Establishing ICU at 43 Dist Hospitals: Not a single unit ready yet

Three years ago, the prime minister ordered setting up an Intensive Care Unit in every district hospital. A project was then initiated to open 10-bed ICUs in 43 district hospitals and 10 medical college hospitals.

But none of the facilities have a functioning ICU yet.

The Tk 512 crore project was approved in April 2020. The facilities that already had the infrastructure suitable for ICUs were chosen under the project.

The ICUs were supposed to be set up by June 30 this year. Officials say ICU equipment has been set up in the 10 medical college hospitals, but they have yet to begin operation.

According to Project Director Prof Shah Golam Nabi Tuhin, work on installing ICUs in 13 district hospitals is currently going on.

He claimed that the project was delayed because of difficulties in opening letters of credit (LCs), the devaluation of taka against the dollar, and the supply chain issues caused by the Russia-Ukraine war.

An expert, however, said the causes for the delay are unsatisfactory.

Project authorities revised the project and are seeking Tk 301 crore more with a new deadline on December 31, 2025. The planning ministry is yet to approve the revision.

The Directorate General of Health Services (DGHS) and the Public Works Department (PWD) are implementing the project titled "Covid-19 emergency response and pandemic preparedness" with funds from the World Bank.

None of the 64 district hospitals had ICUs when the pandemic hit in 2020, said Project Director Tuhin.

Prof Rashid-E-Mahbub, former vice-chancellor of Bangabandhu Sheikh Mujib Medical University, said many critically ill patients die in ambulances while on their way to Dhaka due to the absence of ICUs in district hospitals.

Mentioning it as a critical life-saving issue, he said, "It is heartbreaking for doctors to witness such tragedies."

SLOW PROGRESS

PD Prof Tuhin, who took charge six months ago, said, "There was little progress before my appointment, leaving me with a significant backlog to overcome."

He said the PWD was unable to complete necessary construction work within their stipulated time. "Furthermore, the contractors were confronted with obstacles such as difficulties in importing equipment and a sharp rise in equipment prices due to the depreciation of taka," Tuhin said.

He said the contractors have started importing equipment after the allocation of additional funds to make up for the weak taka.

Former Vice-Chancellor, Prof Nazrul Islam, criticised the authorities for their negligence in implementing the project, stating that the directives of Prime Minister Sheikh Hasina should be promptly executed.

He also highlighted that the implementation of the project will alleviate the pressure on patients who travel to Dhaka due to the scarcity of ICUs. "Once the project is implemented, it will solve several issues at the district level," he added.

Public health expert Lelin Chowdhury, also a consultant at the Health and Hope Hospital, said the reasons given for the delay are unsatisfactory. Establishing 10-bed ICUs at district hospitals and medical college hospitals is not a difficult task.

According to him, the most crucial aspect of setting up ICUs is creating an oxygen bank, which can be done within two to three months.

Citing several examples, he pointed out that private hospitals had set up ICUs within two to three months.

The supply chain issues may have had some impact, but that cannot be blamed for the delay, he said. He emphasised the importance of holding officials accountable for negligence and delay.

The project director said 14 other district hospitals will get ICUs after the first 13 get them and the remaining 16 will get ICUs even later.

He said Shaheed Suhrawardy Medical College Hospital (SSMCH), Khulna Medical College Hospital, Barishal Medical College Hospital, and Sylhet Medical College Hospital are among the 10 medical college hospitals that have got the ICUs.

He said Munshiganj 250-bed District Hospital, Feni-250-bed General Hospital, and Lakshmipur General Hospital are among the first 13 hospitals that would get ICUs.

SSMCH Director Khalilur Rahman said 10 ICU beds have already been set up.

Md Manzurul Alam, the civil surgeon of Munshiganj, said, "Infrastructure has already been built and the manpower has also been appointed to the district hospital. The equipment could arrive any day."

DGHS Director General Prof Abul Bashar Mohammad Khurshid Alam told The Daily Star that officials were working hard to implement the project.

Highlighting the need for recruiting manpower to run the ICUs, he said some will be recruited under the project and the rest through the regular process of the DGHS.

Prof Debabrata Banik, president of the Bangladesh Society of Anesthesiologists, said they have trained over 2,500 doctors, nurses, and staffers to manage the ICUs.