So<. Su. .M<v/. Vol. 17. No. 3. pp IX’) 191. 19X3 Printed m Grenr Bntan. All rights reserved 0177~9536~X3~03OI x9.03$03.00~0 C’opyrtght 0 19x3 Pcrg;lmon Press Ltd zyxwvutsrqp RESEARCH NOTE A NOTE ON THE HIERARCHY OF HEALTH FACILITIES IN BANGLADESH BIMALKANTI PAUL* Department of Geography. Kent State University. Kent. OH 44242, U.S.A. Abstract-The existing health facilities available in Bangladesh have been categorized according to their hierarchy with the help of a triangle. Further attempts have been made to classify them on the basis of their location and management type. It is proposed that retaining the basic principles. health facilities of any country of the world can be classified according lo their hierarchy. location and management type through a similar triangle. In a note published in this journal in 1977 McGlashan [l] deals with a conceptualization of the generalized tiedical care hierarchy. He posits different health care hierarchies in a triangular model of both developed and underdeveloped countries. Adopting such an approach, this brief note tries to categorize the hierarchy of health facilities in Bangladesh. Like most developing countries. the existing health facilities available to the people of Bangladesh are inadequate both in quantity and quality. To make the situation worse whatever little facilities do exist are so badly distributed that the services do not reach the overwhelming majority of the population. particularly those living in the rural areas. The government of Bangladesh. since independence, has been trying to build institutional health-infrastructure throughout the country with a view to provide access to modern medical-care facilities to most of its people. Still, the majority of the people of both urban and rural areas largely depend on non-institutional health facilities provided by the private medical practitioners. How- ever. based on the types of services they offer, the health facilities in Bangladesh may be divided into five broad categories: (I) hospitals: (II) dispensaries; (III) Union Family Welfare Centre (FWC); (IV) other health centres (with only out-patient facilities); and (V) private health-care providers. (I) H0.spiral.s In Bangladesh medical facilities are called hospitals where both in-patient and out-patient services are available. According to their size. location and number and types of services they offered, hospitals of the country can be classified into the following cate- gories: (al Medical College Hospitals/Teaching Hos- pitals: (b) District Hospitals: (cl Sub-Division Hospi- tals: (d) Specialized Hospitals: (e) Other Hospitals: (f) Thana Health Complex (THCI: and (g) Maternal and Child Welfare (MCW) centres. *Bimal Kanti Paul. currentI! a Ph.D. student in Geogra- ph> at the Kent State University. is an Assistant Pro- fessor (on leave). from the Department of Geography. Universit! of Dacca. Dacca. Bangladesh. Hierarchically, hospitals attached to medical col- leges rank in the top having higher number of beds (300-500). physicians (above 12) and offer relatively more medical facilities and services. District and Sub- Division Hospitals are respectively second and third ranking hospitals located at the district (second lar- gest administrative unit) and sub-division (third lar- gest administrative unit) headquarters. The District Hospitals, generally speaking. have 50-150 beds and 3-12 physicians while in the case of Sub-Division Hospitals the number of beds ranges between 20 and 125 and physicians between 1 and 4. A number of hospitals like tuberculosis hospitals. child hospitals. infectious disease hospitals. leprosy hospitals, mental disease hospitals. etc. may be cate- gorized as specialized hospitals. These hospitals vary greatly in size. Pabna Mental Hospital. for example. having 400 beds is larger than some of the Medical College Hospitals with respect to the number of beds. But most specialized hospitals are either equivalent to District or Sub-Division Hospitals. Hospitals, other than Medical College Hospitals, District and Sub-Division Hospitals, and Specialized Hospitals as cited in the preceding, can be lumped together as ‘Other Hospitals’. This other category of hospitals also vary in size. A few of them (e.g. Kumudini Hospital, Tangail and Holy Family Hospi- tal, Dacca) are as large as the Medical College Hospi- tals. Some are equivalent to District (e.g. Port Trust Hospital. Chittagong) and Sub-Divisional Hospitals (e.g. Christian Hospital, Chandraghunal while the great majority are smaller than the Sub-Divisional Hospitals (e.g. Rajghat T.E. Hospital, Sylhet, Police Academy Hospital, Rajshahi, Jail Hospitals, Railway Hospitals, etc.). Thana Health Complex (THC) is a standard health facility which provides comprehensive preventive and curative health care to the rural people. This complex is located at the rural Thana (fourth largest adminis- trative unit) headquarters which has both in-patient and out-patient facilities. THC has a standard pro- vision of 31 beds with l-5 doctors. Maternal and Child Welfare (MCW) centres are the Union (lowest administrative unit) level centres which have both in-patient and out-patient maternal and 189