Community Clinic received recommendations and opinions from the on-duty doctors, patients and other officials. The main objectives of the survey were to increase transparency and accountability in the performance of service providers, to increase the scope of health rights of the poor and marginalized people in the area, to identify relevant policies, measures and implementation problems for all and to make necessary recommendations.
Overall health situation of Satkhira district
The overall health care situation in Satkhira, a border district in the south-west of the country, is fragile. Although the number of health care institutions is moderate in proportion to the population, due to the crisis of infrastructure and manpower, the people are not able to enjoy 100% of the benefits of government health services. Due to lack of proper utilization of limited resources and lack of supply of medicines and manpower as per the demand, large population of the district is being deprived of government health facilities. Ordinary people are being deprived of government healthcare at the field level. However, despite limited health care, the general public's faith and interest in government health facilities is growing.
Satkhira district consists of 6 upazilas including Shyamnagar upazila and an administrative thana consisting of a large area of Sundarbans starting from Chandanpur union of border Kalaroa upazila. The population of Satkhira district, which covers an area of 3,856.33 sq km, is 2,064,000. In this densely populated district, there is one Upazila Health Center in each of the remaining 6 Upazilas including the District Sadar Hospital. Besides, there are 9 union health centers in different unions of 4 upazilas. There are 108 Union Community Clinics. At present the number of community clinics is 140. Despite the increase in population, the government health system is running in the district with the help of certain people. Although the number of beds in Sadar Hospital and 5 Upazila Health Centers has been increased, the infrastructure and manpower have not increased. The 100-bed District Sadar Hospital is running with a manpower of 50 beds. Although Tala, Kalaroa and Shyamnagar, Kaliganj, Sakhipur Upazila Health Centers have been upgraded from 5 to 31 beds, the number of beds and manpower has not been increased. Even after two years of upgrading Kaliganj Upazila Health Complex from 31 beds to 50 beds, the number of beds and food for the patients is being provided as 31 beds.
Healthcare Situation: Sadar Hospital
Satkhira District Hospital, established in 1980, was upgraded from 50 beds to 100 beds in June 1996. Activities start from 1st July. But the manpower was not increased. The hospital is running with a manpower of 50 beds. On the other hand, an average of 150 to 200 patients are admitted in a 100-bed hospital every day. Most patients have to stay on the floor due to lack of beds. Although the number of beds has been increased, work is underway to increase the infrastructure.
One of the two X-ray machines of Satkhira Hospital is in operation. Ultrasonogram machine has been introduced. A new eco machine has been launched here. Sophisticated blood testing equipment has been installed. The hospital has a system of conducting blood and related tests from the pathology department of the hospital with a fixed fee. The 50-bed infrastructure of the hospital is in proportion to the manpower required. Even after 15 long years of upgrading to 1 bed, manpower of 100 beds has not been provided. According to the standard organogram, the total manpower required for a 100-bed general hospital is 325 people. At present there are 104 posts. The number of vacancies proposed is 221.
Number of patients and money allocated:
Satkhira Hospital was allocated Tk 1 crore 30 lakh for the last financial year. Of this allocation, 75 per cent 72 lakh 10 thousand rupees was spent on medicines. In addition, 10% of the cost for the purchase of surgical equipment is 10 lakh 30 thousand rupees, 5% for chemical reagents, 5 lakh 15 thousand rupees, 3% for oxygen gas 3 lakh 3 thousand rupees, 4% for yards, bandages, cotton 4 thousand 4 lakh 12 thousand rupees for bedsheets, mosquito nets, pillows etc. and Rs.
Satkhira Hospital has an average of 850 to 1000 patients in the outpatient department every day. These patients buy tickets with 5 taka and take the advice and prescriptions of the medical officers as well as get medical benefits from the specialist doctors. There is no prescription for outpatients. A certain portion of the medicine supplied indoors is supplied to outpatients. Medicines supplied externally are distributed among the patients by patching. Most of the patients here seek the advice and treatment of ophthalmologists, dental, ENT, medicine, pediatricians, surgeons, orthopedics, specialists and gynecologists. The average number of outpatients is about 55% female, 35% male and 10% pediatric.
In addition to the inter-departmental beds in Satkhira District Hospital, there are 80 to 100 additional patients on the floor every day. In addition to the prescribed 100 beds, these patients are not getting food even if they get certain medicines provided by the hospital apart from medical facilities. The annual allocation for food in the hospital is 26 lakh 37 thousand 500 rupees. The daily allowance for hospitalized patients is now 75 rupees. Although there is a rule to provide bread, sugar, banana and eggs every morning, additional patients are not given food as there are more patients. Rice, fish, meat, curry / pulses are served at noon and night. Although food is provided free of charge for patients in ordinary beds, patients in cabins have to pay for food. According to the majority of inpatients, the quality of the information provided in the hospital is relatively good.
Health care image of Sadar Hospital at a glance:
There is a Citizen Charter list outside the hospital. A notice has been drawn in front of the ticket counter stating the reasons for the increase in ticket prices. There is a list of medicine supplies. With a manpower of 50 beds, prescriptions and medicines are provided to 600 to 1000 patients in the outpatient department every day. Hundreds of patients wait from morning to noon to see a specialist doctor. Many patients have to go without medication after being wisely shown by a doctor. The hospital provides services to pregnant mothers. Cervical cancer is tested. Maternity mothers are vaccinated at the hospital. The money of the social welfare department of the hospital is given only for the poor patients admitted in the hospital with a certain amount of grant. With the permission of the Civil Surgeon and Residential Medical Officer, a maximum of Rs. 300 / - was purchased in case of emergency at the request of the patient's family. In the last one month (August 12), 15,480 patients have been treated outside the hospital. Of these, 8,938 are women and 5,853 are men. The number of children is 2,869.
There are no paying beds in the hospital. There is no need to rent a seat for a general bed. Only for the cabin you have to pay 3 shots per day including diet. The general admission fee for hospital admission is Tk 10, direct admission fee for emergency department is Tk 12 10 paise and direct admission fee for gynecology ward is Tk 18 60 paise.
Various tests of blood are done at a fixed rate in the pathology department of the hospital. Blood group, cross matching, screening videltest, blood sugar, blood urea, paganness test, FCG, stool, urine, are tested. Patients in the indoor, outdoor and cabin are x-rayed with an X-ray machine. Under the new government rules, blood screening, cross-matching and general patients for outdoor and general beds will be charged Rs 250 and cabin patients Rs 500 respectively.
All these patients have to stay on the floor in different wards. Although there are 9 beds in the children's ward, the average number of pediatric patients is 30 to 40. They are kept on the bed of the bed. Again, many children are forced to stay on the floor. On the other hand, due to lack of space in the ward, most of the patients are kept in the verandah of the ward. Although the hospital has a staff of 50 beds, certain nurses are on duty, but during the day, patients are served by trainee nurses.
Outpatients are deprived of medical facilities as specialist doctors are scheduled to operate on the day of the week. In addition, due to the crisis of doctors, outpatients have to sit for hours to seek medical care. With a manpower of 50 beds, the doctors on duty outdoors have to work hard to manage and care for 600 to 1000 patients in the outpatient department every day. Increases the suffering of physicians as well as patients. The hospital currently has adequate modern equipment. However, there is not enough manpower. There are no more doctors and nurses than needed. In addition to the hospital admission fee, one has to pay the prescribed fee for various tests in pathology. In many cases, these tests are provided free of cost to poor patients in the local system.
The hospital has an ambulance. There is a rental list. There are generators for power supply. The lab has only IPS system to protect the equipment and medical supplies. The allegation that the required medicine was not available from the hospital is somewhat true. Although the hospital has accommodation for doctors, there is only RMO. Besides, the security system is very bad. The Standing Committee on Health is effective.
A total of 20 inpatients and outpatients of the hospital were interviewed in the survey. Most of these patients spoke of drug shortages. Although doctors and nurses are served in the inpatient department, they have to buy about half of the medicine from outside. Although the electricity system is good, there are no separate toilets for men and women in the hospital. The toilets are dirty and untidy. All the admitted patients are well used by doctors and nurses. According to the patients, there is no problem of brokers in the hospital. In addition to the admission fee, they had to pay extra fees for examinations in X-ray, ultrasonography and pathology departments. They were not given any separate receipt as the value of the money received was written on the ticket.
Outpatient complaints are different. Most of these patients had to wait about 1 to 2 hours to talk to the doctor. They said the problem was due to the doctor not coming to the room on time and the patient crowd. They could not answer whether the hospital has the necessary doctors, manpower and equipment for health services. In order to improve the quality of service, these patients are recommended to increase the number of doctors and provide necessary medicines.
Kamruzzaman, a pharmacist at Sadar Hospital, said the hospital had a list of medicines. Official medicine is no longer sold outside the hospital. He feels that the annual budget allocation needs to be increased to ensure the presence of patients and the supply of medicines according to their needs.
Store keeper AKM Fazlul Haque
AKM Fazlul Haque is the District CS Store Keeper. Medicine is provided at the hospital every three months. Here come 20 types of medicine. Tablets and capsules together about 4 lakh. Patients complain that medicines are not available from the hospital as there is no supply of medicines as per the demand. The problem is that the number of patients is more than the allocation of medicines. He thinks it is necessary to provide the necessary medicines to get adequate services.
Technologist Rabindra Nath Ghosh
Rabindra Nath Ghosh is working as a technician (lab) at Sadar Hospital. This lab tests blood TC, DC, ESR, hemoglobin, VDRL, uric acid, platelet MP, urine (routine) urine (pregnancy), stool, BT, CT, blood sugar, blood urea, serum bilirubin. At least 30 to 40 outpatients come here every day, including hospitalized patients. Recently some new machines have come. In addition to blood tests, various tests are done with hormone analyzer, hematology analyzer, electrolysis centrifuge fuse ear oven. Working in small houses is a problem due to the infrastructure crisis. He said that in order to improve the quality of service, it is necessary to increase the required manpower, change the infrastructure and provide reagents as per the demand.
Staff Nurse Rashida Begum
Rashida Begum, a senior staff nurse at the District Sadar Hospital, said proper services could not be provided due to lack of skilled manpower. According to him, he recommended the creation of the post of Nursing Supervisor, Senior Staff Nurse, 4th Class Staff Growth, Sub-Service Supervisor. He recommended increasing the number of skilled manpower and adequate nurses to provide adequate services.
RM and Dr. Maruf Hasan
Dr. Maruf Hasan is acting as RMO (Residential Medical Officer) of Satkhira Sadar Hospital. To get services in this hospital you have to collect tickets and pay admission fee. Only free medicine is provided here. Admission is free operation for patients in ordinary beds. A special arrangement of Rs. 300 / - is provided by the Social Welfare Department for the specially admitted patients.
There is not enough manpower in proportion to the service. The higher authorities have been informed about this. There are not enough beds and manpower in the inter-department. The hospital has an ambulance and oxygen. The ambulance is on. The services provided by the hospital are not adequate for the local people. Due to low budget allocation, manpower crisis and low supply of medicines, services are not being provided as per demand. There is a double phase connection for power supply. The medicines listed in the hospital are not enough compared to the need. Poor patients admitted indoors are given a maximum assistance of Rs. 300 on application. He said that in order to provide effective and adequate services, manpower, supply of medicines as per the demand is required.
Civil Surgeon Dr. A. Z. Atik
Dr. AZ Atik is the Civil Surgeon of Satkhira. He said there was a need to increase manpower for healthcare activities in the area, strengthen security measures, increase allocations in the MSR and diet sectors and increase public participation in the development of hospitals.
Image of Kaliganj Upazila Health Complex at a glance
Kaliganj upazila consists of 12 unions of Satkhira district. The 31-bed to 50-bed building of Kaliganj Upazila Health Complex, 35 km away from the district headquarters, was inaugurated on December 20, 2010. Although administrative permission was given to provide 50 beds and food to the patients on January 16, 2011, the order was not complied with till September 12. As a result patients have to stay on the floor. Patients do not get food.
The health complex is being matched with 31-bed manpower. The suffering of the patients is extreme as there is no doctor allotted for the bed. The X-ray machine is on. The ambulance is on. In the last one month, a total of 3135 patients have been provided free services. Of these, 2,910 have received treatment in the outpatient department. Of these, 625 are men, 1,443 are women and 642 are children. A total of 225 people received treatment in the inter-department. Of these, 69 are men and 138 are women. About 200 to 250 patients throng the outpatient department every day. The number of women is more. Medical facilities are available at Tk 3 for external department and Tk 10 for inter-department. Most patients have to buy some emergency medicine from outside.
The allocation for the last financial year was Tk 30 lakh. Of this allocation, 75 per cent was spent on medicines at a cost of Tk 22.50 lakh. In addition, 10% 3 lakh rupees for purchase of surgical equipment, 5% 1 lakh 50 thousand rupees for chemical reagent, 2% 60 thousand rupees for oxygen gas, 4% 1 lakh 20 thousand rupees for gauze, bandage, cotton and bedsheet, mosquito pillow. 2% 80 thousand rupees for furniture, 2% 70 thousand rupees for furniture and 75 lakh rupees per bed for food at the rate of 13 lakh, 6 thousand 6 hundred and 50 rupees.
What hospital inpatients and outpatients say
Most of the patients who come to Kaliganj Upazila Health Complex have their homes within 2 to 6 kilometers. Patients admitted to the hospital received seats normally and with admission. However, as the number of beds was not increased, more than 31 patients had to stay on the floor. Admitted 10 patients said that they are very satisfied with the use of doctors and nurses. They had to pay 10 rupees for admission. Here they are satisfied with the quality and quantity of food. However, there are problems in the bathroom.
Most of the patients in the outpatient department get the medicine with the prescription of the medical officers. Patients have to read the problem because there is no specialist doctor. The patients have received most of the medicines from the hospital in the prescription given by the doctor. Even then, many of them had to buy some medicine from outside, they said. In order to improve the quality of health services, they have advised the necessary specialist doctors and medicine suppliers as per the demand.
Staff Nurse Kamna Rani Sikder
According to Kamna Rani Sikder, a senior staff nurse on duty at Kaliganj Upazila Health Complex, the hospital lacks skilled manpower. Gaini needs a consultant. He recommended staff nurses and brooms, wardboys, nanny, along with security measures.
Medical Technologist Lab MD Shamim Iqbal
MD Shamim Iqbal is the Medical Technologist of Kaliganj Upazila Health Complex. There are microscopes, digital clometers, scientific fuses, machines. Blood CBC, Urine RE, Paganness Test, SO Titre, Blood Sugar, Blood Grouping and RA are done with a certain amount of fee. An average of 25 to 30 patients come for the test every day. There is no manpower required to run the lab. He thinks that a blood bank fridge with analyzer and ELISA machine is needed to run the lab.
Pharmacist Zahurul Azim
Zahurul Azim is in charge of pharmacist in Kaliganj Upazila Health Complex. The hospital supplies antacids, paracetamol, metronidazole, tetracycline, amoxicillin, indomethacin, libofloxacin, and histamine. The annual demand for medicine is to be paid. There is no opportunity to sell them outside as they have official labels on them. According to him, there is an adequate supply of medicine. He recommended to increase the manpower.
Health Officer Dr. Abul Kalam Azad
Dr. Abul Kalam Azad is in charge of Kaliganj Upazila Health Complex. Medicine supply, lack of manpower are the main problems here. He thinks that a specialist doctor is needed for the service. The hospital has a proper management committee instead of a standing committee on health. This committee meets every month. He said that in order to provide effective and adequate services, it is necessary to increase the required manpower, supply of medicines and a conducive environment for providing services.
Picture of Khalishkhali Union Family Welfare Center at a glance
Sufia Khanam has been working as an inspector of Khalishkhali Union Health and Family Welfare Center in Tala Upazila for two years. The center, about 20 km from the district headquarters, provides free pregnancy services, normal delivery services, postpartum services, neonatal services, MR, services for children under 5, EPI, vitamin A capsules and reproductive system services. In the month of August (12), 680 patients received health care from this health center. Of these, 455 are women, 125 are men and 305 are children. Patients who come here for treatment are within half a kilometer to 1 kilometer from the home center. Most of the patients who come here are satisfied with the use of the health workers in charge. They feel the need to provide more medicines to improve the quality of health care.
This center provides services 5 days a week. There is no fee. There is no alternative power supply. There are no security measures. When it rains, water accumulates in front of Odisha. I have to go to the satellite clinic in the village on Sunday. Providing services according to local needs is not enough. Problems are being created due to lack of manpower. Here is a list of medical services. From this center patients are given free paracetamol, metronidazole, cotrim, iron, antacid, amoxicillin and some other medicines. As a local health officer, she has to do delivery work, checkups, visit maternity mothers and provide services. He thinks that a medical officer is needed in this center for effective and adequate service. He thinks that necessary manpower, supply of medicine as per demand, security measures, chairs and tables are required.
Bayardanga Community Clinic at a Glance:
Family Welfare Assistant Sadhana Rani Sardar is in charge of Bayarjanga Community Clinic in Khalishkhali Union of Tala Upazila. These clinics usually provide counseling on health care and family planning and run EPI activities. The clinic is open 3 days a week from the health department and 3 days from the family planning department. An average of 50 to 60 patients are treated in the health department every day. From here 26 types of medicines are given. Most of the patients who come here are women. In the last one month, on August 12, a total of 996 patients received services and medicines from this clinic. Of these, 684 are women and 314 are men.
This clinic has electricity. This connection has been made from the land donor's house. There is an 11-member community group for clinic management. Community group meetings are occasional, but not everyone attends. The homes of the patients treated here are within half a kilometer to 1 kilometer from the clinic. They all feel satisfied with the services of this health center. The health workers in charge of the center feel that security needs to be strengthened, night watchmen need to be deployed and medicine needs to be doubled.
Community group members said
According to Maulana Azizur Rahman, president of the group at the Bayardanga Community Clinic, Rezael Karim, a retired teacher, and Shahin Kaguji, a UP member, patients receive adequate care from the community clinic. There is no fee. However, they have made a proposal to charge a fee of Rs 3 to cover the cost of running the clinic. Group meetings here are once a month. However, they think that the locals can benefit if the health department continues its activities for more days instead of 3 days a week. They also recommend the appointment of a doctor to provide adequate equipment for the delivery system.
Survey results and recommendations for health care development
Satkhira Sadar Hospital, Kaliganj Upazila Health Complex, Khalishkhali Union and Family Welfare Center and Bayardanga Community Clinic The recommendations and opinions of the officials and employees of different departments including the patient are taken.
The results of the survey obtained can be seen
All commentators have identified the manpower structure as a major problem in the existing healthcare situation. He also said that the general public is being deprived of the full benefits of government health services due to lack of infrastructure development and supply of medicines as per the demand. However, compared to the last few years, the quality of health care has improved a lot and people are beginning to regain faith in government health care. The members of the new middle class family are enjoying food facilities including free daily surgery facilities for the patients in the general beds of the inpatient department in addition to the advice of the specialist doctors by collecting tickets at nominal price only. Everyone has identified the crisis of manpower structure, inadequate budget and shortage of medicines in improving the public health care situation.