Hospital expansion: Priority by power

93% new beds go to districts, constituencies linked to ministers; many overcrowded hospitals left waiting

Over the past eight months, the expansion of public hospitals has been concentrated in the home districts or constituencies of a handful of ministers and state ministers, even though health facilities in other districts have a greater need for capacity expansion.

A total of 2,879 beds have been added to 19 hospitals in 14 districts since the BNP government assumed office on February 17. Of those, 2,688 -- or about 93 percent -- were allocated to 14 hospitals in 10 districts linked to several ministers, including Prime Minister Tarique Rahman.

Only 191 beds were approved for five hospitals in other districts, according to documents regarding the health ministry’s decisions on hospital expansion between April 28 and September 22.

Moreover, the BNP government approved two new government medical colleges -- one in Thakurgaon, the home district of Mirza Fakhrul Islam Alamgir, the then LGRD minister, on May 15; and another in Narsingdi, the home district of Health Minister Sardar Md Sakhawat Husain, on June 14.

Experts said some hospitals in ministers’ areas needed expansion because they were already treating more patients than their sanctioned capacity.

However, several facilities elsewhere were under even greater pressure, with higher bed occupancy rates in 2024, show data from the Health Bulletin published by the Directorate General of Health Services (DGHS) in April this year.

“Priority should be determined based on bed occupancy and the number of patients a hospital treats compared with its existing capacity. This should guide decisions on which hospitals need to be expanded first,” Prof Muzahrul Huq, a member of the erstwhile Health Sector Reform Commission, told The Daily Star.

He further said that reducing the flow of patients to Dhaka should also be a priority. To achieve this, public hospitals around Dhaka need to be expanded by adding more beds and healthcare personnel so that patients can receive treatment closer to their homes.

Prioritising hospitals based on political considerations is unfair. “If the home districts and constituencies of ministers or policymakers are given priority, it would be unjust and would not ensure proper services for people,” he said.

Of the 19 hospitals, Shaheed Ziaur Rahman Medical College Hospital in Bogura, the home district of the PM, saw the largest increase in bed allocation on September 8, with the number rising from 1,200 to 1,800 beds.

Seeking anonymity, a health ministry official said more than three patients were being treated against every available bed at the hospital, underscoring the need to expand its capacity.

However, the same rationale was not applied in the case of Mymensingh Medical College Hospital (MMCH). Despite recording the highest bed occupancy rate among all medical college hospitals in 2024, the facility has not seen an increase in bed capacity since 2013.

The 1,000-bed facility had a bed occupancy rate of 329 percent in 2024, compared with 308 percent at the hospital in Bogura.

Moreover, MMCH treated 3,21,524 inpatients, more than double the number (1,23,364) handled by the Bogura hospital.

A recent visit to MMCH laid bare a severe shortage of beds, with dozens of patients being treated on floors and corridors.

“I have been trying to get a bed, but none is available,” 65-year-old Ishaq Ali, who was being treated in a corridor after being admitted with a lung infection, told our correspondent on October 7.

On October 6, the hospital had 4,098 patients against its 1,000-bed capacity, said the hospital’s assistant director (administration) Mohammad Mainuddin Khan. “We are providing food and emergency medicines for all admitted patients, but we cannot arrange beds for everyone.”

BED ALLOCATION

The second-largest bed expansion went to Mugda Medical College Hospital in Dhaka-9 constituency of State Minister for Road Transport, Bridges and Railways Habibur Rashid Habib and the medical college hospital in Dinajpur, the home district of Social Welfare Minister AZM Zahid Hossain.

The 500-bed hospitals in Mugda and Dinajpur were each expanded to 1,000 beds between May 21 and August 19 despite occupancy rates of 157-169 percent.

By contrast, hospitals in Khulna (266 percent), Sylhet (259 percent), Cumilla (221 percent), Rangpur (199 percent) and Barishal (190 percent) received no such expansion.

The case of Sylhet MAG Osmani Medical College Hospital underscores the unmet need for expansion at some of the excluded hospitals.

A total of 3,172 patients were receiving treatment at the hospital against its capacity of just 900 beds on October 8, meaning the number of patients was more than three times the hospital’s bed capacity.

“I have been asking for a bed for the past two days, but they cannot provide any,” said Rustam Ali from the city’s Jalalabad area who was being treated for injuries to his hands and feet.

Asma Begum from Sylhet’s Osmaninagar upazila was tending to her grandson Jisan, who had developed measles-like symptoms, on the hospital floor.

“I found a small space, so I spread a mat for my grandson to lie on. A doctor came by once, examined him, and said we could remain here for now,” she told our Sylhet correspondent on October 7.

Rajshahi Medical College Hospital, which treated more than two patients for every available bed, saw a relatively modest expansion in July with its capacity rising from 1,200 to 1,300 beds. The facility is located in the constituency of Land Minister Mizanur Rahman Minu.

Besides, the capacity of the Sadar hospital in Rajbari, home district of State Minister for Cultural Affairs Ali Newaz Mahmood Khyom, and the general hospital in Joypurhat, the home district of State Minister for Public Administration Abdul Bari, was raised by 150 beds in the same month.

Rangamati General Hospital and Langadu Upazila Health Complex (UHC) in Rangamati, home district of the then Chattogram Hill Tracts affairs minister Dipen Dewan, were also among the facilities that received capacity upgrades.

Earlier in May, the 100-bed district hospital in Narsingdi, the home district of the health minister, saw its capacity rise to 250 beds. It had an occupancy rate of 117 percent, lower than that of at least 25 hospitals in other parts of the country. Besides, the district has another 100-bed hospital.

In addition to district hospitals, three UHCs in the constituencies of two ministers saw their bed capacity double between May 17 and August 2.

On May 17, two 50-bed UHCs were upgraded to 100 beds in Chakoria and Pekua under Cox’s Bazar-1, the constituency of Home Minister Salahuddin Ahmed.

The UHC in Bhairab under Kishoreganj-6, the constituency of State Minister for Textiles and Jute Shariful Alam, saw a similar rise in bed capacity on August 2.

In June, the government had decided to upgrade all UHCs to 101-bed facilities to improve access to public healthcare services nationwide. On August 12, the decision was revised, and a new plan was adopted to upgrade all UHCs to 151-bed facilities in phases.

Around a month later, the health ministry upgraded Nandigram UHC in Bogura from 31 to 50 beds, along with another UHC in Feni. It also expanded the capacity of the 500-bed National Institute of Cancer Research and Hospital in Dhaka by 200 beds in September.

By contrast, only 191 additional beds were approved for five hospitals outside ministers’ areas, including four 31-bed UHCs that received just 19 beds each in Taraganj of Rangpur, Osmaninagar of Sylhet, Atgharia of Pabna and Fulgachhi of Feni. The National Institute of ENT in Dhaka received the remaining 115 beds and was expanded to 250 beds.

When contacted, the health minister rejected allegations that hospital expansion projects were influenced by political considerations.

“We are doing this entirely on the basis of need. We are increasing facilities in areas where medical services are inadequate,” he told The Daily Star on October 14.

Sakhawat said the government was planning to establish a 1,600-bed hospital in Lalmonirhat and implement several other healthcare projects in different districts.

Asked why most hospital expansion projects were concentrated in the constituencies of ministers and state ministers, he said, “Would you judge the hospital expansion in Rangamati based on the minister representing the area, or on the healthcare needs of the people there? Remote and neglected areas need to be brought into the mainstream.”

When this correspondent pointed out that many hospitals with higher bed occupancy rates did not receive similar expansions, the minister said projects for those facilities were also under consideration and urged all to wait for a year to see the progress.

[Our Mymensingh and Sylhet correspondents contributed to this report]