A system short of healing hands

With only 15 health workers per 10,000 people, Bangladesh remains far below WHO benchmark of 44.5

A severe shortage of health workers is putting Bangladesh’s healthcare system under growing strain, with only around 15 doctors, nurses, and midwives per 10,000 people, far below the World Health Organisation’s benchmark of 44.5.

Given the current pace of training and recruitment of health workers, the density is projected to reach 31.77 by 2030, leaving a gap of nearly 13 health workers per 10,000 people, according to the latest data from the health ministry.

Experts said hospitals function best when they have doctors, nurses, and allied health professionals, such as laboratory and imaging technologists, in an appropriate balance.

The recommended ratio is one doctor to three nurses and midwives, and five allied health professionals.

However, Bangladesh has less than one nurse or midwife for every doctor and fewer than two allied health workers.

This gap is hampering the functioning of healthcare facilities, even though the number of health professionals has increased over the past few years.

The latest data show that the growth has failed to keep pace with rising demand and remains uneven across different categories of health workers.

Experts said the shortage is being felt more acutely as Bangladesh faces a growing burden of non-communicable diseases (NCDs), including cancer, diabetes, and cardiovascular diseases, which often require long-term treatment.

At the same time, the health system must meet maternal and child health needs and tackle communicable diseases such as measles and tuberculosis, while dengue continues to drive thousands of patients to hospitals every year, they said.

Prof Be-Nazir Ahmed, former director of disease control at the Directorate General of Health Services (DGHS), said, “If we have a large population with a high burden of disease, the demand for healthcare workers will naturally be very high. Quality services cannot be ensured if we do not have enough healthcare providers.”

Referring to overcrowding at hospitals, he said wards designed for around 24 patients sometimes have 48 or more, while nursing staff remain scarce. A doctor at upazila health complex often has to see 100-150 outpatients a day, leaving them with barely a couple of minutes for each patient.

The crisis is even more acute in terms of specialists, with patients often waiting months for appointments. Some specialists see hundreds of patients and work late into the night.

“All these things are not conducive to providing standard health services.”

Referring to the government plan to appoint 5,000 doctors, he said the recruitment approach has largely been ad hoc.

“You have to make plans for nurses, allied health professionals, support staff, equipment, beds, and the space required for them to work.

“Unless the entire package is planned and implemented together, simply increasing the number of doctors or beds will not bring the expected improvement in healthcare.”

WHAT DO THE LATEST DATA SHOW?

As of 2025, Bangladesh had 1,41,700 registered MBBS graduates and 1,16,194 available for service -- both figures representing an increase of about 51 percent from 2019.

The number of registered nurses also nearly doubled to 1,07,047 over the same period.

The combined density of doctors, nurses, and midwives also rose to 15.16 per 10,000 people last year from 8.3 in 2019, according to the health ministry’s Human Resources for Health (HRH) Data Sheet 2025.

Despite the growth, the health workforce remains far below the WHO’s indicative threshold of 44.5 set under its 2016 Global Strategy on Human Resources for Health: Workforce 2030.

HEALTH WORKFORCE RATIO UNEVEN

In Bangladesh, the staffing ratio across government health agencies remains uneven, underscoring a gap in coordination among them in recruiting health workers.

Last year, the DGHS, which employs the largest number of doctors, had 38,255 sanctioned posts for doctors, compared with 50,825 positions for nurses and midwives under the Directorate General of Nursing and Midwifery (DGNM) -- a ratio far below the recommended one doctor-to-three nurses ratio.

Other agencies, including the Directorate General of Family Planning (DGFP), also appoint doctors and other health workers.

Asaduzzaman Jewel, general secretary of Bangladesh Nurses Association, said that in the past, recruitment largely focused on doctors whenever staff shortages arose, ignoring the need to maintain a balanced ratio of doctors, nurses and other health professionals.

“We have long been demanding a coordinated recruitment process, but successive governments have paid little attention to these demands.”

The current government is no different, he said, adding that while it has moved to recruit 5,000 doctors, no such initiative has been taken to recruit nurses.

The persistent shortage has left nurses in public hospitals overstretched, making it difficult for them to provide quality care. Patients, however, often hold nurses responsible for problems that stem from broader systemic and management failures, he said.

“This creates a misconception about nurses and eventually demotivates them. They become frustrated and lose interest in their work.”

WHAT AUTHORITIES SAY?

DGHS Director General Prof Pravath Chandra Biswas said the government has already initiated the process of creating around one lakh additional posts for health workers to strengthen primary healthcare.

District health authorities have been instructed to expedite recruitment for vacant posts, he said, adding that most district health facilities are expected to see significant progress within the next three to six months.

According to the HRH 2025 data, 4,308 doctor posts and 1,653 nurse posts remained vacant. However, data from August this year show that both the number of sanctioned posts and vacancies had increased, with 9,990 doctor posts and 4,870 nurse posts remaining vacant.

Biswas said the recruitment of 5,000 doctors is expected to be completed by early next year. The DGHS will then assess the need for further recruitment, taking into account staffing requirements at upazila health complexes slated for expansion to 151 beds each.

Meanwhile, the process of creating 2,500 posts for medical technologists under the DGHS and other health agencies has already begun.

“We will continue the recruitment drive to meet the target,” he added.

When contacted, DGNM Director General Dil Afroza said a phased approach is being followed to create posts and recruit health workers to address staff shortages.

“We cannot do everything at once. We have to build our capacity gradually. Nurses need to be trained before the creation of posts and deployment.”

Referring to Health Minister Sardar Md Sakhawat Husain’s recent statement, she said the authorities are committed to recruiting around 25,000 midwives for public healthcare facilities within the next few years.

She also said that recruitment was underway to fill vacant posts, and that DGNM had already sent a proposal to the ministry to create 15,000 posts for nurses.