Kidney dialysis services for 276 patients at Chittagong Medical College Hospital (CMCH) could face major disruption when its 10-year agreement with an Indian company to operate the hospital's dialysis centre expires on 29 November, with no confirmed interim plan to ensure uninterrupted treatment.
CMCH Director Brigadier General Mohammad Taslim Uddin said the government has begun procuring replacement machines for a government-run dialysis facility. However, the new service may not become operational until February or March 2027. This could leave patients without a clear alternative for three to four months, despite many requiring dialysis two to three times a week.
The Sandor centre, which began operating on 4 March 2017 under a public-private partnership, has 31 machines – 24 negative-pressure and seven positive-pressure – and employs 45 people, including doctors, technicians and engineers.
Sandor Assistant Manager Taief Rahman said the company had proposed reducing the session fee from Tk3,397 to Tk2,800, but no decision on renewing the agreement had been communicated.
For 60-year-old Nargis Begum, who has relied on the centre for more than three years, the uncertainty threatens access to treatment she can afford. Her only son works as a day labourer and struggles to pay even the subsidised Tk621 session fee, while private dialysis is beyond the family's means.
The health ministry has instructed authorities to procure 31 dialysis machines for CMCH, while another 60 have been arranged or are being procured for the National Institute of Kidney Diseases and Urology in Dhaka.
But procuring equipment alone does not ensure a functioning service; the machines must be installed and commissioned, with trained staff and adequate infrastructure in place.
With the existing agreement nearing expiry and the replacement facility months away from operation, authorities have yet to establish how patients will receive dialysis during the transition
Procurement underway, interim plan unclear
The director said the hospital is working to provide dialysis through its own facility, including for patients who require positive-pressure machines. Under the existing arrangement, Sandor supplies the machines and personnel, while the hospital provides infrastructure, including water, electricity and oxygen-line facilities.
The original agreement set the session fee at Tk2,190, with annual increases of 5% bringing it to Tk3,397. Patients pay Tk621 per session, while the government subsidises the remaining Tk2,776.
Taslim said patients would have to seek treatment elsewhere for three to four months while the replacement facility is prepared. With CMCH's existing dialysis capacity limited, many will have to turn to private facilities, where treatment costs around Tk45,000 a month for two sessions a week and Tk60,000 for three – far beyond the means of many patients dependent on subsidised care.
Muhammad Rakibul Hossain, who has received dialysis at the Sandor centre for four years, requires a positive-pressure machine available at only a limited number of facilities in Chattogram. Although private hospitals have such machines, he cannot afford their treatment costs.
Manpati Das brings her eight-year-old child to the centre three times a week. She said missing even one session leaves the child restless and distressed.
"We want the agreement to be renewed. We cannot afford dialysis elsewhere. We have no option left but death," she said.
Sabina Yasmin, who travels from Sitakunda with her husband, Abul Kalam, has relied on the centre for two years and is uncertain where they will seek treatment during the transition. Nasir Uddin, a patient from Patenga, is concerned about finding comparable care at the same cost.
Sakia Begum, who has brought her child to the centre for three years, has appealed to the health minister, fearing she will be unable to save her son without continued treatment.
The immediate challenge is how patients will bridge the three- to four-month gap without missing essential dialysis or being forced to pay for treatment they cannot afford. While the government is procuring replacement machines, authorities have not yet confirmed arrangements to accommodate all existing patients during the transition.