Nonetheless elusive in spite of everything these years

There are well-defined and established practices of referral programs in lots of international locations. However the policymakers fail to know it once they communicate concerning the referral system.

— Muhammad Abdus Sabur, adjunct school on the IHE of DU

In 2014, then well being minister Mohammad Nasim at an occasion in Rangpur Medical School Hospital formally introduced the inception of a affected person referral system for Rangpur division.

It, nonetheless, fell flat because of insufficient logistic help and unavailability of certified physicians and auxiliary workforce at main healthcare centres.

Two extra makes an attempt to get the referral system getting into 2016 and 2019 too failed. Each fizzled out after discussions amongst high-ups.

Underneath a referral system, a affected person first goes to a close-by main healthcare centre, public or non-public. If want be, that healthcare centre will ship the affected person to hospitals which can be higher outfitted to deal with them. 

Main hospitals, however, is not going to see any walk-in affected person, until the affected person is in important situation. They are going to deal with solely sufferers referred by the smaller hospitals and healthcare centres.

The bigger hospitals can ship sufferers again to smaller hospitals for follow-ups. 

The system creates a hyperlink between the hospitals of three tiers — main, secondary and tertiary — to make sure high quality of companies, scale back value, and keep away from pointless rush at tertiary hospitals.

For years, the federal government couldn’t put together a protocol for the referral system, not to mention introduce it, leading to anarchy within the nation’s well being sector, well being specialists stated.

At present, sufferers bear on common 68.5 p.c of all healthcare prices. If the referral system was in place, this value may very well be slashed as they might not be paying for the inefficiency of the healthcare system, they stated.

Well being officers stated if the system have been in place, stress on giant tertiary hospitals may very well be halved. Presently, many go straight to these hospitals with minor diseases, deterring the hospital’s means to correctly deal with important and emergency sufferers.

They stated a stable affected person referral system may join round 18,000 public and 16,000 non-public healthcare amenities with all different high-level hospitals countrywide.


About 5,000 union healthcare centres countrywide are presupposed to be the primary place for sufferers to go to. However none of them work 24/7 because of an absence of docs and different help workers, well being officers stated.

Many of the upazila well being complexes additionally fail to correctly serve sufferers because of shortages of docs, help workers, logistics, and inefficiency in hospital operations.

With out choices, individuals rush to giant hospitals in cities.

Joynal Abedin, 62, of Cumilla, had been affected by chest ache for six months. He had no confidence within the upazila well being advanced or the medical faculty hospital in Cumilla. “There isn’t any correct therapy there,” he stated.

He travelled 70km to Dhaka and stood in a queue of 500 sufferers on the Nationwide Institute of Cardiovascular Illnesses (NICVD).

The NICVD physician, Nurun Un Nobi Khandaker, stated Abedin may have had therapy in his locality. “This can be a specialised hospital that handles advanced heart-related diseases. However we’ve got to deal with numerous sufferers with minor diseases each day,” he stated, including, “The frenzy may have been halved if these sufferers had visited main healthcare hospitals first.”

If there had been a affected person referral system, Abedin would have been seen by a main healthcare physician first, who would have despatched him for an ECG. After going by way of the outcomes, the physician,  if wanted, would have despatched the affected person to a greater outfitted hospital like NICVD. This could have saved journey prices and ensured well timed therapy of the affected person and diminished overcrowding of NICVD.

Prof Ahmedul Kabir, further director basic (administration) on the Directorate Basic of Well being Providers (DGHS), stated poor companies in main healthcare amenities make for an incredible barrier to the referral system.

“Till we’re capable of present high quality companies on the main stage and acquire public belief, it doesn’t matter what we are saying, the referral system is not going to be a actuality.”


Well being specialists imagine that funds constraints, inefficiency, and an absence of dedication from policymakers to make sure high quality healthcare have been the largest impediments to the introduction of the referral system.

Relating to the 2019 initiative to introduce the system in Manikganj and Chapainawabganj, Mohammad Zaved, deputy programme supervisor at hospital service administration of the DGHS, stated, “We solely had two session conferences with healthcare workers in Manikganj, and couldn’t progress additional because of the pandemic.”

However the 2016 initiative in Nilphamari and Rangpur, lengthy earlier than the pandemic, suffered an analogous destiny.


Specialists say that creating a system to handle this huge community requires a political will and a correct funds that may guarantee expert workforce and vital logistic help on the grassroots.

However protecting medical professionals in rural areas has been a giant problem.

The well being and household welfare ministry issued a round on August 27, 2021, proposing to increase the year-long internship programme for MBBS graduates to 2 years.

If the proposal had been adopted, the interns would have needed to spend the second 12 months at union-level healthcare centres.

The federal government, nonetheless, backtracked amid protests from interns and medical college students.

“This was an excellent transfer. However I do not know why the federal government retracted. It exposes an absence of political dedication,” Gonoshasthaya Kendra Founder Zafrullah Chowdhury informed The Every day Star.

He, nonetheless, stated the agricultural healthcare centres weren’t appropriate for interns and docs to remain.

At present, docs beneath the federal government healthcare service are required to spend the primary three years of their job in rural areas. In lots of circumstances, they don’t keep the complete three years, citing poor lodging amenities and an absence of different facilities.

“Healthcare professionals serving in rural areas are incentivised in developed international locations. Except the federal government incentivises medical college students and professionals, they won’t like to remain in rural areas. There are safety points too,” Zafrullah stated.

Syed Abdul Hamid, professor on the Institute of Well being Economics (IHE) at Dhaka College, stated secondary and tertiary hospitals must be concurrently readied earlier than introducing the referral system.

“There are well-defined and established practices of referral programs in lots of international locations. However the policymakers fail to know it once they communicate concerning the referral system,” stated Muhammad Abdus Sabur, adjunct school on the IHE of DU.

Prof Md Eshreshamul Huq Chowdhury, secretary basic of Bangladesh Medical Affiliation, stated the nation’s docs would fortunately adjust to any initiative to introduce a referral system.

“A referral system will pave the way in which for utilising the complete capability of our healthcare system and create extra jobs,” he stated.

In India, there is no such thing as a nationwide referral system, however many provinces have their very own system that connects healthcare amenities at totally different ranges, in response to Shariful Haque, deputy programme supervisor (hospital service administration) on the DGHS.

In England, the NHS e-Referral Service (e-RS) is a nationwide digital platform by way of which sufferers are referred from main care to elective care companies. The e-RS permits sufferers to decide on their first hospital or basic practitioner.


At present, the hospital service administration on the DGHS is engaged on a referral system, involving private and non-private amenities, in Manikganj and Gopalganj.

There will likely be a round the clock referral desk at every hospital the place the staffers will join sufferers to upper-level hospitals, stated Borsha Jchinta Soren, deputy programme supervisor for the structural referral system on the DGHS.

“Now we have been designing this in a means that hospitals will keep prepared with correct therapy preparations in order that sufferers do not battle to get therapy in time,” added Borsha.

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