Bangladesh shuts down 1,000 unlicensed hospitals, diagnostic centers

The government remains clueless about the exact number of illegal private clinics and diagnostic centres, despite recently shutting down over 1,000 facilities.

The Directorate General of Health Services (DGHS) claimed to have closed nearly all illegal facilities identified on a list submitted to the High Court last month.

This list included 1,027 unlicensed private hospitals, clinics, diagnostic centres and blood banks, alongside 15,233 licensed facilities operating across the country.

However, discrepancies exist between the figures provided by the health directorate and those suggested by industry insiders.

There are claims suggesting the number of unlicensed facilities may actually be higher than the number of licensed ones.

In response to that, the health directorate says though it is their responsibility to check illegal facilities, they have to be realistic about their capacity and manpower limitations.

“Determining the exact number of illegal healthcare facilities is a challenge,” admitted Prof Dr ABM Khurshid Alam, director general of the health directorate. “There are likely two or three unlicensed clinics or diagnostic centres in almost every village,” he told The Financial Express.

Citing instances of local politicians, union council members and influential figures patronising these illegal facilities, Dr Khurshid Alam elaborated on the challenges faced by them.

He said such individuals exert huge pressure on authorities during crackdowns on these establishments.

“Local political influence is a major factor contributing to the proliferation of illegal health facilities,” he added.

The recent crackdown on illegal healthcare facilities intensified following the death of five-year-old Ayaan Ahmed in January, offers a glimmer of hope for regulating the health sector.

Ayaan died at the United Hospital in Gulshan after undergoing a circumcision procedure at their Badda branch medical college. His tragic death sparked outrage as a subsequent probe found that the Badda branch of the hospital did not have the health directorate licence.

Mainul Ahsan, secretary general of the Bangladesh Private Clinic Diagnostic Owners Association, estimates that there are around 14,500 unlicensed private hospitals, clinics, diagnostic centres, and blood banks operating nationwide.

His organisation, which only gives memberships to licensed facilities, currently has around 1,500 members.

Mr Ahsan directly contradicted the health directorate’s figures on unlicensed healthcare facilities, saying, “The health directorate is fully aware of the number of unlicensed private facilities in the country.”

According to him, many of these unlicensed facilities never applied for licences in the first place, knowing they would not meet the approval criteria. Besides, the licensing process itself is lengthy and bureaucratic.

“These unlicensed facilities do not have the requisite number of qualified physicians, nurses, technicians and pathologists,” Mr Ahsan said. “In remote areas, private facilities often rely on a limited pool of healthcare workers who rotate through different clinics.”

The lack of qualified healthcare personnel is compounded by the issue of attracting doctors and nurses to rural healthcare facilities. Mr Ahsan suggests that the current situation is exacerbated by the unwillingness of doctors to work in village hospitals and clinics.

This explanation aligns with data from the World Health Organization (WHO), which indicates that Bangladesh has a severe shortage of doctors. The country currently has only around 5.25 doctors per 10,000 people, falling far short of the WHO’s recommended global standard of 1 doctor per 1,000 people.

Health directorate struggles due to lack of capacity

The health directorate is facing difficulties due to a lack of capacity. This includes a shortage of manpower to run inspections and a lack of executive power to take immediate action against illegal healthcare facilities.

“The most we can do is close a facility if it’s found to be illegal. But even then, they often reopen it the next day because we simply do not have enough staff to monitor the unlicensed facilities continuously,” said health directorate Director General Prof Dr ABM Khurshid Alam.

The situation is similar in civil surgeon offices, which also suffer from serious manpower shortages, according to Dr Khurshid Alam.

“We are operating with an outdated organogram from 1982. We have repeatedly tried to update it to give the health directorate more authority, but have not been successful.”

“Hospitals are not factories,” he said. “We cannot just shut one down suddenly without discharging patients and giving proper notice.”

Instead, Dr Khurshid Alam called for increased support from district administrations to provide executive magistrates during the drives.

Is a separate supervisory wing the solution?

Public health specialists argue that targeting a select few private facilities would not bring about real change. They believe it could even create opportunities for bribes to keep illegal facilities operational.

Public health expert Professor Dr Abu Jamil Faisal told the FE that there are thousands of unlicensed private healthcare facilities, far outnumbering licensed ones.

He called the current inspection drives a “mere formality” and said they would not achieve the changes the health authorities are hoping for. “If they were effective, we would not see these repeated deaths due to botched treatments,” he added.

Professor Faisal believes the health directorate cannot handle the vast number of private health facilities alone. He suggests forming a separate body to oversee monitoring and supervision of the healthcare sector.

Mozaherul Haque, a former advisor to the World Health Organization (WHO), said many countries around the world have well-established monitoring and supervision systems for healthcare facilities.

Health authorities assess whether healthcare facilities are meeting the conditions of their licences. If everything is satisfactory, they issue recertification.

“This is supposed to be an ongoing process,” said Mozaherul Haque, “but it’s unlikely to be followed rigorously in Bangladesh. That is why so many hospitals manage to fulfil the licensing criteria to open, but then fail to maintain those standards afterwards.”

He also suggested keeping the licensing criteria up-to-date and placing responsibility with the district authorities. These authorities would be responsible for both maintaining the standards and being held accountable if facilities under their jurisdiction fail to meet them.

Dr Abu Hossain Mainul Ahsan, director (Hospitals and Clinics) at the health directorate, told the FE that they have almost shut down all unlicensed hospitals in the country.

“There are no unnecessary delays in our licensing process,” he added. “People’s health is at stake – it is a matter of life and death – so we cannot afford to be lenient.”

He also said that they have instructed all healthcare facilities to display their licence details prominently at their main entrances. He warned that legal action will be taken against any private healthcare facility found to be violating their recently issued 10-point guidelines. The Financial Express