chapter 2

HEALTHCARE NETWORK IN BANGLADESH

Structural changes for better administration

The intricate web of healthcare network in Bangladesh is spread across the country. With the Ministry of Health and Family Welfare (MOHFW)
in the lead, the network comprises implementing authorities, regulatory bodies and healthcare facilities from national to the community level.
Along with the public health departments of the Government, various NGOs and private institutions constitute a large segment of this web. The
Ministry is responsible for formulating national-level policy, planning, and decision-making. The national-level policies, plans, and decisions in
the provision of healthcare and education are translated into actions by various implementing authorities and healthcare delivery systems. The
Ministry and its relevant regulatory bodies also have an indirect control over the healthcare systems of the NGOs and the private sector. However,
only the organizational structure of the Directorate General of Health Services (DGHS) is described briefly in this chapter.

New administrative structure of the Ministry of Health and Family Welfare

In March 2017, the Government split the Ministry into two divisions. The new divisions under the ministry are:
(i) Health Services Division and (ii) Medical Education and Family Welfare Division.On 16 March 2017, the Cabinet Division issued
gazette notifications (SRO No. 61-Law/2017) in this regard. Another gazette notification (SRO No. 62-Law/2017) issued on the same date
described the allocations of businesses of the newly-formed divisions of the Ministry.

Hierarchy of personnel in the Ministry of Health and Family Welfare

Figure 2.1. Hierarchy of personnel in the MOHFW

Honorable Minister

Honorable state Minister

Secretary

Additional Secretary PS to Secretary

Joint
Joint Secretary Joint Secretary
Joint Joint Secretary Joint Secretary
(World health (Family Joint chief
Secretary Secretary (Development (Finance &
& public welfare & (Planning)
(Admin) (hospital & & medical Audit)
nursing) health) program)
education)

Deputy Deputy Deputy Deputy Deputy Deputy Deputy Deputy

secretary secretaries secretaries secretaries secretaries secretaries secretaries secretaries
(discipline)

Senior/ Senior/ Senior/ Senior/ Senior/ Senior/ Senior/ Senior/

Assistant Assistant Assistant Assistant Assistant Assistant Assistant Assistant
secretaries secretaries secretaries secretaries secretaries secretaries secretaries secretaries
  System analyst
 Accounts officer
 Librarian

Secretary : 1

Number of personnel Other personnel Core personnel

Additional Secretary : 1 Administrative Officer : 53 Cataloger : 1

Joint Secretary : 6 Steno-typist : 39 Computer Operator : 4
Joint Chief : 1 Office Assistant/Upper Division Assistant : 10 Draftsman : 2
Deputy Secretary : 13 Office Asstt.-cum-Computer Operator : 6 Lower Division Assistant : 1
Deputy Chief : 2
PS to Secretary : 1 Typist : 12 Cash Sarker :2
Senior/Assistant Secretary : 35 Data-entry Control Supervisor : 2 Stenographer : 1
Senior/Assistant Chief :19 Data-entry Operator : 1 Plain Paper Copier Operator : 1
System Analyst :1 Accountant : 2 Duplicating Machine Operator : 2
Programmer : 3 Assistant Accountant : 3 Dispatch Rider : 2
Maintenance Engineer : 1 Cashier/Accounts Assistant : 4 Driver : 2
Assistant Programmer : 4
Audit Super : 4 Daftary : 1
Assistant Maintenance Engineer : 1
Senior Computer Operator : 2 Auditor : 8 Office Assistant/MLSS : 89
Accounts Officer : 4 Statistician : 1 Sweeper : 3
Librarian : 1
Total : 96

Implementing authorities
There exist nine implementing authorities under the MOHFW as follows:

Total :277

Figure 2.2. Implementing authorities under the Ministry of Health and Family Welfare (for full names of organizations, see the section preceding this
Figure)

Regulatory bodies

There exist five regulatory bodies (Figure 2.2) under the MOHFW. These are:
Figure 2.3. Regulatory bodies under the MOHFW

Directorate General of Health Services

With more than one hundred thousand officers and staff members, the Directorate General of Health Services (DGHS) is the largest
implementing authority under the MOHFW.Along with the operation of healthcaredelivery systems in the country, the DGHS provides technical
assistance to the Ministry in undertaking new programs and interventions and for improvements in the existing ones. The healthcare-delivery
systems under the DGHS extend from national to the community level.The activities are implemented under regular revenue setups and the
development programs.
The development programs are designed following a sector-wide, multi-year approach.

Management structure and type of health

facilities under the DGHS
The six tiers of healthcare infrastructure under the DGHS comprises: national, divisional,district, upazila (subdistrict), union, and ward.
At the national level, there are institutions both for public health functions as well as for postgraduate medical education/training and
specialized treatment to patients.Activities in each division are governed by a divisional director for health, who is assisted by deputy directors
and assistant directors.There is one infectious disease hospital and one or more medical college(s) at the divisional headquarters. Each medical
college has an attached hospital. Some divisional headquarters also possess general hospitals and institutes of health technologies. The tertiary-
level care is basically provided by the divisional institutes.As the district health manager, the civil surgeon (CS) is responsible for delivering
secondary and primary-care services. In each district, there is a district hospital. Some district hospitals have superintendents to look after the
hospital management. In others, civil surgeons look after the district hospitals. Some of the district headquarters have medical colleges with
attached hospitals, medical assistant training schools, and nursing training institutes.Health manager at the upazila level is the upazila health &
family planning officer (UH&FPO). S/he manages all public-health programs, especially the primary healthcare services in the upazila and also
looks after the upazila hospital (having 30 to 50 beds).The upazila where the district headquarter is located does not have an upazila hospital; the
district hospital provides the services due for the upazila hospital.Three kinds of health facilities exist at the union level: rural health centers,
union subcenters, and union health & family welfare centers (UHFWCs). Each union-level health facility employs a medical doctor among
other staff. Only outdoor services are available at the union level. All union facilities have sub-assistant community medical officers to provide
health services to the people.At the ward level, the MOHFW established 12,584 community clinics (CCs). One such community clinic is planned
for every 6,000 to 8,000 people, with a total of 13,861 CCs in the country. The existing union and upazila facilities (~4,500) also provide
community clinic services. Up to 30 September 2017, a total of 13,442 CCs were in operation. These are functioning under the operational plan
of community-based healthcare under the DGHS. These facilities are mainly responsible for delivering primary healthcare services, like EPI,
treatment for common diseases (pneumonia,fever, cough, etc), family planning services,health education, and first-aids and serve as the first
contact points for patients. Some of the community clinics have also stated services for normal delivery through CSBA at the community clinic.
The MOHFW aims to develop the CCs as the unit of comprehensive healthcare-seeking behavior change in the respective local communities
through a sense of ownership and provision of leadership by community people. There are also domiciliary health workers – one for every 5,000
to 6,000 people at the ward or village level. Figure 2.4 shows the types of organizations and facilities under the DGHS from national to the
ward level, with managerial hierarchy.To run the community clinics, 14,890 posts of full-time CHCP (one for each CC) were created,and
recruitment in almost all the sanctioned posts was completed by the Ministry. All of them have been trained to provide better care to the
healthcare-seekers. The CHCPs have been given laptop computers with Internet connection to update the local-level health data; the online
central databases upload these data for future use.
 Director General

Additional Director General(Administration) Additional Director General( Planning &

Development)

Direct Direct Direct Direct Direct Direct Direct Direct Direct Direct Director Director
or or or or or or(Me or or or or
dical (Prima (Plannin (Dental)
(Admi (Centr (Finan (Home (Mana Educa (Hospi ry (Disea (Myco g&
nistrat al ce) o and gemen tion & tals) Health se bacteri Researc
ion) Medic Tradit t Health care) Contr al h)
al ional Infor Manp ol) Diseas
Stores Medici mation ower) e
& ne) Syste Contr
Depot) m) ol)

Deputy Deputy Deputy Deputy Deputy Deputy Deputy Deputy Deputy Deputy Deputy Deputy
Director Director Director Director Director Director Director Director Director Director Director Director
s s s s s s s s s s s s

Assistan Assistan Assistan Assistan Assistan Assistan Assistan Assistan Assistan Assistan Assistan Assistan
t t t t t t t t t t t t
Director Director Director Director Director Director Director Director Director Director Director Director
s s s s s s s s s s s s
Figure 2.4 Administrative set up of the DGHS
2.5 Types of facilities from national to the ward level, with managerial hierarchy

Managerial hierarchy
Directorate General
Managerial Director Additional Deputy Assistant
Directors
of Health Services General Director Directors Directors
Generals

Generals
Type of Health Facilities
• Public Health Institute
Director of Deputy Assistant • Postgraduate Medical
National level
Institute Director Director Institute & Hospital with
Nursing Institute
• Specialized Health
Center

Divisional Director
• Medical College and
(Health)/Director Assistant
Deputy Hospital, with Nursing
(Medical College Director Institute
Director
Hospital) • General Hospital with
Division level Nursing Institute
• Infectious Disease
Principal, Vice Principal, Hospital
Medical College Medical College • Institute of Health
Technology

Civil Surgeon Deputy Civil • District Hospital with

Surgeon Nursing Institute
• General Hospital with
District level Nursing Institute
• Medical College &
Superintendent, Resident Hospital
District Hospital Medical Offcer with Nursing Institute
• Chest Disease Clinic
• Tuberculosis Clinic
• Leprosy Hospital
• Medical Assistant
Training
Upazila Health Resident School
Upazila level & Family Medical Offcer
Planning • Upazila Health
Offcer Complex

Medical Sub-assistant
Offcer Community
Medical Offcer/
• Rural Health Center
Pharmacist
Union level • Union Subcenter
• Union Health & Family
Assistant Health Welfare Center
Health
Inspector Health Assistant
Inspector

Ward level Community Healthcare Provider • Community Clinic

 Organogram of 250 beded hospital

Caretaker Peronnel-2
Caretaker

Assistant Director

Administration Outdoor Indoor Support

Office Medicine EMO

-31 MIS-3 Personnel- RMO Personnel- Personnel- Personnel-
Personnel- Personnel-
1.Administr 1.Statistic 4 Personnel-1
4
ative s-1 1.Resident
2.Main 2.comput physician-1
assistant er 2.Medical
cum Orthopedic
operator-
accountant s DE
1
3. Office Personnel-1 Personnel-2
Personnel- 3.Record Personnel-
assistant keeper-1
4. Driver
5.Junior
mechanic/p
Surgery
ump Personnel-
departmen
operator Ward Gynae obs
t
6.Lilen service Personnel-
Personnel-
keeper Personnel 2 Personnel-
2
7.Ticket -4
clurk 1.Stuard
8.Sterilizer Pediatrics
cum
Cardiology Personnel-
mechanic
9.Herbal Personnel- 2
assistant 1
(gardener)
Cleaning
10.MLSS
service
Skin & sex
Personnel Personnel-
-18
1

Account
section
Personnel-5
1.Accountant
-1
2. assistant
accountant-1
3.Cashier-2
4.Cash govt-
1

Food &
kitchen
service
Personnel-6
Cook-6

Outsourcing
Personnel-
24
1.Electrician
-1
2.Ward
boy-2
 Organogram of 100 beded hospital

Caretaker

Administration-43
Administrative-1 Outdoor-17 Indoor Support service
Main assistant cum accountant-1
Office assistant-1
Office assistant cum typist-3
Statistics-1
Data entry operator-1
Record keeper-1
Driver-2
Junior mechanics-1
Herbal assistant-1
Gardener-1
MLSS(Office)-10
MLSS(Ward boy)-6
Ward master-1
Cook-4
Cleaner-7
Security Guard-1
Strecher bearer-2
Dome-1
Organogram of 50 beded hospital
Administration-44
Main Assistant-1
Medical technologist
(BCG/EPI)-1
Store keeper-1
Medical technologist
(Sanitary inspector)-1
Health inspector-2
Assistant Health inspector-
6 Gardener-1
Health assistant-29
MLSS-1
Accountant-1
Cashier-1
UH&FPO
UH&FPO-1
MLSS-1
Hospital OPD-16 IPD-33 Support service-10
administration-24 RMO-1 Junior consultant Medical technologist
Main assistant cum Medical officer-3 (Anaesthesia)-1 (Radiology/Imaging)-1
accountant-1 SACMO-1 Anaesthesist-1 Pathologist-1
Statistics-1 TB/Leprosy control Junior consultant Medical technologist
Office assistant cum assistant-1 (Medicine)-1 (Lab)-3
typist-3 Dental surgeon-1 Assistant Medical technologist
Driver-1 Medical technologist-1 surgeon(Medicine)-1 (Physio)-1
Junior mechanics-1 EMO-1 Junior consultant Lab Attendent-1
SACMO(Emergency (Surgery)-1 Pharmacist-2
MLSS(Office)-2 medicine)-4 Assistant surgeon Compounder-1
Cook-2 Emergency attendant-1 (Surgery)-1
Wardboy-3 Medical officer-1 OT boy/OT attendant-1
Aya-2 Herbal Junior
Cleaner-5 assistant(Gardener)-1 consultant(Cardiology)-1
Security Guard-2 Cardiographer-1
Junior consultant
(Gynae & obs)-1
Assistant surgeon-1
Junior consultant
(ENT)-1
Junior consultant
(Eye)-1
Junior consultant
(skin & sex)-1
Junior consultant
(Orthopedic)-1
Junior consultant
(paediatrics)-1
Medical Officer
(Indoor)-1
Nursing superviser-1
Senior staff nurse-14
Assistant nurse-1
Organogram of 31 beded hospital

UHFPO

UHFPO-1

Administration-54 OPD-8 IPD-30

Main assistant cum accountant-
1 Medical officer-2
Statistics-1
Medical technologist (BCG)-1
Office assistant cum typist-3
Driver-1
Junior mechanics-1
Gardener-1
MLSS(Office)-3
Cashier-1
Cleaner-5
Secuirity Guard-2
Medical technologist (Sanitary
inspector)-1
MLSS-1
Health inspector-2
Assistant Health inspector-5
Health assistant-24
TB/Leprosy control
assistant(communicable
disease)-1
RMO-1 Junior consultant(Anaesthesia)-1
Junior consultant(Medicine)-1
Medical assistant(SACMO)-2 Junior consultant(Surgery)-1
Dental surgeon-1 Junior consultant(Gynae & obs)-1
Medical technologist-1 Medical technologist(Radiology/Imaging)-1
Herbal assistant(Grdener)-1 Medical technologist(pathology)-1
Medical technologist(Lab)-1
Nursing superviser-2
Senior staff nurse-10
Assistant nurse-1
Pharmacist-2
Store keeper-1
Wardboy-3
Aya-2
Cook-1
Moshalchi-1

Organogram of 10 beded hospital

RMO

Medical Officer-1
MLSS-1

Administration-5 OPD & IPD-15

MLSS-3 Medical Officer-1
Cleaner-2 Medical Technologyst(Lab)-
1
Pharmacyst-1
Senior staff nurse-4
Assistant nurse-4
Cook-1
Moshalchi-1
Wardboy-2