factionalism weak health sector instability

Party politics has weakened the health sector. The rulers have prioritized individual and group interests over improving service quality. Soon after the fall of the Awami League government, there is unrest in government hospitals and educational institutions. The question looms large whether the interim government will create political balance in the health sector, or run the health sector with competent people.

From 2009 until the fall of the Awami League government, the Awami League-backed doctors' organization Swadhanath Prakash Parishad (Swachip) controlled the health care and medical education sectors with great power. In addition to influencing recruitment and transfer, Swachip's leaders have also done business in the health sector.

A search committee should be made to find qualified persons. By maintaining deprivation, the health sector cannot function properly without deserving people.
Syed Abdul Hamid, Professor, Institute of Health Economics, University of Dhaka

Not only that, Swachip has deprived the members of Doctors Association of Bangladesh (DAB) in various ways. Despite having all kinds of qualifications, pro-BNP doctors were not promoted on time. They have not been made any project leader. Independent doctors are also deprived of Swachip or DAB politics. There are precedents, many have left government jobs in humiliation and frustration due to lack of merit assessment.

The exact opposite was the case from 2001 to 2006. BNP was in power then. DAB had absolute dominance in all areas of health sector. Swachip was cornered by DAB leaders and workers. Individuals had the same experience during that period as well. The health care sector and medical education system have been the most affected by Swachhip and DAB. Their vested interests have hindered the development of the health sector.

Public health expert Abu Jamil Faisal told Prothom Alo that the health sector is a direct proof of how party politics can weaken the service sector. Banning party politics in the health sector should be on the priority list of the interim government. It will not be possible to reform the health sector by keeping Swachip and DAB active.

Big-Mage-Little Brother in OP

Most of the work in the health sector is implemented mainly through health, population and nutrition sector programmes. The program is of five years duration. The fourth program ended a couple of years ago. The fifth program was supposed to start in July this year. The main money is given by the government, a part is given by the development partners.

The health, population and nutrition sector program operates through 31 Operation Plans (OPs) or thematic plans. E.g.: nutrition, communicable diseases, non-communicable diseases, primary health, alternative medicine, maternal and child health—separate OPs for such topics. OP has allocation of funds for five years.

Each OP has three coveted posts: Line Director, Program Manager and Deputy Program Manager. There is one Line Director, one or two Program Managers and 2 to 10–12 Deputy Program Managers. At present almost all posts are occupied by Swachip members. In this case, merit or competence was not seen. During their student life, they used to do politics in Awami League's student organization Chhatra League in various medical colleges. Usually the elder brother of former BCL works as line director, some younger in age as program officer and younger brother as deputy program officer. Allegedly, the brothers joined forces to commit corruption in procurement, foreign travel and training in the health sector.

Individual or group interest

Professor Abul Basar Mohammad Khurshid Alam performed an important surgery on former Health Minister Zahid Malek at Dhaka Medical College Hospital. A few days after the start of the Corona epidemic in 2020, the then Director General of the Department of Health, Professor Abul Kalam Azad, was forced to resign due to allegations of corruption. Prof. Khurshid Alam was appointed as Director General even though he had no experience in managing the administration. His tenure in government service ends in December 2020. His tenure on contractual appointment was extended till December 2024.

11 institutes and medical colleges have contractual appointments in top posts. Apart from this, tenure of several professors has been extended in the same process. However, no pro-BNP doctor got this benefit.

The picture of anger and frustration of pro-BNP doctors can be clearly understood from an action of the interim government. The interim government last Sunday canceled the contractual appointment of Abul Basar Mohammad Khurshid Alam and appointed Professor Robed Amin as the director general (on duty) of the Directorate of Health. Robed Amin was the Line Director of the Non-Communicable Disease Control Program. Robed Amin could not enter the office until Tuesday. DAB leaders and workers locked the office. They want to appoint a deprived person as director general.

DAB has launched a movement against Robed Amin. Last Monday, Dhaka North City Corporation's DNCC Hospital was visited by Health Advisor and some officials of Health Department including Robed Amin. DAB leaders and workers forcefully entered there. There were some fourth grade employees. There was a scuffle. DAB leaders and workers entered the meeting room and started shouting. At this stage a doctor stood on the table. They allege that Robed Amin has committed corruption, his position is against the student movement. Health advisor Nurjahan Begum was seen sitting helplessly during the entire incident.

After the incident, Robed Amin told Prothom Alo that the allegations against him are all false.

factionalism in medical education

The ultimate example of partisanship is the Bangabandhu Sheikh Mujib Medical University (BSMMU). All the five vice-chancellors who have been appointed consecutively since 2009 are either members of Swachip or directly involved in Awami League politics. Not only that, Vice-Chancellors, Proctors or others accompanying the Vice-Chancellor are also members of Swachip. There is no dissenter in any major position in this educational institution.

173 doctors appointed during the BNP regime (2003, 2004 and 2006) were promoted in one day, three days after the fall of the government on August 8. Apart from these 173, the promotion of other teachers associated with different politics was blocked. Now they are being promoted secretly.

When the process of giving these promotions was almost over, several top officials including the Vice-Chancellor, two Vice-Chancellors of BSMMU resigned under pressure on Sunday.

The Awami League government made preparations to establish four more medical universities. Each was headed by a Swachip member.

This factionalism is not only in the medical university, but the principal of 37 government medical colleges is involved in the politics of Awami League. About 50 civil surgeons of 64 districts are members of Swachip or close to Awami League.

There are 495 upazila health complexes in the country. The responsibility of Upazila Health Officer is given to him, who has party loyalty. Every important post from the center to the field level is occupied by party people.

Meanwhile, the Ministry of Health has OSD the Director General of the Directorate of Health Education Professor Tito Mia and two additional Directors General Professor Bayezid Khurshid Riaz and Professor Kamrul Hasan on Monday. All three of them were involved in Chhatra League politics during their student life, all three were associated with Swachip. Kamrul Hasan is currently the general secretary of Swachip. DAB leaders want to put their people in these positions.

The only pharmaceutical company

The only government drug manufacturing company is Essential Drug Company Limited or EDCL. Medicines are manufactured in EDCL factories in Dhaka, Bogra, Gopalganj. Condoms are manufactured in a factory in Khulna. Rubber for making condoms is produced in Madhupur.

The managing director of EDCL is an Awami League leader. He is a dermatologist, not a pharmacist. More than four thousand people work in this company. Majority of them are working class. Experts say, it is possible to run this institution with half the manpower. The predominance of the people of a district in this only business establishment in the health sector is noticeable.

What to do now

Those who have been deprived for so long are saying, now is the time to accept the debt. DAB doctors are attacking the authorities. Meanwhile, several institutions including BSMMU, National Mental Hospital, Shaheed Suhrawardy Medical College Hospital, National Orthopedic Hospital and Rehabilitation Institute (Pangu Hospital), Sheikh Russell Gastroliver Institute and Hospital have been vandalized.

In several institutions, besides doctors, nurses and third-fourth class employees are also marching, taking part in the vandalism. According to them, they have been deprived in various ways in the last 16 years.

It is difficult to make health institutions service-oriented with partisan politics and allegations of deprivation. A senior official of the health care department, who did not want to be named, told Prothom Alo that many people know who are worthy and honest people. These people should be prioritized. Priority should be given to the deserving but deprived. Providing equal space to the people of both parties to bring political balance will not increase the quality of service.

When asked what to do, Professor Syed Abdul Hamid of Dhaka University's Institute of Health Economics told Prothom Alo that one government did not come to power by removing another government. Here the context is different. This government came to power by talking about reforming the state through the student movement. The government should form a search committee. Qualified person should be found. The deserving and deprived should be given their due place. By maintaining deprivation, the health sector cannot function properly without deserving people.