| In discussing medical manpower in Bangladesh prior to March 1971, it is noted that physician training of high quality received priority but was poorly adapted to the country's needs. Many physicians left the country; those remaining avoided rural practice. There is almost no economically feasible way of providing enough physicians to meet the entire population's needs. There are fewer nurses than doctors, since salaries have been poor and hours long and irregular. Lady health visitors (LHV) and health technicians represent the male and female "health assistant"; they are trained in endemic disease control, hygiene, preventive medicine, etc. Dressers, compounders, and dispensers are capable of providing simple curative medicine, and are willing to serve in rural areas. Other "healers," such as hakims, homeopaths, faith healers, and "quacks" are the only health resource for the majority of the people. Midwifery and family planning personnel include the nurse-midwife, trained midwife, trained dai, family planning visitor, family planning dai, and untrained dai. Availability of proper facilities is minimal in Bangladesh. The few hospitals are concentrated in urban areas. Rural health centres have lagged behind in development goals, and supplies and instruments for all health centres are scarce and expensive. Improvement of the existing manpower situation requires giving priority to tarining of subdoctorate personnel, both professional and auxiliary, and provision of facilities in which they can work. The organization of the health services facilities would range from many rural health units staffed by auxiliaries, to fewer rural health centres staffed by auxiliaries, to fewer rural health centres staffed by auxiliaries and professionals, to small and medium-size hospitals and major medical centres. It is recommended that admission requirements to auxiliary training programmes be reduced to attract more candidates and that training programmes be located in rural areas. Foreign aid could assist in planning the system, training personnel, and providing facilities. |