Health Bulletin 2009

The following paragraphs describe the prevailing system for routine information collection:
a. Population information: MIS (health) conducts annual household survey to collect
demographic information from each household of the country. The system is well known as GR
or Geographical Reconnaissance. For GR, the rural health workers of DGHS (health assistant,
Assistant Health Inspector and Health Inspector) use to visit the households in January and
February each year. GR form is complicated. Each form covers 18 families with 47 different type
of information (variables or fields) per household. No provision exists for giving incentives to the
health workers. The allocation for GR per union (lowest administrative unit, average number of
households: ~5,000) is only Tk. 2,000 (US$ 29), which covers all expenses excluding GR
Forms. Having considered that all posts of health workers are filled up, each health worker
needs to visit 60 to 70 households daily (considering 25 working days per month) to complete
GR in January and February. It is both theoretically and practically impossible. But, nobody
cared to recognize this weakness of the system. Monitoring and supervision system was weak.
Therefore, there was doubt about the data quality. The data forms were complied at union level
and submitted to sub-district (subdistrict) health office where sub-district form is constructed
putting individual union data and compute sub-district total and then sent to Dhaka via district
health office. All sub-district forms were brought to MIS (health), DGHS office for data entry.
Only about 12 persons, already over burdened with other responsibilities, were supposed to
enter the data in computer. But, due to poor motivation about the data quality they never cared
to do the job. Yet GR was conducted year after year with no report published in any year,
except in 2004 when the last report was published using GR data of 2002. GR data could be
good source for estimation of, amongst others, child and maternal mortality rates, cause-specific
death rates, age-and sex-specific population sizes, for local as well as national level planning
and decision making. The idea of GR is great, which can be synonym of annual health census
and a strong demographic health surveillance system. But, this dream was never fulfilled
although time, money and efforts of health managers and health workers all over the country
were heavily engaged.
b. Health service statistics: It is estimated that only about 20% of all patients in Bangladesh,
who seek health care, go to public health facilities. The rest seek health care from any of the
different type of non-public providers, viz. informal healers, drug retailers, private practitioners,
private clinics and hospitals, through out of pocket payments. Despite this fact, health service
statistics of MIS (health) were primarily based on public health facilities. The number of
functioning public health facilities other than community clinics under the DGHS of Bangladesh
is 1951, of which 1,362 are union sub centers having only out-patient day services, and 589
hospitals having out-patient, in-patient and emergency services. School health clinics and urban
dispensaries are not included in this estimate.
Outpatient data from union sub-centers come to the respective sub-district health office where
the data are compiled. In subdistrict health complex, in-patient and emergency patient profiles
are also prepared. Data from sub-district are sent to civil surgeon's office in district. The district
and general hospitals also prepare their own out-patient, in-patient and emergency patient
profiles and send to respective civil surgeon. The civil surgeons send the subdistrict and district
data to MIS (health), DGHS. All other public hospitals send their patient profiles directly to MIS
(health), DGHS.
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