Beruflich Dokumente
Kultur Dokumente
Nursing Instructor
Dhaka Nursing College, Dhaka
E. mail: mbishwa@rocketmail.com
Goals
According to the World Health Organization, the goal of health care systems
are good health, responsiveness to the expectations of the population, and fair
financial contribution. The vital function of the system depends on progress towards
the system such asprovision of health care services, resource generation, financing,
and stewardship. Other dimensions for the evaluation of health systems include
quality, efficiency, acceptability, and equity. They have also been described in the
United States as "the five C's": Cost, Coverage, Consistency, Complexity, and
Chronic Illness. Also, continuity of health care is a major goal.
Health Workforce
There are 59 Medical colleges (41 of them are private), 13 nursing colleges (7
of them are private), 69 nursing institute (22 of them are private), 17 medical assistant
training schools (10 of them are private), and 16 institute of health technology (13 of
them are private).The nation of Bangladesh has managed to develop wide network of
medical college, nursing college, nursing institute and paramedical institutes. In spite
of this growth to health workforce production, the country is still having health
workforce shortage and geographical imbalances.
Health Information
Significant initiatives of present government has taken for improvement of the
MIS at all levels for enabling the system to deliver timely reliable information to the
planners, managers and professionals of the health sector for evidence-based decision
making. Health bulletin is published in regularly and timely, collected and storage
system of modernize data, publication of health information system (MIS),
assessment report using Health Metric Network HMN) assessment tools are few
examples of recent initiatives of the government to improve Health Information
System (HIS) in the country.
Health Financing
There are about 3% of GDP is spent on health, out of which the government of
Bangladesh contribution is about 1.1%. In term of dollar, the total health expenditure
in the country is about US$ 12 per capita per annum, of which the public health
expenditure is only around US$ 4 only.
Health Stewardship
The government has taken many steps to improve its leadership and regulatory
role to improve equity and quality of services, especially to reach the poor and the
disadvantaged. Initiatives for development of new health policy, revitalization of
primary health care by making all community clinics functional with required human
resource, supplies and logistics, recruitment and appropriate deployment of human
resource for health and gradual extension of e-health services to the rural area.
The next tier of public sector health care is located at the district level where
each of Bangladeshs 64 districts can now provide modern hospitals with a bed
capacity ranging from 50 to 200 patients. There is a government program to increase
the bed capacity in many of these hospitals to 250 beds. It is estimated that by 2000,
there were 34,786 hospital beds in district hospitals, giving a bedpopulation ratio of
approximately 1:3,450. The zila or distric hospitals are better equipped than the
upazila health complexes, and cases that are more serious are referred to this level.
In contrast to the primary health care system available in rural areas, there is
very limited availability of public sector primary health care in the urban areas to
service the urban poor. But urban areas also have big public hospitals where serious
cases from rural areas are referred in addition to serious cases from urban areas.
The
provision of primary health care in the urban areas is a gap that needs to be addressed,
and the solution lies either in a partnership-based approach with NGOs and the
private sector or in the development of an urban network of public sector primary
health care provision.
The big public hospitals in the cities, and particularly in the capital Dhaka, are
the apex of the public health system and serve as teaching hospitals where the next
generation of doctors are trained. Although the quality of equipment is often very
poor, as is the supply of medicines, many of the best doctors in Bangladesh are still to
be found in the big public teaching hospitals.
public sector has meant that the access to health services for poor people has not been
satisfactory in the past, and this has justified the entry of NGOs into the health sector.
Unless Bangladesh can develop its own public sector health system based on
taxes it can collect within Bangladesh, the provision of health care across the country
will remain patchy and vulnerable to the changing funding decisions of international
donors and charities.
The work of the Bangladesh Rural Advancement Committee (BRAC)
highlights the nature of the interventions made by the NGOs. They started their
interventions in health care in 1979, in collaboration with the International Centre for
Diarrhea Disease Research Bangladesh (ICDDR,B), to provide oral rehydration
solutions (ORS) to prevent deaths from diarrhea. The idea was to teach households to
treat diarrhea with oral rehydration solutions that could easily be made up at home.
These programs were very successful in reducing mortality and became
internationally recognized as successful innovations in health care in developing
countries.
(ii)
total GDP (gross domestic product). But public health spending was only 0.8% of
GDP, the remaining 2.3% of GDP being accounted for by private health care
provision. Thus, public sector health spending was only about 25% of total spending
on health. In addition, the total spent on health is small because Bangladeshs per
capita GDP is not very high. In per capita terms, in 2002, Bangladesh spent only
US$11 per head on health, which means that each individual in Bangladesh on
average only had $11 to cover all their health needs.
The low level of health spending and the growing share of the private sector
raise important questions about whether the emerging health sector in a country like
Bangladesh can address the constitutional right of all its citizens to access health care.
We can also ask whether these developments are appropriate for ensuring a healthy
workforce that can contribute to the rapid development of the economy. On the other
hand, there is no doubt that the public sector was not well funded, that the quality of
health care delivery was often poor. Therefore, the growth of private hospitals and
clinics has at least improved health care for those who can pay for these services.
Parallel to the development of the private sector clinics, there has also been a
growth of NGOs (non-governmental organizations) providing health care to the poor.
NGOs are classified as part of the private sector, but they are funded by international
donors and local charities, and therefore have characteristics of the public sector. But
their coverage is still limited and their future depends on the continued availability of
funding from these sources, primarily international donors.
Finally, we have to note that the public sector health care system in
Bangladesh has had some notable successes, particularly in expanding immunization
and fighting diarrhoeal diseases and epidemic control, and in family planning. These
areas are not suited for private sector development at all, and here Bangladesh can be
proud of a relatively good public sector performance on which it has to build on in the
future
Future vision:
The government has formulated a perspective plan keeping in view the needs
of the health sector for the future. The formulation of a national health policy would
provide strategy directives on major health issues. The future vision for the health
sector would include universal access to basic healthcare and services of acceptable
quality; improvement in medical education; improvement of nursing education;
improvement in nutritional status, particularly of mothers and children; prevention
and control of major communicable and non-communicable diseases; strengthening
planning and management capabilities; improvement in logistics of
production/procurement, supply and distribution of essential drugs, vaccines and other
diagnostics and therapeutic equipment; increase in overall life expectancy of the
population; survival and healthy development of children; the health and well being of
women; protection and preservation of the environment; disability reduction; and the
adoption and maintenance of healthy lifestyles.
University of Dhaka, offers subsides to students but applies much higher admission
requirements. Cost of individual seeking nurse training at private institutionsbear cost
privately , but they can offset these cost through scholarships or rebates based on their
HSC performance . A nurse practice legally in Bangladesh only after passing the
listening examand registering with BNC.
Minister of
Health
Deputy
Minister
Secretary of
Minister of
Director of Nursing
Services
DDNS
DDNS
Education
ADNS
4 Divisional
ADNS
Health
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ADNS
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Senior
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Assistantnurse
Nursing
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Assistant
Staf
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Bangladesh
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College of
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Project
Director
Deputy Register
Nursing
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staf
Conclusion:
The constitution of Bangladesh clearly stipulates securing for its citizens
.the provision of the basic necessities of life, including food, clothing,
shelter, education and medical care. All governments have recognized the
importance of improving health care provision in Bangladesh and have
pledged to ensure that there is universal access to essential health of an
adequate quality for all its citizens. Health care in a developing country raises
a number of important issues and debates. Access to health care is a
fundamental right in itself, as the constitution of Bangladesh recognizes.
Therefore, as an end in itself, the government has to ensure that the quality of
health care improves over time. The health of a societys citizens is critical for
the performance of the economy and the capacity of the economy to compete
internationally. Therefore, health care is also a means for achieving the
broader development goals of the country.
References:
1.htp://ban.sear.who.int/en/section25.htm
2.
http://www.searo.who.int/en/section313/section1515.htm
3.
http://projects.cie.org.uk/banglo/text
book/envirooonnnmentaldevelopment/health/sectionA
4.
http://www.aifo.if/english/resources//online/book/others/healthcare.upham.
pdf
5. WHO country co-operation strategy 2008-2013, Bangladesh
6. Zaph P.D, Curing what alls you: Improving health care delivery in
Bangladesh through nursing policy 2009( p- 3,6,11,14)
Contents:
1.Introduction
2.Goal
3.Health Care System
References
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^New Yorker magazine article: "Getting there from here." 26 Jan 2009
3.
^ ab World Health Organization. (2000). World Health Report 2000 Health systems: improving performance. Geneva, WHO
http://www.who.int/whr/2000/en/index.html
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^ World Health Organization. (2000) World Health Report 2000 Health systems: improving performance. Geneva, WHO Press.
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^ Nolte, Ellen. "Variations in Amenable MortalityTrends in 16 HighIncome Nations". Commonwealth Fund. Retrieved 10 February 2012.
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External links