A Health Policy and Systems Research Reader on Human Resources for Health

Background: Bangladesh is identified as one of the countries with severe health worker shortages. However, thereis a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors inBangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs ofthe population. This paper attempts to fill in this knowledge gap by using data from a nationally representativesample survey conducted in 2007. Methods: The study population in this survey comprised all types of currently active health care providers (HCPs)in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with acomparable average population of approximately 25 000) which were proportionally allocated based on a‘Probability Proportion to Size’ sampling technique for the six divisions and distribution areas. A simple free listingwas done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking withcommunity was done for confirmation and to avoid duplication. This exercise yielded the required list of differentHCPs by union/ward. Results: HCP density was measured per 10 000 population. There were approximately five physicians and twonurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisionswas found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualifiedvillage doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across thecountry. Also, there were twice as many community health workers (CHWs) from the non-governmental sectorthan the government sector and an overwhelming number of traditional birth attendants. The village doctors(predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, whilethe paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditionalhealers, homeopaths (qualified and non-qualified) and basic care providers. Conclusions: Bangladesh is suffering from a severe HRH crisis–in terms of a shortage of qualified providers, aninappropriate skills-mix and inequity in distribution–which requires immediate attention from policy makers. BackgroundHuman resource for health (HRH) is the critical limitingfactor determining the health of the population besidessocioeconomic, behavioural and environmental factors[1,2]. Globally, there is a close correlation between theconcentration of qualified health workers (doctors,nurses, dentists and midwives together) and key healthoutcomes such as immunization coverage, primaryhealth care outreach, and infant, under-5 and maternalsurvival. This is because “in health systems, workersfunction as gatekeepers and navigators for the effective,or wasteful application of all other resources such asdrugs, vaccines and supplies” [3]. The shortage of quali-fied health workers, especially in low-income countries,has drawn attention in recent times, as it seriouslythreatens the attainment of the millennium developmentgoals (MDGs) [4,5].* Correspondence: [email protected] and Evaluation Division, BRAC, 75 Mohakhali, Dhaka-1212,BangladeshFull list of author information is available at the end of the articleAhmed et al. Human Resources for Health 2011, 9:3http://www.human-resources-health.com/content/9/1/3 © 2011 Ahmed et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.CH1