1. The document discusses human resource management in the health sector of Bangladesh, outlining key HR functions and challenges. 2. It notes Bangladesh has a shortage of health professionals, with physician and nurse densities of 3.0 and 2.8 per 10,000 people respectively. Vacancy rates are highest for lower-level positions. 3. Strategic challenges include inadequate salaries, lack of incentives for rural postings, political influence in appointments, and migration of skilled workers abroad. Improving HR management is seen as vital to strengthening the health system.

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Term Paper
Topic: Human Resource Management in Health Sector of
Bangladesh
Name: Dr. Md. Ahsan Aziz Sarkar
Roll: 9209
92nd Special Foundation Training Batch

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Content List
Introduction 3
Strategic HR Management and Planning 6
Job Analysis and Staffing 7
Equal Employment Opportunity 8
HR Planning and Retention 9
Talent Management 9
Total Rewards 10
Risk Management and Workers protection 11
Employee Relationships 12
Conclusion 12
Bibliography 14

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1. Introduction:
In the introductory part this paper will explain the key concepts related to human resource
management, health sector and current health and HR management status of Bangladesh. It will
be followed by current management strategies and challenges faced by Bangladesh in different
functional domains of HR management. In the concluding part this paper will be summarized
and few recommendations will be made.
1.1 Human Resource Management:
Human resource (HR) management is designing management systems to ensure that human
talent is used effectively and efficiently to accomplish organizational goals. Human capital is the
collective value of the capabilities, knowledge, skills, life experiences, and motivation of an
organizational workforce. Managing people in an organization is about more than simply
administering a pay program, designing training, or avoiding lawsuits. Human resource
management in health sector is of utmost importance for ensuring better health, quality of life,
and increasing life expectancy. Most important components of HR management plan are listed
below.
HR management components:
1. Strategic HR management and planning
2. Staffing
3. Talent Management
4. Total Reward
5. Risk Management and Worker Protection
6. Employee and Labor Relations
7. Equal Employment Opportunity
1.2 Health Sector
Health sector is the economic sector concerned with the provision, distribution, and
consumption of health care services and related products like manufacturing medical equipment,
supplies and pharmaceuticals. Healthcare facilities, medical equipment, supplies, and
distribution, biotechnology, pharmaceuticals are some of the big industries related with health

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sector. Physicians, researchers, nurses, midwives, pharmacists, pharmaceutical professionals are
first line professionals delivering the services and goods. So human resource management
means, managing these professionals. The figure below is a glimpse of health care system in
Bangladesh.
Figure 1: Major stakeholders in Bangladesh health care system
Country
Comm
unity
Family
Patient
BangladeshGovernment1. Funding
2. Administration
3. Service delivery Primary,secondary,
tertiaryGovt.Health
Services
Private Health
Services
Medical Specialists
Physicians
Nurses
Alliedhealthprofessionals
(Homeopathy,Ayurveda)
Paramedicsand
technologists
Administrators
Drug and equipment

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Below is an administrative structure of government health care service.
Figure: Ministry of Health and family Welfare organogram
1.3 Bangladesh
Bangladesh is the 46th largest economy of the world with a per capita income of 1087$ in
2016. Density of physician and nurse are 3.0 and 2.8 per 10,000 population respectively with
hospital bed allocated 4.0 for the same number of people. It spends on an average of 2.73
percent of its GDP on health care sector which numbered around Tk. 12,000 crore in 2016.
Ministry of Health and Family
welfare
Minister
Secretary
Divisions
Administrative
Hospital andNursing
PublicHealth
DevelopmentandMedical
education
FamilyPlanning
Audit
Discipline
PolicyandPlanning
Sub-ordinate Organizations
Directorate General of Health
Services
Directorate General of family
Planning
Directorate of NursingServices
National Institute of Population
researchand Training
Drug AdministrationSection
Transport andEquipment
maintenance Organizations
National Electro-medical Equipment
Maintenance WorkshopandTraining
Centre
HealthEconomicsUnit
HealthEngineeringUnit

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2. Strategic HR Management and Planning
The government seeks to create conditions whereby the people of Bangladesh have the
opportunity to reach and maintain the highest attainable level of health as a fundamental human
right and social justice. The Vision of the health sector is to see the people healthier, happier and
economically productive to make Bangladesh a middle income country by 2021. The Mission is
to create conditions whereby the people of Bangladesh have the opportunity to reach and
maintain the highest attainable level of health. The Goal is to ensure quality and equitable health
care for all citizens in Bangladesh.
To attain this vision, mission and goal Bangladesh Government has drawn a strategy directed
towards providing or improving family planning, maternal and child health care, nutrition and
non-communicable diseases preventing services. Some important strategies are
1. Increasing the health workforce at Upazila and Community Clinic levels.
2. Drug management and procurement will be supported with ICT and additional staff to
improve drug provision and reduce the time between procurement and distribution.
3. Development of Upazila Health system, local level planning, decentralized
administration and financial authority, and public-private partnership.
4. Pursuing various innovative ideas, health insurance for public servants, and strengthening
internal coordination of Health and family welfare industry.
If we look at the HR metrics of health sector we will find about number of specialized cadre,
cadre and other health stuff working for government. Out of 127,841 sanctionedpostsunderthe
DGHS, about half (41.41%) are of ClassIIIcategory,physicians(ClassI) comprise 18.80%,ClassII 16.66%,
and ClassIV employeescomprisethe rest22.71%. Of the available 106,104 healthpersonnel,
41.35% are of ClassIII,21.09% are doctors(ClassI),16.78% are of ClassII, and20.55% are of ClassIV.
The ClassI non-doctorscomprise 0.42%of the sanctionedpostsand0.22% of the available staff.Table
16.1 also showsthat21,737 sanctionedpostsremainedvacantasof June 2016, whichconstituted17%
of the total sanctionedposts.Vacancyrate was6.88% (1,654 posts) for doctors,56.46% (306 posts) for
ClassI non-doctors,16.37% (3,486 posts) for ClassIIstaff,17.12% (9,062 posts) for ClassIIIstaff,and
24.89% (7,229 posts) for ClassIV staff.

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Figure 3: Number of sanctioned filled up and vacant post under DHHS
Category of post Sanctioned Filled up Vacant (%)
Class 1 24,028 22,374 6.80%
Class 2 21,294 17,808 16.37%
Class 3 52.939 43,877 17.12%
Class 4 29,038 21,809 24.89%
Total 127,841 106,104 17.00%
So we can see total number of sanctioned post is inadequate to meet the health need of 160
million people. Interesting to note that vacancy rate is more for lower classes employees which is
complete opposite to developed world trends.
3. Job Analysis and Staffing
Job analysis consists of job specification and job description. Job specification defines
the task, duty and responsibilities of the potential employee and job description mentions
required knowledge, skill and attitude to do the job. UNDP has made a detail job specification
description for local government employees and Government adopted it. Job description for class
1 and 2 employees is defined by public service commission and similar bodies whereas class 3
and 4 employees are locally appointed.
One recent alarming trend is recruiting large number of health professionals every 3 to 4
years with nothing in between. As large number of professionals are recruited bar to efficiency is
lowered resulting in low quality in this service sector. Posting of the higher grade servants is
often decided by bribe and lobbying. Appointment and posting of lower grade employees are
following the same pattern.

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Promotion is a good incentive for employees. Government trying to bring discipline in
that part by adopting Health Information System but often accused of political bias. Timescale
and senior scale promotion method at the same sector often jeopardized the incentive value.
70% of health workforce is concentrated in the urban areas where only 25% of the
populations live by. So quality health care delivery in the rural setting is neglected where only 5-
6 physicians in the Upazila level work to provide health care of 2-3 lakh people. No job benefit
is available for working in the rural and remote areas.
4. Equal Employment Opportunity
At the core of equal employment is the concept of discrimination. The word
discrimination simply means “recognizing differences among items or people.” For example,
employers must discriminate (choose) among applicants for a job on the basis of job
requirements and candidates’ qualifications. However, when discrimination is based on ideology,
ethnicity, race, gender, or some other factors, it is illegal and employers face problems.
Constitution of Bangladesh promised to eliminate any type of discrimination. Illegal
discrimination occurs with employment-related situations in which different standard are used to
judge individuals based on political leanness. 45% of government posts are reserved for different
group of people which is another source of discontent. Only 1/3rd of the professional group
consists of female which reflects social backwardness and conservatism. Some of the specialties
are dominated by certain gender group like medicine and surgery by males and nursing and
gynecology by females.
Sexual harassment in the workplace is another threat in workplace. No strong regulation
exists to protect female workers. As per job need females often have to do fieldwork or night
duty which is another source of job dissatisfaction.

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5. HR planning and retention
Voluntary and involuntary job turnover is low in the government sector of Bangladesh
which is the biggest job provider of the country. Higher job retention figures reflect better benefit
than private sector. However migration of expert workforce in the developed country like any
other sector workforce is hurting our health care delivery system. In the last 15 years 5,000
physicians migrated in Canada alone.
Job retention rate in the expert group can be increased by careful consideration of
education and training, choice of posting, salary and other allowance, length of service and
demographic characteristics of the job. Private sectors appear lucrative for experts as they pay 5
to 30 times more than the government sector. Few regulations do exist in Conduct Rules to deter
migration however incentives rather than punishment is required to retain expert professionals.
Performance rating is another poorly implemented initiative in government service.
Promotion, reward, punishment are not based on annual performance so workers feel little
encouragement in improving their qualities. Recently government is thinking about initiating
Annual Performance Appraisal with a 360 degrees approach involving higher authority,
colleagues, clients and employee himself in the assessment process. If successful it will reduce
the grievance related with posting and promotion and encourage employees to improve their
service standards.
6. Talent management
Talent management consists of training, career development plan, performance
management and appraisal. Various government and private institutes are giving training on
health associated subjects like epidemiology, public health, medical technology, engineering,

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health economics etc. Government doctors need to take 2 months Foundation Training which is
one of the requirements for service confirmation. Training facilities are not world class and they
lack adequate trainers to manage huge number of hopeful applicants. Philippine introduced
world class nursing facility decades back and now they have surplus of nurses who work all over
the world. Bangladesh lacks this type of initiatives.
Higher study opportunity is often hampered by limited training posts and lack of
infrastructures. As care system is not up to the mark large number of patients visit foreign
countries to receive up to date treatment for their conditions. Specialists are often sent in remote
areas with no infrastructure and facility of delivering their services.
Career development plan is poorly mapped with little benefit at the lower end of job
grades. One of the main reasons for corruption is inadequate salary structure which is insufficient
to meet daily basic needs. With no clear promotion structure for lower grade employees and
undergraduate degree holder they lack the enthusiasm to wholeheartedly conduct their duties and
responsibilities.
7. Total reward
Paying employee market value is important. Salary, different types of allowances,
Compensation benefit, retirement benefit, pension, insurance, educational assistance, child and
elder care assistance, holiday and vacation pay, different types of leave, study leave, rest and
recreation leave are given to satisfy the workers. All these benefits are inadequate compare to the
national and international market value of the services. As the inflation rate is higher than the
GDP growth, little benefit employees enjoy following salary increments.
Very little reward employees get based on their annual performance. Autonomy and
decentralization at all levels are discouraged so local problems persists. Outsourcing and
temporary posts are created in private and multinational corporations to maintain the standard of

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service but lack in government sectors. Right sizing, downsizing, outsourcing are important
considerations in 6th 5 year plan of the government; once implemented it will benefit the worthy
workers and the community.
8. Risk Management and Workers Protections
Workers safety law, anti-discrimination law, labor laws are implemented by government
to protect the workers right. Government workers are also protected against unduly harassment
by law which requires permission of higher authority for investigation and arrest against any
civil court charge. Maternity, hospital, sick, quarantine and medical leaves are present to protect
workers’ health. However in the clinical care settings employees receive only one weekly
holiday which is two in other sectors.
For rural, remote and risky no compensation whatsoever is provided. Some of the remote
places take different modes of transport to reach and poor residential facility. Common
perception is that remote places are reserved for punishment posting and for those without
political connection. This concern is a major cause of job dissatisfaction and voluntary
retirement.
Undue influence from administration, bureaucracy, and local political power structure is
negatively impacting service outcome. Non-locals professional often refuse to stay at rural areas
because of lack of security and intimidation from local goons. Disable citizens have their own
quota in the job circular but often face difficulty while performing the job.

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9. Employee Relationships
The term 'employee relations' refers to a company's efforts to manage relationships
between employers and employees. For committed workforce generation fair and consistent
treatments of all employees are prerequisite. There is no post for employee relations manager in
the existing system. Lack of effective workers union deprived the workforce to communicate
their needs and demands to the authority.
Under the existing system monthly coordination meeting is arranged where employees
can express their opinion. However budget deficit and office politics often hampers good
initiatives. Employee relationships need to be considered to build a trustful and confident
organization.
10. Conclusion
Getting quality health care is a constitutional right not a privilege. To implement that
right Government of Bangladesh have taken clear strategy directed towards improving health
delivery system, strengthening health system and good governance. Human resource and
health information system development, financing health sector, decentralization and local
level planning, and e-health are some of the ways to implement those strategies. Physical
resources and skillful, motivated, knowledgeable clinical and non-clinical staff working in
the public and private intervention facility are required for better performance and delivery of
health care.
Size, composition and distribution of the health care workforce determined under HR
planning, workforce training issues under training and talent management, the migration of
health workers in urban and global setting under HR retention, the level of economic
development in a particular country under workers benefit and compensation, and socio-
demographic, geographical and cultural factors under employee relationships and equal

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employment opportunity of HR functional domains must be addressed before expecting an
effective change in the health care sector of the country.
While the specific health care reform process varies by country, some trends can be
identified. Three of the main trends include efficiency, equity and quality objectives based
HR management.
Efficiency can be increased by performance contract, outsourcing of service, contracting
out or internal contracting. Government has already taken major initiative to implement some
of these recommendations.
Equity can be achieved by systematic planning, abolishing quota system, fairness in
recruitment and transfer process, and financial protection mechanism for rural, remote and
efficient workers.
Technical quality can be achieved by adopting modern techniques, better training of
workforce and digitalization of the system. Sociocultural quality reflects patient’s
acceptance which requires implementing citizen charter declaration of every organization.
Since all health care is ultimately delivered by people, effective human resources
management will play a vital role in the success of health sector reform.

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Bibliography
1. David A. DeCenzo, Stephen P Robbins. Fundamentals of Human Resource Management.
10th edition. Wiley, 2009.
2. Robert L. Mathis, John H. Jackson. Human Resource Management. 13th edition. South
Western College Pub, 2010.
3. Raymond A. Noe, John R. Hollenbeck, Barry Gerhart, Patrick M. Wright. Fundamentals
of Human Resource Management. 6th edition. McGraw-Hill, 2015.
4. Jeffrey Liker. The Toyota Way. McGraw-Hill, 2003.
5. Stefane M Kabene et al. The importance of human resources management in health care:
a global context. Human Resources for Health Journal. 27 July 2017.
6. Health population and Nutrition Sector Strategic plan (HPNSSP) 2011-2016; Planning
Wing, Ministry of Health and Family Welfare, Bangladesh.
7. Health Bulletin 2016. Management Information System. DGHS, Mohakhali, Dhaka.
8. National Health Policy, 2012. Ministry of Health and Family Welfare, Bangladesh.