Nurses and Community Healthcare Workers

Addressing the Challenge of Affordable and Quality Healthcare in Bangladesh

In a densely populated country like Bangladesh, the provision of affordable and quality healthcare services remains a significant challenge, marked by persistent inequities across different regions and socio-economic groups. As Bangladesh aims to achieve middle-income status by 2031, health-related targets are crucial, particularly in ending preventable maternal and neonatal deaths.

In 2020, the maternal mortality rate stood at 163 deaths per 100,000 live births, highlighting the need for a substantial reduction to meet the SDG-3 target of 70 by 2030.

During the MDG era (2000-2017), Bangladesh experienced a 38% decline in maternal mortality by strategically allocating modest resources to health, prioritizing primary care services, and addressing social determinants of health. Research indicates that a 10% increase in the coverage of nurses and midwifery services in low-income countries could potentially result in a 27% reduction in maternal mortality, underlining the importance of investing in these essential healthcare professionals.

Addressing the Nursing Shortage in Bangladesh: Challenges and Opportunities

Regrettably, Bangladesh currently faces a significant shortfall in its nursing workforce, with only 24% of the required number of nurses, as indicated by the doctor-nurse ratio of three nurses to one doctor. This imbalance is further exacerbated by regional disparities, with urban areas having 5.8 nurses for every 10,000 people compared to only 0.8 nurses in rural areas. Not only is there a numerical shortage, but the lack of skilled and trained nurses and healthcare workers is also a pressing issue.

Compounding the problem, a substantial 53% of births in the country occur at home, primarily overseen by untrained community-level healthcare workers. Data from the BDHS 2017-18 indicates that 35% of these births are assisted by untrained traditional birth attendants (TBAs). The shortage of qualified nurses in healthcare facilities not only affects the quality of care but also compels marginalized populations to seek healthcare from unqualified providers, perpetuating disparities.

The gender dimension is also noteworthy, influencing healthcare-seeking behavior in rural areas. Unfortunately, nursing as a profession has not received formal recognition for an extended period, and the number of nursing colleges is not commensurate with the population.

In the aftermath of liberation, the Bangladesh government initiated various programs for traditional birth attendants (TBAs), nurses, and midwives, introducing reforms to the healthcare education system in different phases. In the 1980s, the Ministry of Health and Family Welfare (MOH&FW) commenced short training programs for TBAs, evolving into the introduction of the B.Sc. course for Nursing in 2006 and formal inclusion of midwifery education in 2016.

Over the past four decades, multiple initiatives have been launched to address the shortage of skilled healthcare workers. Family welfare visitors (FWVs) trained in public health administration and training institutions, known as family welfare visitors’ training institutes (FWVTIs), play a crucial role in providing community maternal and child health care services. Private institutes and NGOs are also actively contributing to strengthening maternal healthcare services by educating nurses and midwives.

To bridge the existing 76% shortage of nurses, collaborative intervention and investment from the government, private sector, and NGOs are imperative to promote nursing and midwifery education. Integrating both trained and untrained healthcare workers into formal training courses is crucial. Increasing the number of seats in nursing and midwifery colleges and institutes, both government and private, is essential to enhance the capacity of TBAs and midwives.

Improving the quality of existing training institutes and colleges, along with reforming the conventional education system, is necessary. The exchange of knowledge between frontline workers such as TBAs, health volunteers, and academicians can enhance practical skills. Deployment in primary healthcare facilities can further enhance their experience, capacity, and system management at a low cost.

As Bangladesh confronts the aftermath of the COVID-19 pandemic with limited resources, investing in rebuilding the healthcare system and enhancing the skills of healthcare workers is crucial. The Bangladesh Nursing and Midwifery Council (BNMC) should implement an effective screening mechanism to deploy qualified and certified nurses and midwives. A separate plan, resource allocation, and zoning of health service providers for establishing nursing schools can greatly aid implementers and policymakers.

Engaging different stakeholders, including technical training institutes, public health experts, healthcare professionals, researchers, media, and educationists, is essential in this process. Upholding the theme of International Nurses’ Day 2022, “Invest in Nursing and respect rights to secure global health,” is crucial to ensuring affordable healthcare coverage, reducing expenditure, and preparing nurses and midwives with the competence to provide healthcare services.