A staggering 4,749 physicians are posted as attachment (OSD) in Dhaka against only 783 sanctioned posts, causing a dearth of doctors at district level and below.
According to statistics available with the Directorate General of Health Services (DGHS), Dhaka division has 42 per cent more doctors than the sanctioned posts.
On the other hand, 63 per cent posts of Barisal division are lying vacant.
Acknowledging such an anomaly, DGHS director general Prof Abul Kalam Azad said many doctors continue to stay in Dhaka using their connection with the powerful quarters.
Not only the doctors' organisations such as the Bangladesh Medical Association and the Swadhinata Chikitsak Parishad, some ministers and lawmakers exert their influence to keep doctors attached in Dhaka. Even journalists are also found doing the same.
"Much time is wasted for lobbying. We are compelled to deviate from our stand due to this type of lobbying," the DG health observed.
He was speaking as the chief guest at a health policy dialogue on 'Equitable Distribution of Medical Doctors to Ensure Universal Health Coverage'.
Health Policy Dialogue (HPD), a local health-sector think tank, hosted the event at CIRDAP Auditorium here.
The HPD was initiated in September 2017 by icddr,b's 'Strengthening Health, Applying Research Evidence (SHARE)' project.
Statistics show that 20.4 per cent of the sanctioned 25,655 posts are vacant now, thus aggravating the situation, in terms of availability of doctors, at least, in some places.
There are 5,380 vacant posts now.
However, as many as 8,470 doctors are available against the sanctioned posts of 5956 in Dhaka division.
In contrast, only 690 doctors are working against 1,091 sanctioned posts in Barisal division.
Prof Azad said the medical manpower deployed at district or upazila levels will never be satisfied unless they are offered some incentives.
There are more people in Dhaka against sanctioned posts, he said, adding that some of them come for post-graduation and many others for better opportunities.
There is no career or promotion for a doctor without post-graduation.
Regarding a lack of doctors in various fields, he said doctors themselves chose specialisation, not the DG (health).
But the responsibility lies with DGHS when they come back completing post-graduation, Prof Azad added.
In his keynote paper, scientist and SHARE project coordinator Dr Iqbal Anwar highlighted the present situation of health workforce distribution in Bangladesh.
He said doctor shortages are severe in every division except Dhaka. A total of 3,516 are on deputation here.
But DG (health) is not aware where 214 doctors are working, he added.
Dr Anwar highlighted setbacks in the existing system like highly centralised healthcare system, weak governance and regulatory framework, weak management and institutional capacity in health ministry.
He also pinpointed inequitable allocation of doctors, high rate of vacancy at upazila level, high level of deputation, inadequate amenities and lack of proper educational facilities for children of health professionals posted in rural areas.
Vice-president of Community Clinic Health Support Trust Makhduma Nargis said time has come to revise health manpower planning.
There are provisions for 10 consultants at each upazila health complex, but not for adequate number of medical officers, she added.
There are many good things in the health policy, but the health sector has been operating in the old and traditional path, Ms Nargis mentioned.
Former professor of National Institute of Preventive and Social Medicine Akram Hossain said services of BCS health cadre itself have created some confusion. Government doctors give services outside public facilities, he said.
They will only serve at government health set-ups when there will be institutional practice with all arrangements, he added.
Speakers said a large number of OSDs and high vacancy rate together is a huge problem in keeping doctors at grassroots level public health facilities.
The government actually does not know what kind of service it wants to provide at which level.
Besides, there is no calculation of how many doctors are needed taking into consideration all formal and non-formal doctors.
The speakers accentuated the need to ensure doctors' protection, career plan and enough regular salary to keep them at rural areas.
There is no research on health system. Equitable distribution of doctors can be done by using information technology, they added.