Bangladesh has made significant progress in recent times in many of its social development indicators particularly in health. This country has made important gains in providing primary health care since the Alma Ata Declaration in 1978. All health indicators show steady gains and the health status of the population has improved. Infant, maternal and under-five mortality rates have all decreased over the last decades, with a marked increase in life expectancy at birth. It has achieved a credible record of sustaining 90% plus vaccine coverage in routine EPI along with NIDs (national immunizations days) since 1995. But some of this progress is uneven and there still exists inequalities between different groups and geographical regions. A major constraint identified towards reaching the MDGs and other national health goals is the issue of shortages in the health workforce and the uneven skill mix.

Like most transitional societies, a wide range of therapeutic choices are available in Bangladesh, ranging from self care to traditional and western medicine. The public sector is largely used for in-patient and preventive care while the private sector is used mainly for outpatient curative care. Primary Health Care (PHC) has been chosen by the Government of Bangladesh as the strategy to achieve the goals of “Health for all” which is now being implemented as Revitalized Primary Health Care.

The Public Sector
The primary care in the public sector is organized around the Upazila Health Complex (UHC) at sub-district level which works as a health-care hub. These Units have both in- and out-patient services and care facilities. Most commonly, they have in-patient care support with 31 beds, while some UHC have over 50 beds. Many UHC Units have a package service called “comprehensive emergency obstetric care services” (EOC) available, with an expert gynaecologist, an anaesthetist and skilled support nurses on duty round-the-clock. and basic laboratory facilities. At a lower tier, the Union Health and Family Welfare Centre (UHFWC) are operational, constituted with two or three sub centers at the lowest administrative level, and a network of field-based functionaries. The public sector field-level personnel are comprised of Health Assistants (HAs) in each union who supposedly make home visits every two months for preventive healthcare services, and Family Welfare Assistants (FWAs) who supply condoms and contraceptives pills during home visits. Recently some of the female HAs and FWAs have been trained as birth attendants (skilled birt attendants – SBAs), to provide skilled services within a household setting. The number of health assistants is determined according to the size of the population. The Health Assistants and Family Welfare Assistants are supervised by a Health Inspector (HI) and a Family Planning Inspector (FPI) respectively, posted at the union level. The UHC is staffed by ten qualified allopathic practitioners and supporting staff, while the UHFWCs are staffed by professionals such as a Medical Assistant (MA/SACMO) and mid-wife (Family Welfare Visitor), both trained in formal institutions. The Union Health and Family Welfare Centers (UHFWCs) provide out-patient care only.

Above the sub district are the district hospitals (100-250 beds) and medical colleges (serving a group of districts with around 650 beds) providing secondary care, and national tertiary level care facilities. A common tendency is observed in terms of utilization – a stark imbalance in service utilization at public health facilities. There is low utilization of most facilities at the primary level (Upazila and below) and overutilization of facilities at the secondary and tertiary levels.

The Private Sector
In the private sector, there are traditional healers (Kabiraj, totka, and faith healers like pir / fakirs), homeopathic practitioners, village doctors (rural medical practitioners RMPs/ Palli Chikitsoks-PCs), community health workers (CHWs) and finally, retail drugstores that sell allopathic medicine on demand. In addition to dispensing medicine, sellers at these mostly unlicensed and unregulated retail outlets also diagnose and treat illnesses despite having no formal professional training. All of these informal providers are deeply embedded in the local community and culture and are easily accessible, providing inexpensive services to the villagers with occasional deferred payment, and payment in kind being accepted instead of cash. To this is added an emerging cadre of semi-qualified community health workers / volunteers, who are formally trained by the NGOs (such as BRAC, Gonoshasthya Kendra etc); their numbers have been increasing since the 1990’s with the expansion of PHC infrastructure in the country.

Traditional Medicine
Grouped under “traditional medicine” are most of the medical practices that fall outside the realm of ‘scientific’ medicine. Thus, Kabiraj, totka, herbalists, practitioners of ‘Folk Medicine’ and faith healers (e.g. pir, fakir etc.) of different shades fall under this broad umbrella. Many of these healers (e.g. faith healers) provide a much narrower range of services for a more limited set of conditions.