It was 15 years ago, in 2006, a WHO report listed Bangladesh among the countries with a critical shortage of professional health workforce (who have received formal academic training from a recognized institution), with around 5 among doctors, nurses and midwives per 10 000 population. Who did Bangladeshi consult for healthcare provision? Over 60% of the population relied on unqualified health workers, such as kabiraj, totka, faith healers, traditional birth attendants, palli chikitsoks homoeopaths, and drug sellers.
Unsafe solutions, no doubt, but the only available choice as these untrained and unqualified healthcare providers live within the local communities, especially in the rural areas of Bangladesh, and are, therefore, much easier to access. Easier, but very risky, since unqualified informal healthcare providers carry out improvised treatments and irrationally prescribe the use of medicines, drugs, and even antibiotics.
An untrained drug seller interviewed in Shahjahanpur, Bogra: “I don’t understand why we would need a valid license. People ask for medicine and we sell it. I have been doing this for 10 years and I never had any restrictions before.” Photo by WHO Bangladesh
During the last 15 years, the government of Bangladesh has taken numerous initiatives to ensure equitable and inclusive access to quality healthcare, regardless of the demographic and geographic identities. A study jointly conducted by the Ministry of Health and Family Welfare (MOHFW) and WHO between 2019 and 2020 showed an average of 49 healthcare providers, 33 qualified and 16 unqualified, for 10 000 people. From 2007 to 2020, the country has experienced an increase of 12% in the presence and accessibility of qualified healthcare workers.
A traditional birth attendant interviewed in Godagari Upazila, Rajshahi: “We don’t know how to stop a hemorrhage, but a pregnant mother must not panic; she has to follow the instructions of the elderly people, and she will be safe. Photo by WHO Bangladesh
The traditional birth attendants and traditional healers, 97 per 10 000 people in 2007, have now decreased to 6 per 10 000 people, as many of them underwent qualifying skill development programs, certifications, and training delivered by the government and various NGOs. Furthermore, the improved access to safe and qualified healthcare providers is also a consequence of several policies that brought formal healthcare and socio-economic development programs closer to the rural communities and reduced poverty throughout the country.
The path towards universal health coverage is still long and surely challenging, and the cultural component of the unqualified medicine has undoubtedly deep roots; but the last 15 years have proved that, with its strong commitment, Bangladesh is moving in the right direction to ensure safe and accessible healthcare to all.