Bangladesh suffers from both a shortage of and geographic mal-distribution of HRH. There are an estimated 3.05 physicians per 10,000 population and 1.07 nurses per 10,000 population (estimates based on MoHFW HRD 2011). There is a severe gap between sanctioned and filled health worker positions: 36% vacancy in sanctioned health worker positions and only 32% of facilities have 75% or more of the sanctioned staff working in the facilities (World Bank, 2009). 28% of treatment provided in government health facilities is through alternative medicine (Ayurveda, Unani, and Homeopathy), yet as of June 2011, there was a 50% vacancy rate for alternative medicine providers (MoHFW AMC 2011).

Health workers are concentrated in urban secondary and tertiary hospitals, although 70% of the population lives in rural areas (Country Case study (GHWA, 2008). Major challenges include: an overly- centralized health system, weak governance structure and regulatory framework, weak management and institutional capacity in the Ministry of Health and Family Welfare (MoHFW), fragmented public service delivery, inefficient allocation of public resources, lack of regulation of the private sector – which employs 58% of all physicians, shortage of HRH, high turnover and absenteeism of health workers, and poor maintenance of health facilities and medical equipment.

Despite these challenges and the fact that HRH was not considered a priority in the current sector program, there have been recent successes including: increase in the number of graduates and health worker training facilities, and an increased number of rural health facilities. The MoHFW prepared its new sector program – the Health, Population and Nutrition Sector Development Program (HPNSDP) and is revising its draft National Health Policy, based on lessons learned from previous programs. Goals include: developing an HRH plan, creating a functional HRH Information System (HRIS), scaling up the production of critical health workers, introducing incentive packages to deploy and retain critical health workers in remote and rural areas, addressing the challenge of skilled birth attendance by training community-based SBAs and/or nurse-midwives and family welfare visitors, and streamlining the recruitment and promotion of nurses (PID, World Bank, 2011).

COUNTRY COORDINATION AND FACILITATION (CCF) IN BANGLADESH:

The first stakeholder dialogue on Human Resource for Health (HRH) in Bangladesh took place on 28th March 2012. The dialogue was mainly to start advocacy on the need of adequate and skilled health workforce for well functioning health system and advocate for the Country Coordination and Facilitation (CCF) process as initiated by