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Use of antihypertensive medications: an Educational need in Saudi Primary Health Care

The Barriers of Breast Cancer Screening Programs Among PHHC Female Physicians

Clinical study of lipid profile in diabetic patients

Development of a Community- based Care System Model for Senior Citizens in Tehran

Past, Present and Future of Family Medicine in Bangladesh

The Effects of Breast Cancer Early Detection Training Program on the Knowledge, Attitudes, and Practice of Female PHHC Physicians

Marine Animal Injuries to children in the South of Jordan

Infantile Dyskinesia and vitamin B12 Deficiency

Informatics in Clinical Practice Monitoring and Strategic Planning


Abdulrazak Abyad

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Past, Present and Future of Family Medicine in Bangladesh


Mamun-Al-Mahtab, K. M. Mamun Murshed, Uttam Kumar Barua, Nuzhat Choudhury, K. M. Shahnoor Hossain, Md. Mahbubur Rahman, Rooh-e-Zakaria, Swati Munshi, Rima Afroza Alia,

Bangladesh Primary Care Research Network (BPCRN),
Dhaka, Bangladesh

Correspondence to

Dr. Mamun-Al-Mahtab MSc, MD
Chairman, Bangladesh Primary Care Research Network (BPCRN)
Email: shwapnil@agni.com


Bangladesh is a small country in South Asia with an area of 1,44,000 sq. km. and a population of over 140 million. It is the 8th most populous country of the world, but in terms of land area Bangladesh ranks 93rd [1]. The population density is 1060 per sq. km [2].

Right to healthcare was recognized as one of the fundamental rights for every Bangladeshi citizen in the very first constitution of the newly liberated People's Republic of Bangladesh in 1972 [3]. Directorate General of Health Services and later Directorate of Family Planning was established by the Government as independent Departments under the Ministry of Health and Family Welfare, to provide backbone for delivering primary health care in Bangladesh.

The Directorate of Family Planning is concerned with birth control, maternal and child health while the Directorate General of Health Services is responsible for overall health care of the country. Under these two Departments 341 health complexes and 2329 health centres have been established in the country at the sub-district and union levels respectively, which are the two smallest administrative units in Bangladesh [4]. The Union Health centres are staffed by 1-2 graduate physicians and a number of paramedics and traditional birth attendants (TBA), while 9 graduate physicians and several nurses, paramedics, TBAs, laboratory technicians and other support staff are posted in the sub-district health complexes. However in most cases, the more remote and peripheral sub-district health complexes and union health centres are under-staffed.

The physician: patient ratio in Bangladesh is 1:4775 [2]. Most physicians are based in urban areas meaning that the scenario is even poorer in the rural communities, where primary health care is provided by quacks, rural medical practitioners, traditional medicine practitioners and paramedics. Only 30% of the population of Bangladesh has access to primary health care [2].

In the urban areas, in big cities, district towns and municipalities, people mainly depend on medical graduates, fresh or experienced, and specialists for their every day health needs. Specialists play an important role in providing primary health care in Bangladesh. No referral is needed to consult a specialist physician here. Patients usually consult the respective specialists based on their initial idea about their disease. So whereas a patient with complaints of headache resulting from a brain tumor may correctly go to a Neurosurgeon directly at the very beginning, more commonly they end up in the wrong consultation chambers. For example patients with irritable bowel syndrome often consult Hepatologists for fear of cirrhosis of liver.

Bangladeshi patients can access primary health care through different gateways, which adds a huge problem. Not only the patients suffer because of the huge difference in the quality and standard of health care they receive, they are also vulnerable to mal-treatment in the hands of non-qualified practitioners (e.g. quacks, rural medical practitioners, traditional medical practitioners etc.) Besides, over the years, the situation has become so difficult and complex that it will take years to put primary health care on the right track in Bangladesh. We are trailing far behind what the Brazilians have achieved by establishing 'health teams' comprising GP, nurse, nurse assistants and community agents with the support of World Bank [5], [6].

Primary health care in Bangladesh is financed by both the public and the private sectors. But the majority of the 140 million Bangladeshis use the public system. In 2005, Bangladesh utilized a significant portion of her gross national product in health care and a bulk of this money went to primary health care.


The College of General Practitioners of Bangladesh has been conducting a Fellowship programme for general practitioners for several years with limited success. As the specialty and the Fellowship offered by this college were not recognized by the Bangladesh Medical and Dental Council and the Bangladesh Government, it attracted little enthusiasm among medical graduates. Family medicine has been recognized as an independent specialty in Bangladesh for less than a year, although neither the only medical university in Bangladesh, nor the medical faculties of the different public and private universities are offering any course in Family Medicine as yet. The Bangladesh College of Physicians and Surgeons has recognized this specialty and devised the training programme for residents specializing in this branch. The development though very late, received momentum as the Royal College of General Practitioners of UK selected Dhaka, the capital city of Bangladesh, as the Regional Centre for holding clinical MRCGP examination. With all the international, regional and local attention it is therefore expected that the subject will flourish in Bangladesh in it's own right far sooner that expected.


The crude reality however is that the country will probably have to wait for a few more years to have her first set of qualified Family Physicians who can then contribute in a more useful way to the advancement of this specialty for the better interest of not only the subject, but also the people and the country as a whole.

The recently introduced training programme for Family Medicine residents in Bangladesh is somewhat similar to the GP training programme in the UK. However, as of now, the fact remains that the relationship between primary care physicians and the specialists is precarious without any type of coordination by the health system.


Family Medicine in Bangladesh is faces a number of challenges, namely:

  1. Lack of health professionals with clinical competence to act in primary health care.
  2. Homogenization of the general practice in entire Bangladesh with different realities co-existing.
  3. Ignorance by specialists who are, in general, rather dismissive towards Family Medicine.
  4. Lack of interest on part of specialists not wanting to lose their 'specialist family practice'.
  5. Lack of interest among fresh medical graduates in Family Medicine.

Although a lot depends on the support of the policy makers and the Government, specialists involved in 'specialist general practice' and graduate physicians engaged in general practice can contribute effectively in this regard by means of quality practice and research to prove the effectiveness of Family Medicine and primary health care. The integration of teaching and practice in Family Medicine is important [7]. There is lack of interest as well as qualified researchers interested to work in this field in Bangladesh. It is also important to ensure delivery of quality primary health care and to break the vicious cycle of bad clinical practice by untrained and ill-trained health professionals. Ensuring adequate employment and income for the qualified Family Physicians in the public and private sectors will also help ensure quality of clinical practice at primary health care. The initiatives, however in this regard in Bangladesh, are so far sparse.


The Bangladesh Primary Care Research Network (BPCRN) has been established, with active cooperation from the International Federation of Primary Care Research Networks (IFPCRN) and the Pakistan Primary Care Research Network (PPCRN), where Family Medicine is most developed in South Asia. The unique characteristic of BPCRN is that this newly established organization is headed by and comprises mostly of specialists with a passionate approach to Family Medicine while it also includes graduate general practitioners. BPCRN looks forward to collaboration with other regional and international primary care research networks and primary health care societies. It is expected that such collaboration will prove beneficial for the cause of Family Medicine and ultimately primary health care not only in Bangladesh, but in the entire South Asian region, the home of a bulk of the world's population, where structured Family Medicine is unfortunately virtually non-existent.

  1. Vision Statement: To promote skills in research methodology among Family Physicians.
  2. To promote and support primary health care research in Bangladesh.
  3. To identify issues in Family Medicine and to address them through research based on sound scientific principles.
  4. To conduct affairs of the network through the following office bearers to be elected for a period of three years by the members of the group:
    Chairman (1 no.), Vice-Chairman (1-3 nos.), Honorary Secretary (1 no.), Treasurer (1 no.), Scientific Secretary (1 no.), Member (1-5 nos.)
  5. The network will have an Advisory Committee comprising of eminent local, regional and international Family Medicine Specialists and physicians.
  6. To ensure regular interaction between network members through meetings and e-mails.
  7. To conduct research to influence Government policy in favor of Family Medicine and primary health care.
  8. To support and promote collaboration between academic physicians interested in Family Medicine working at institutions and universities with those working in the community.
  9. To help improve quality of care provided to patients in the community by general practitioners through research.
  10. To present works of the network at national and international forums and journals.
  11. To establish collaboration with regional and international Family Medicine Associations and Primary Care Research Networks.

The aim of establishing structured primary health care in Bangladesh with Family Medicine as an independent specialty can be achieved with priority government support and sincere cooperation from the medical fraternity. BPCRN aims to contribute in achieving this goal in whatever way possible.

1. Anonymous. Wikipedia The Free Encyclopedia, 2006.
2. Anonymous. Statistical Yearbook of Bangladesh. Bangladesh Bureau of Statistics, Statistical Division, Ministry of Planning, Bangladesh Government, 1998.

Ahmed E .Constitutional amendments. Banglapedia. Asiatic Society of Bangladesh, 2003.


Anonymous. US Library of Congress Country Study, 1988.

5. Anonymous. World Bank Report 1993- Investing In Health. Oxford University Press, 1993.
6. Ministério da Saúde. Programa de Saúde da Família: saúde dentro de casa. Brasília: Ministério da Saúde/ Fundação Nacional de Saúde, 1994.

Schmidt M.I., Duncan B.B. Academic medicine as a resource for global health: the case of Brazil. BMJ, 329:753-754, 2004.