‘Capacity must increase to manage patient load’
DMCH Director Calls for Bigger Capacity to Match Heavy Patient Demand
Thebangladaily.com – Dhaka Medical College Hospital is treating far more patients than its current staffing, bed allocation and medicine budget were designed to support, outgoing Director Brigadier General Md Asaduzzaman has said as he prepares to return to the Bangladesh Army within the coming days.
During his tenure, the hospital pursued measures aimed at easing pressure on services, including recruitment initiatives, expanded diagnostic facilities, cleanliness campaigns, action against broker activity and plans to raise critical-care capacity. Work has also moved ahead on a Development Project Proposal that could ultimately expand the hospital to 4,000 beds.
The central challenge, he said, remains the difference between DMCH’s official capacity and the scale of its daily patient load. While trainee and resident doctors help limit broader physician shortages, anaesthesia services and nursing remain under pressure.
“The biggest problem was the shortage of manpower and infrastructure compared with the patient load.”
The hospital has 2,600 beds and roughly 2,300 nurses. Staffing constraints are particularly acute among support personnel, whose work is essential to maintaining services across a hospital that operates around the clock in three shifts.
When Asaduzzaman took charge, DMCH had about 1,000 permanent and daily-wage support workers. Every day, the outpatient department receives around 6,000 visitors, while the emergency department handles about 2,000 more. More than 4,000 patients are admitted at a time, creating a workload that exceeds the hospital’s intended capacity.
Recruitment Steps Bring Some Relief
One of the administration’s priorities was filling long-vacant positions. There had been no fresh recruitment for nearly 15 years, and between 250 and 260 posts were unfilled. The hospital approached the ministry for approval and eventually secured permission to recruit for 72 positions.
Other changes added to the available workforce. Thirty project-based workers were converted into daily-wage employees, while approximately 100 additional workers joined. Altogether, about 202 staff members were brought into the system.
The new personnel include drivers, computer operators, office assistants and workers assigned to laundry and tailoring duties. Though the additions do not resolve the overall shortage, they have helped make routine hospital operations more manageable.
Cleanliness Efforts and a New Management Idea
Improving sanitation has been another major area of focus. The director said the situation is markedly better than it was previously, aided by regular oversight and weekly cleaning drives in which he personally participated each Saturday.
Waste that had collected on rooftops, sunshades and other difficult-to-reach parts of the campus was removed during these efforts. Yet significant limitations remain, particularly the shortage of toilets relative to the number of patients and attendants using the hospital each day.
Asaduzzaman also identified gaps in the training and supervision of cleaning staff. He believes hygiene management should be handled by a specialised professional organisation rather than being treated solely as an internal operational responsibility.
“I believe cleanliness management should be handled professionally by a separate organisation.”
A pilot programme for this approach has been initiated in part of DMCH. If it proves effective, the model could potentially be extended to government hospitals elsewhere in Bangladesh.
Diagnostic Services Expand Despite High Costs
The scale of demand is also clear in diagnostic services. DMCH treats about 4,000 to 4,200 inpatients daily and sees between 7,000 and 8,000 outpatients. Providing tests for every patient is not feasible, particularly because laboratory reagents are costly.
Even within those constraints, the hospital has increased testing capacity. The pathology department has received a new automated machine and an additional laboratory, helping bring the number of tests close to double its earlier level.
The financial impact of the expanded service has also been visible. Diagnostic-service revenue stood at around Tk 39 crore when Asaduzzaman assumed office and reached Tk 52 crore in the most recent fiscal year.
Greater laboratory capacity can reduce delays for patients who need test results to guide treatment decisions. However, the continuing volume of admissions and outpatient visits means that diagnostic expansion will need to keep pace with the hospital’s wider growth.
Medicine Budget Does Not Reflect Actual Admissions
The supply of free medicines remains closely tied to the hospital’s budget. Funding is calculated for 2,600 patients, matching the formal bed count, but the real inpatient population is around 4,200. As a result, a budget intended for a smaller number of patients must be stretched considerably further.
“If the budget is increased, the supply of medicines can also be increased.”
Procurement policy has been another concern. Previously, 75 percent of medicines were purchased from the state-owned Essential Drugs Company Limited, with the remaining 25 percent obtained through the open market. Asaduzzaman argued that more room for competitive purchasing could allow the hospital to obtain a larger medicine supply from the same allocation.
A decision has now been made to divide purchasing evenly, with 50 percent sourced from EDCL and 50 percent from the market. The adjustment is intended to give the hospital greater flexibility while retaining a substantial role for government supply.
Broker Activity Linked to Service Shortfalls
DMCH has also taken steps against brokers who attempt to draw patients away from the hospital. Ansar personnel, doctors, nurses and other employees were instructed to prevent outsiders from entering and soliciting patients. Law-enforcement agencies have assisted with operations on the premises.
But raids alone cannot remove the underlying incentives for broker activity, the director said. Patients who cannot obtain a bed, an ICU place or another urgently needed service may be forced to seek care elsewhere, creating an opening for intermediaries.
“When patients do not get beds or ICU facilities, they have to go elsewhere. Brokers take advantage of this situation.”
For DMCH, the long-term answer lies in matching infrastructure and resources with the patient population it already serves. The proposed 4,000-bed expansion, stronger staffing levels, broader diagnostic services and additional ICU and CCU capacity could help address the pressures that shape nearly every aspect of hospital care.
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