Govt doctors can see patients after hours
Doctors in 83 public hospitals would be able to run private practice after office hours at their institutions from March as the government looks to get more use out of the existing healthcare infrastructure.
The programme, which will begin on a pilot basis next month, will be rolled out in all public hospitals by August.
Doctors would be able to provide consultation service at their own workplace from 3 pm to 6 pm every day except holidays for a fee, according to the draft plan titled "Institutional Practice Guidelines".
To see a senior doctor, the fee would be Tk 300. Of the Tk 300, the doctor will get Tk 200, their attendant Tk 50 and the public hospital Tk 50.
The fee is Tk 150 for a junior physician, with the attendant getting Tk 25 and the hospital Tk 25.
Besides, the fees at the district and upazila-level hospitals will be Tk 150.
Any professor-, associate professor- and assistant professor-level physician can serve patients after hours twice a week at the private chambers.
Physicians will serve twice a week by rotation and they will also be allowed to serve at private healthcare institutions or anywhere else, according to the plan prepared by a high-level committee led by Saidur Rahman, additional secretary (administration) at the health services division at the health ministry.
Of the 83 hospitals chosen for piloting, 50 will be from the upazila-level hospitals, 20 from the district-level, eight from the divisional-level, and five from the specialised hospitals in the country.
Three more meetings would be needed to finalise the protocol, said Abul Bashar Mohammad Khurshid Alam, member of the committee and Director General of Health Services (DGHS).
The 26-member committee will sit in a meeting "to finalise" the guideline this morning at the ministry, according to a circular issued on Monday.
The issue of institutional practice came to the fore on January 22 when Health Minister Zahid Maleque came up with the announcement following a meeting with a six-member committee that recommended the private chamber facility at public hospitals.
Health system experts, however, said the move will not bring any qualitative change as long as the government physicians can get away by serving at private healthcare organisations or their own chambers.
However, physicians at public hospitals in the country are allowed to practice at various private hospitals, clinics or pharmacies after their scheduled office hours.
For example, physicians at Bangabandhu Sheikh Mujib Medical University (BSMMU) serve at private chambers at the hospital from 3 pm to 6 pm once a week by rotation.
They also serve at private healthcare institutions outside.
In the BSMMU model called "afternoon specialised consultant service", one or two specialist physicians, assistant professors and above, from each of around 40 departments serve during the private sessions from 3:00 pm to 6:00 pm every day except Friday.
As many as 550-650 patients receive service on an average daily and each of them pays Tk 200 to the BSMMU, according to Md Rezaur Rahman, director (Hospital) at the BSMMU.
"It is a piecemeal initiative and will create complete chaos," said Rashid-E-Mahbub, former president of the Bangladesh Medical Association (BMA).
The ground reality is that those related services are broadly unavailable in different public hospitals, he said.
Among the non-government hospitals in the country, Birdem General Hospital and National Heart Foundation follow the institutional practice system where their physicians are not allowed to practice outside.
It is widely practised in different countries across the world including India, Canada, the UK and Australia.
In most states in neighbouring India, doctors are offered incentives called "non-practice allowance", according to a report published by India Times online in June last year. Sometimes, junior doctors are allowed to serve for extra hours at public hospitals.
Ahmed Abu Saleh, a professor at the microbiology department at the BSMMU, however, pointed to the positive side of private practice at public hospitals.
"It is better than nothing. Because, many patients get the consultation from the specialist physicians at a cheaper cost," he said.
Ehteshamul Haque Chowdhury, BMA's secretary, sees the move positively.
"Both the physicians, especially the juniors, and the patients will benefit from the initiative -- It will also increase the utilisation of the hospital infrastructure."
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