Many public health facilities are facing severe shortages of essential medicines, while diagnostic laboratory services remain disrupted due to non-functional equipment, reagent shortages and a lack of trained personnel, depriving many of access to healthcare services, according to a government-funded study.
As many as 94 percent of the facilities ended the fiscal year with unspent funds because of governance and procedural bottlenecks, said the study, which was unveiled yesterday.
The study was conducted by the Power and Participation Research Centre (PPRC) on behalf of the Health Economics Unit under the health ministry.
Data from 22 public health facilities, including eight district hospitals, eight upazila health complexes, one medical college hospital, one specialised hospital and three union sub-centres were collected for the study between August and October last year. Researchers also analysed the health ministry’s fiscal 2024-25 budget and interviewed key stakeholders.
Laboratory availability and continuity at primary and secondary levels are 81-91 percent but fall to 43-45 percent at tertiary facilities, said PPRC Executive Chairman Hossain Zillur Rahman, who led the study, unveiled the findings of the study.
But reagent stock-outs disrupted 43 percent of the diagnostic services, while non-functional equipment accounted for another 34 percent.
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Besides, the study found that 19 percent of the diagnostic service disruptions were caused by a shortage of trained medical technologists.
Despite relatively high nominal availability of imaging services (up to 85 percent at secondary level), sustained availability remains low (17–33 percent), with 36–60 percent of services underutilised. Imaging services include X-ray, ultrasonogram, CT scan and MRIs.
It is largely due to non-functional equipment (79 percent) and shortages of consumables (14 percent) and personnel (7 percent), it said.
It found that the availability of essential medicines stood at 22.7 percent at upazila health complexes. It was 23.9 percent at district hospitals and only 11.5 percent at tertiary hospitals. Similar shortages persisted over the previous 12 months.
About 62 percent of the medicines supplied to public health facilities come from the government-run Essential Drugs Company (EDCL).
But EDCL’s limited production capacity, dependence on imported raw materials and weak distribution systems hinder supply.
However, timely and adequate supplies from EDCL could increase essential medicine availability to nearly 90 percent, it said.
The study found that routine medical supplies such as gauze and cotton, syringes and gloves were widely available in public health facilities.
However, many facilities lacked critical emergency supplies, with 64 percent reporting no tourniquets, 55 percent lacking bag-valve-mask resuscitators and 41 percent without umbilical cord clamps, posing risks to emergency, resuscitation and maternal and newborn care.
Nearly 40 percent of the sanctioned medical technologist posts under the ministry remain vacant, with only 3,892 of the 6,406 approved positions filled.
Vacancy rates stood at 27 percent at upazila health complexes, 12 percent at secondary hospitals and 36 percent at tertiary hospitals.
Tertiary hospitals have advanced diagnostic equipment but few or no qualified radiology technologists to operate them, forcing hospitals to rely on outsourced or temporarily assigned staff.
More than 20 percent of the development spending under the Fourth Health, Population and Nutrition Sector Programme went to constructing new facilities, many of which remained non-operational for years because of staff shortages, delayed handovers and failure to meet required standards.
Despite this, new construction projects continued to receive approval.
The health ministry utilised 85 percent of its fiscal 2024-25 budget.
Although 94 percent of the facilities reported having unspent funds at the end of the fiscal year, only 11 percent identified financial mismanagement as a problem.
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The report attributed underspending to administrative and governance challenges, including fear of audit objections, weak budgeting capacity, rigid procurement rules, delays in fund releases and lengthy approval processes for reallocating funds.
As many as 84.2 percent of the health workers received at least one formal training over the past two years, the study said.
But most of the training focused on disease-specific programmes (76 percent) while far fewer received training on governance, procurement and infrastructure management (from 34 to 23 percent).
To address the problems, the study gave several short-, mid- and long-term recommendations.
The study recommended urgent recruitment of medical technologists, simplified procurement procedures, stronger digital budgeting and data systems, and the creation of a dedicated health management cadre.
It also called for greater financial autonomy for health facilities and modernisation of the EDCL and the Central Medical Stores Depot (CMSD) to improve medicine supply.
At the event, Health Minister Sardar Md Sakhawat Husain said his ministry will go through the report and take necessary steps to solve the problems.
The health ministry received the highest ever allocation in this year’s budget and they will work hard to implement it, he said, while urging all health workers to be honest in their work.
Government tenders are sometimes designed with specific conditions to ensure that a preferred individual or company wins the contract, preventing other firms from qualifying.
“Such practices are real and are often detected by auditors,” he said after an official of the Directorate General of Family Planning alleged that despite following the rules, officials often have to pay auditors a 5 percent commission to avoid audit objections.
Officials who work honestly and comply with the rules do not need to bribe auditors, he said, adding that if any auditor demands money, they should report it to him directly and he would face it.
