Introduction :

Bangladesh is one of the most populous countries in the world, as well as having one of
the fastest growing economies in the world.[1]) Consequently, Bangladesh faces
challenges and opportunities in regards to public health.
To ensure equitable healthcare for every resident in Bangladesh, an extensive network of health
services has been established. Infrastructure of healthcare facilities can be divided into three
levels: medical universities, medical college hospitals, and specialty hospitals exist at the tertiary
level. District hospitals, maternal and child welfare centers are considered to be on the
secondary level. Upazila health complexes, union health & family welfare centers, and
community clinics (lowest-level healthcare facilities) are the primary level healthcare providers.
Various NGOs and private institutions also contribute to this intricate network.

Concepts of Public Health:

Public health has been defined as "the science and art of preventing disease, prolonging life
and promoting health through the organized efforts and informed.”

According to WHO

“Public health has been defined as "the science and art of preventing disease, prolonging life and
promoting health through the organized efforts and informed choices of society, organizations,
public and private, communities and individuals". 

According to United Nations-

“Health, as defined in the WHO Constitution, is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity.”

So from this two definition we can give some characteristics of health –

Population-centered

Protecting and promoting healthy conditions and the health for the entire population

Equitable
Working to achieve health equity

Proactive

Formulating policies and sustainable practices in a timely manner, while mobilizing rapidly to
address new and emerging threats and vulnerabilities:

Health promoting

Ensuring policies and strategies that advance safe practices by providers and the population
and increase the probability of positive health behaviors and out comes

Risk reducing

Diminishing adverse environmental and social events

by implementing policies and strategies to reduce the

probability of preventable injuries and illness or nega

tive outcomes

Vigilant

Intensifying practices and enacting policies to sup port enhancements to surveillance activities
(e.g... technology, standardization, systems thinking/mod eling)

Transparent
Ensuring openness in the delivery of services and prac tices with particular emphasis on valid,
reliable, acces sible, timely and meaningful data that is readily available to stakeholders,
including the public

Effective

Justifying investments by using evidence, science and best practices to achieve optimal results
in areas of greatest need

Efficient

Understanding costs and benefits of public health inter ventions and to facilitate the optimal
use of resources to achieve desired outcomes.

Present scenario of Public health in Bangladesh

Bangladesh, with a population of 1.55 million in 2012, is one of the most densely populated countries in the world,
having a population density of 1050 per km2.1 The male/ female ratio is 104.9/100 and the annual population
growth rate is 1.37%.2 The population of Bangladesh is very young as depicted by its wide-based
population pyramid. A large cohort of the young population will enter reproductive age in the
coming decades, a phenomenon partly explaining why the adolescent (15–19 years) fertility rate
in Bangladesh of 118 per 1000 women and increasing life expectancy at birth of 69 years in
2011.3

Bangladesh Demographic and Health Survey is not expected to decrease significantly for decades. As
in other countries, the population is ageing over time due to decreasing fertility rates (6.3 births per
woman in 1975 to

2.3 in 2011).3

Unsafe food remains a major threat to public health 4 each year, citizens suffer from the acute effects of
food contaminated by microbial pathogens, chemical
substances and toxins. There is a need to minimize
the consumer’s exposure to unhygienic,
contaminated and adulterated food and drinks
through strict laws to control marketing of such
products.1

One such factor is violence against women. This is a

widespread social problem that causes mental stress,
physical suffering and even death, and is believed to be
grossly underreported. One study reveals that in
Bangladesh about 52% of men in both urban and
rural sites reported ever physically assaulting
female intimate partners.5 According to the Joint
Monitoring Programme (JMP) of the World
Health Organization (WHO) and the United
Nations Children’s Fund (UNICEF), 83% of the
population have access to safe water for drinking.6
While the population at risk of.
consuming arsenic contaminated drinking water is estimated at 20 million, the number of exposed
persons may well be lower because of ongoing awarenessraising activities. 1,7 The challenge is to
ensure access to safe water for 100% of the population. Basic sanitation coverage is 55% against the
target of 70% by 2015.6 Although more than 90 million people in Bangladesh shifted to fixed -point
defecation in the last five years, diarrheal diseases remain a leading cause of child and infant
morbidity. A research study shows that only 1% of the population wash their hands with soap and
water before having a meal, 0.7% before feeding children, and

30% after defecation.8

1.1 The Public Health Care Delivery System

Compared to many other developing countries, Bangladesh has a relatively developed public
infrastructure of health facilities as well as a relatively extensive human resource base for the delivery of
health and family planning services. There is an extensive network of hospitals, health centres,
dispensaries and training centres in Bangladesh. This network at the district level and below, comprises
64 district hospitals, 402 health complexes at the upazila level (UHCs), about 4,000 health and family
welfare centres (HFWCs) at the union level and thousands of community clinics (11,000-13,000) at the
ward level.

The country's health system is hierarchically structured and can be compared to a five layer pyramid.
First, at the base of the pyramid, there is the ward level health facility (CC), consisting of a health
assistant and a family welfare assistant. At the second level is the union health and family welfare centre
(HFWC) staffed by a medical assistant, one family welfare visitor and one pharmacist, which
concentrates on the provision of maternal and child health care, and provides only limited curative care.
Third, there is the Upazila Health Complex (UHC) with nine doctors, two medical assistants, one
pharmacist, and one radiographer and one EPI technician. The UHC is responsible for inpatient and
outpatient care, maternal and child health services and disease control. Fourth, the district hospital (DH)
is the first layer of the health care pyramid to have theatre facilities, but some selected UHCs have also
got EOC facilities. Finally, the medical colleges and post-graduate institutes form the top of the health
services pyramid offering a wide range of specialty services.

Theoretically, Bangladesh has a health care system of some sophistication. Massive investments have
been made into infrastructural development and thousands of doctors, nurses and other health workers
have been produced. But despite these, large segments of the population of Bangladesh have limited or
no access to the health services at all and for many of the rest, the care they receive is inadequate. The
national health services, established and administered for all, is allegedly being consumed by a selective
few who are favoured by geography, social class, wealth or position. The under-served majority is largely
rural but also includes the urban poor (Khan 1988, 1994, DHS 2004, 2007, Bangladesh Health Watch
2007, 2008).

Efforts to improve health have had modest impact on the health of the vast majority of the population in
Bangladesh. This is commonly attributed to two main reasons. First, health activities have typically over
emphasized sophisticated, hospital based care, while neglecting preventive public health programme
and simple primary care provided at conveniently located facilities. Second, even where health facilities
have been geographically and economically accessible to the poor, deficiencies in logistics, staff
absenteeism, poor supervision, informal payments and lack of social acceptability have often
compromised the quality of the care they offer and limited their usefulness. Essentially, it is the poor and
vulnerable members of society who are particularly prone to the largest burden of cost and poor service
delivery (Mannan et al. 2003, Euro Health/World Bank 2004).

Like many other developing countries, the public health sector in Bangladesh is plagued by absenteeism,
informal payments and perceptions of poor quality.

One study observed that the overall public health care services have declined between 1999 and 2003,
while the rate of utilisation of private health care facilities has increased for the same period (Andaleeb
et al. 2007). Another study demonstrates that the overall utilisation rate for public health care services
in Bangladesh is as low as 30 per cent (Ricardo et al 2004).

Available evidence suggests that poor governance in the health sector is negatively influencing service
delivery mechanism in Bangladesh, which, in turn, results in low utilisation of public facilities. Non-
availability of drugs and commodities, discrimination against the poor, imposition of unofficial fees, lack
of trained providers, weak referral, feedback and monitoring systems, unfavourable opening hours and
interdepartmental difficulties contribute to low use of public facilities in Bangladesh (Ahmed and Khan
2011, HEU 2010). There is also an extreme shortage in health providers, with overall shortages as high as
60,000 for doctors and 160,000 for nurses (Bangladesh Health Watch 2008). There are also huge
disparities in the distribution of providers between urban and rural areas, with only 16 per cent of
qualified doctors practicing in rural areas. Bangladesh has one of the lowest nurse ratios in the world
and the capacity of the existing training institutions is insufficient to significantly increase these numbers
in the near future (Bangladesh Health Watch 2008).

1.2 Access to and Utilisation of Health Services

The factors underlying access and utilisation are diverse. Income is only one factor that might explain
access to health services in developing countries like Bangladesh. It is necessary but not sufficient–other
factors such as institutional and non-economic factors (cultural and social constraints, gender, etc.) play
an equally important role in determining access to health services and their utilisation.

The three aspects of health, such as status, access and utilisation, are distinct though interrelated.
Indicators of health status, e.g. mortality and morbidity rates, can reflect whether health services have
had any impact on the health of the population. A greater availability of health services is obviously
intended to improve health status and to reduce inequity in the distribution of health services.
Availability of health facilities and services is the essential prerequisite for access to health care.
Availability should also conform to the cultural perspectives and specific needs of the population such as
availability of required number of doctors and nurses, female doctors, specialist doctors and
paramedics. However, it is important to consider the actual utilisation of available health facilities since
equity and access are likely to have an impact on health status only if these facilities are actually utilised.

To be effective, health services should be available, accessible and affordable. But mere availability of
health facilities does not result in their utilisation. Accessibility has a number of key dimensions ((Osmani
2003), which include:

(i) Physical Accessibility (distance, travel time and travel costs);

(ii) Economic Accessibility (cost of medicine, cost of consultation, cost of hospitalisation, cost
incurred with respect to tests/investigations); (iii) Social and cultural context (gender) affecting
accessibility; (iv) Perceived quality of services:
- availability of doctors
- availability of medicine
- attitudes of doctors/nurses
Physical accessibility includes distance to health facilities including travel time, cost of travel and waiting
time, while economic accessibility includes costs incurred for accessing these services. Information
accessibility, on the other hand, implies that people should have informed choice regarding the sources,
types and quality of services.

For access to government health services, they should also be of good quality. The quality of health care
may be defined in a variety of ways in the context of varying socio-cultural and development settings,
but so far there is no consensus on a single set of accepted criteria to measure quality. Donabedian
(1980) defines quality of care as that kind of care, which is expected to maximise patient welfare, and
depends on whether effective care is sought and individual and social preferences regarding care is
manifested. It also underscores the importance of performance of health care practitioners, health care
system and relative costs and benefits of patients. One of the most widely cited recent definitions
indicates that quality of care is the “degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are consistent with current professional
knowledge” (Lohr 1990). Quality of care is also defined in terms of two key dimensions, access and
effectiveness, which implies whether the users get the care they need and whether the care they receive
is effective (Campbell, Ronald and Buetow 2000).

Accessibility is an important and determining factor in fighting episodes of illness. Along with physical
inaccessibility, financial inaccessibility is also very important. Costs of health care, especially cost of
medicine, cost of diagnostic test including consultation fees, are beyond the reach of poor people. To be
economically accessible, services have to be affordable on the basis of equity in financial contribution.

1.3 Review of Existing Literature

1.3.1 Physical Accessibility
The three main aspects of physical accessibility are distance from the health facility, travel time and
travel cost to arrive at the facility. Numerous studies have shown that physical access to health services
is an important determinant of utilisation of public health facilities in Bangladesh. Location is one of the
most important factors to determine the access to health services in Bangladesh as documented in the
CIET baseline survey (CIET Canada and MOHFW 1999), Bangladesh Health and Demographic Surveys
(DHS 2004, 2007) and Bangladesh Health Watch Report (2007). Geographic access at least partially
explains why consumption rates are higher in urban areas compared to rural areas (NIPORT et al. 2001).

Earlier evidence shows that patients visiting public health facilities have to wait much longer to see the
doctor (see, for example, Khan 1988). However, the findings from a recent study (Mannan et al. 2003)
show that physical accessibility is not a major barrier in the sense that patients do not have to travel a
long distance to reach health facilities at the district level and below (the average distance traveled by
patients attending DHs was 8 km, compared to 3.2 and 1.8 km for patients at the UHC and HFWC,
respectively). And once patients arrive at the facilities, they do not have to wait for a long time to get to
the services (the average waiting time was 25 minutes for patients in the DHs, followed by 17 and 13
minutes in the UHC and HFWC respectively). But, according to the Euro Health/World Bank study (2004),
patients visiting higher level facilities (district hospitals, teaching hospitals and specialised hospitals)
have to wait much longer to see the doctor: waiting time was highest (82 minutes) for outpatients
attending specialised hospital, second highest (65 minutes) for teaching (medical college) hospitals, and
lowest (58 minutes) at the district hospital. However, physical access emerged as a barrier to maternal
and child health services in particular. In the 1999-2000 DHS, 79 per cent of women reported that the
lack of a health facility nearby was a constraint to consumption. In the same survey 50 per cent of
women responded that getting to the health facility was a problem to them. Levin and colleagues (2001)
confirmed the significant negative association between both distance to the provider and travel time
and the use of health services. A child was less likely to be taken to a qualified allopathic provider or a
traditional practitioner than a village doctor if the travel time was 40 minutes or greater compared with
travel time of 15 minutes or less. Other research has shown that a majority (74 per cent) of sick children
in a rural area of Bangladesh were taken less than two miles for treatment, and that a majority of those
children were seen by private practitioners. In contrast, children who were taken more than two miles
for treatment received health care from qualified allopathic providers (Bhardwaj and Paul 1986).

1.3.2 Social and Cultural Context–Utilisation by Age and Gender

The social and cultural context has an important impact on the utilisation of health services in
Bangladesh. Social and cultural factors particularly affect the role of gender and the participation of
women in household decision-making. Women are less likely to utilise health services and receive lower
allocation of food at the household level (Chen et al. 1981, D’Souza and Chen 1980). The DHS
(Demographic and Health Survey) data show that 44 per cent of women reported difficulty in getting
permission to go to a health provider as a constraint to health service consumption. In addition, 49 per
cent of women reported that finding someone to accompany them was a problem. Amin and Colleagues
(1989) found that men who were sick were more likely than women to utilise modern qualified
providers in rural Bangladesh. The gender bias may reflect beliefs that it may not be appropriate for
women to be seen by a male provider. In addition to the long-standing cultural biases against women,
the fact that the health providers available in rural Bangladesh are predominantly male suggests that the
problem of women’s access to care will not be easily solved.

Further evidence from Mannan et al. (2003) shows how the gender bias affects the utilisation pattern of
health facilities (at the district level and below). Compared to males, females are less likely to use
services both during the early years of life (i.e. before age 5) and also during later years (i.e. after 60
years of age). The data indicate that younger boys (<5 years) and older males (65 years and over) are
more likely to utilise public health facilities than their female counterparts. The same study also shows
that utilisation patterns of health facilities for females are inversely related to the levels of care i.e.
female utilisation decreases as one goes up along the levels of care (from UHFWC to UHC to DH).

1.3.3 Economic Accessibility

“Economic accessibility” means that health facilities, goods and services (drugs and other treatment
related items) must be affordable by all. But the findings from the present study suggest that out of
pocket expenses have major consequences in the process of seeking care. Government facilities are the
last resort for the hapless poor who cannot afford to consult a private qualified doctor. But evidence
shows that even though health care services are supposed to be free at public facilities, patients have to
bear the costs of medicine and laboratory tests, as well as some additional costs (Mannan et al. 2003,
Euro Health/World Bank 2004, Transparency International 2006).

From the economic perspective, healthcare utilisation decisions depend on the relative magnitude of
costs and benefits involved from the standpoint of persons who make these decisions to use healthcare
for themselves or for others. The costs of seeking care typically include financial expenses and income
losses that may be incurred as a result. Income losses can be high if considerable time is spent in
commuting or standing in queues to obtain medical care.

For the same reason, the amounts paid for healthcare services, such as cost of medicine, consultation
fees and hospital charges, are also likely to be an important determinant of health care utilisation. There
are also other factors that influence healthcare utilisation behaviour. For people with higher education,
the perceived benefits from effective treatment and/or preventive care may be higher than for the rest
of the population. Benefits could be higher for individuals whose health is considered intrinsically more
important in certain cultural settings, as for people belonging to higher socio-economic classes and for
males. The perceived need for medical care would depend both on the availability of healthcare facilities
and the capacity to pay for health services. An analysis in India using data from the 42nd round of the
NSS shows that the chance of an ill person seeking treatment is greater among males, among members
of households where the head is literate, and among scheduled castes and tribes (Gumber 1997). Finally,
economic status of the household plays an important role in the health seeking behaviour. The
perceived need for medical care would depend both on the availability of healthcare facilities and the
capacity to pay for health services.

The cost of health care can be a strong determining factor of health care utilisation, as well as a cause of
poverty. Ability to pay is a particularly important determinant of access when a high proportion of health
care is financed privately, and without any type of financial risk protection from health insurance. In
Bangladesh, 60 per cent of total health expenditure in 2000 was in the form of out-of-pocket payments
by individuals, so that households’ ability to pay for care is important (WHO 2002). There is essentially
no social security or private health insurance, although public hospitals are intended to provide a form
of insurance in the case of serious illness. The findings from Mannan et al. (2003) show that economic
status of the household plays an important role in the health seeking behaviour.

Different types of cost items can be barriers to the use of health care. Health care costs can be divided
among direct medical costs (e.g. medicines and service fees), direct non-medical costs (e.g.
transportation costs) and indirect costs (e.g. traveling and waiting time, lost earnings). The available
evidence shows that the cost of medicines was the most important cost element that prevented people
from using health services (CIET Canada and MOHFW 2001, Mannan et al. 2003).

In addition to cost, quality of services is an important determinant of use of public health services.
According to the CIET survey, only 10 per cent of households in 2003 compared to 38 per cent in 1999
rated government health and family planning services as “good.” During the same period, the proportion
of patients visiting unqualified practitioners rose from 30 per cent to 49 per cent; the proportion of
those receiving all the prescribed medicine fell from 33 per cent to 23 per cent; the percentage of
patients who paid for health services rose from 80 per cent to 82 per cent; and the level of patient
satisfaction with providers’ behaviour fell from 66 per cent to 56 per cent. This is a significant decline
within the span of four years (1999 to 2003) in the quality of services rendered by public health facilities.
Inadequate and poor quality medicines were cited as the biggest problem affecting the quality of
services provided at government facilities by 55 per cent of households. Similar findings also emerged
from Mannan et al. (2003) and Euro Health/World Bank study (2004).

1.3.4 Disease Burden on the Poor

The poor bear a disproportionate share of the burden of ill health and suffering. Poverty is a significant
constraint to health care access and utilisation. Expenditure incurred for health care has some adverse
impact on household consumption. Findings from Mannan et al. (2003) show that expenditure on health
resulted in withholding of other subsistence resources (reduced food consumption, less expenditure on
children’s education, etc). Thus, illness requiring treatment and hospitalisation has significant adverse
implications for the economic well-being of affected households, particularly for the poor.

Poor health has significant adverse implications for the economic well-being of affected households and
individuals, particularly for poor households. One way by which this occurs is in the form of out-of-
pocket health expenditures for diseases that are relatively expensive to treat. Another way in which
adverse health can influence the economic well-being of affected households arises from incomes
foregone on account of the morbidity (or mortality) of affected members, or taking time off from work
to care for the sick individual. Krishnan (1995) points out that a single episode of hospitalisation can
account for between 20 and 60 per cent of annual per capita income, with the proportion being even
higher for poorer groups. This can lead to tremendous financial burden on poor households and
indebtedness, sometimes resulting in liquidation of their assets. This would certainly indicate that
episodes of illness affect the economic position of the households rather badly.

The findings from a recent study (Mannan et al. 2003) show that overall, 8.8 per cent of monthly
household income was spent on illness treatment. But the poorest households had to spend about 38
per cent of household income to meet the treatment cost of illness episodes, which is a heavy burden by
any reckoning. The findings clearly indicate that members from the poorer households have to undergo
a lot of economic pressure to finance their treatment cost/medical needs. Thus, for low-income
households there is a real risk of indebtedness in times of illness requiring treatment. The various
sources utilised for meeting treatment costs include drawing from savings, borrowings from
friends/moneylenders, and distress sale of assets/property.

The cost of health care often results in foregone medical treatment. The cost of medicine, various
charges associated with tests/investigations and the cost of hospitalisation are some of the most
important barriers to health services utilisation. The extreme poor households spend more than one-
third of their household income on health care expenses. If this burden can be relieved through free
supply of medicine and adequate supply of related items, this would have substantial impact on poverty
reduction.

The situation becomes really precarious for patients who need hospitalisation. In the case of in-patient
treatment in a government facility, especially if surgical intervention is required, the households have to
incur a huge amount as out-of-pocket expenditures on medicines, diagnostic tests and other related
items. To meet the hospitalisation expenses many households have to borrow money and even liquidate
their assets. Thus, while the diseases mercilessly weaken the people, both physically and financially, the
burden of treatment makes them more helpless, accelerating the process of pauperisation.

The health authorities in Bangladesh recorded zero deaths from Covid-19 and
33 infections in 24 hours to Sunday morning.

Besides, another 269 patients recovered from the infectious disease, taking the
recovery rate to 97.26%, according to the Directorate General of Health
Services.

The latest additions took the country’s total caseload to 1,953,012 and the total
number of recoveries to 1,899,419, while the death toll remained unchanged at
29,127.

Health Problems on Bangladesh :

Due to a large population, Bangladesh faces a large burden of disease:

 Non-communicable diseases: diabetes, cardiovascular disease, hypertension, stroke, chronic

respiratory disease, cancer
 Communicable diseases: tuberculosis, HIV, tetanus, malaria, measles, rubella, leprosy[16]

Malnutrition and environmental sanitation problems add to this burden.

ix. Immunization
Influenza and pneumonia are two common health issues among the top 10 causes of mortality in older people.
Influenza immunization for the elderly has been emphasized, which has benefited. But pneumonia is still one
of the most severe diseases, particularly in women and the elderly.
 
x. Access to health care
Some common problems given below:
 
i. Physical inactivity
The most common health issue in the contemporary world is keeping an inactive lifestyle. An inactive lifestyle
causes cardiovascular diseases and diabetes, increases depression and mood swings. In addition, being inactive
for a longer time is accompanied by pre-ageing. So, it is essential for healthy ageing, and to prevent fatal
diseases, you should consume nutrient-rich food and live an active life with a physical workout.
 
ii. Overweight and obesity
Obesity is diagnosed in the ⅔ population of the U.S and is responsible for their many serious personal health
issues. Hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep
apnea, respiratory difficulties, dyslipidemia, and endometrial, prostate, and colon cancers are caused by
overweight or obesity. The National Heart, Lung, and Blood Institute of the National Institutes of Health
provides comprehensive guidelines and practical recommendations to reduce weight and manage obesity.
 
iii. Tobacco
In this stressful era, tobacco addiction is the most common health issue. Excessive tobacco usage is the leading
cause of lung cancer and deaths in the United States. According to the Centers for Disease Control and
Prevention (CDC), smokers who quit tobacco are succeeded in preventing respiratory diseases and pre-deaths,
resulting in longer lifespan.
 
iv. Substance abuse
Another common health issue is using drugs among youth and older people to reduce depression and anxiety.
Drug and alcohol addiction are the most common types of substance misuse. This substance addiction may
have severe health implications, including heart &kidney failure and neurological complications.
 
v. HIV/AIDS
Elder over 50 accounts for 11 to 15% of all AIDS diagnoses in the United States. People over 50 years of age
are at higher risk of developing AIDS than youngers due to a weaker defensive system. Elders are less likely to
use condoms, their immune systems deteriorate with age, so HIV is easily transmitted to elders and affect
them. Unfortunately, elderly citizens are underrepresented in research, clinical medication trials, preventive
initiatives, and intervention activities, resulting in increasing cases of AIDS.
 
vi. Mental health
The most common health issue is mental health which can take away our dreams. Mental health issues are
caused by reactions to medications, vision and hearing problems, infections, nutritional imbalances, diabetes,
or other health issues. Depression is the most prevalent mental health issue that affects people in their later
years and at a young age. Depression in the elderly may lead to suicide if left untreated. Here’s a shocking fact:
the suicide rate among old white males is greater than that of any other age group, including teenagers. So, this
personal health issue requires consideration and attention from close ones www.papsociety.org/xanax-
alprazolam-1-mg/.
 
vii. Falling and injuries
Falls are the leading cause of injuries, hospitalizations for trauma, and injury-related deaths among youngers.
Every year, one out of every three youngers fall accidentally. Exercise, a balanced diet, and some medicines
can improve your health by giving you strength and decreasing injury and falling rates. Some strategies such as
making changes to your home, providing home security, and installing fire-prevention devices can reduce the
probabilities of injures. According to an estimation, people aged 65 and up are twice than other age groups to
suffer and die in a house fire.
 
viii. Environmental quality
Poor environmental quality is a significant aspect of personal health issues these days. Poor environmental
quality is responsible for many severe diseases and consequences because it is not easy to improve its quality.
Even though pollution affects everyone, some studies show that low-income, racial, and ethnic minorities are
more likely to reside in regions with poor environmental quality, resulting in a higher rate of infectious and
serious diseases.

Role of Social Worker to reduce health problems in Bangladesh :

Medical social work is a sophisticated method of modern social work by which social work knowledge,
methods, and strategies are used in medical sector. Helping a sick person depends on a number of things
including the nature of illness, the kind of person who is sick, the social system of which he is a part, and the
resources that are available to him for the treatment. The needs are often complex and that require several
kinds of help at a time.

The medical social work practice that requires in hospitals and health care systems to facilitate good health,
prevent illness, and aid physically ill patients and their families to overcome the social and psychological
problems (Barker, 1995). Medical social work practice is a responsible relationship to medicine and public
health with the structure of programs of health and medical care (Kurtz, 1975). Through, the understanding and
application of social work principles and techniques, it aims to help the patient to utilize the fullest capacity the
medical center have and work out a pattern of life that is consistent with his physical limitations and satisfying
to the patients (Goldstine, 1955). Hence, medical social work is a service based on social work knowledge and
skills where the psychosocial factors behind the diseases are addressed. It helps the clients to improve their
mental state. In this arrangement, necessary steps are taken for their recovery.

Social work practice in health care can no longer be viewed as specialized practice within an acute hospital.
Rather it becomes an approach that fully integrates micro and macro services and that transcends systems.
Social work in health, therefore, requires the

delivery of broad based social health services to individuals, families and population within a range of systems,
such as schools, work places and community social health agencies to promote social well being. For this
purpose social work develops a model in health care that is termed as "Social Health Model' (Lowe, 1997).
This Model comprises with four basic elements that the social worker should keep in mind. The elements are
as follows:
1. Community social problems and their relationship must be identified. Social workers make a partnership
with the community residents and organizations to help them identify and analyze their social health needs and
concerns as well as their strengths.

2. Intervention must be designed to improve and maintain the social functioning of individuals, groups,
organizations and communities. Further service programs must be universal, comprehensive and integrated,
accessible and accountable in order to support the overall well being of the community.

3. Intervention must be designed to focus on prevention health promotion, diagnosis. treatment and
rehabilitations as well as on social action

4. Monitoring and evaluating the process of identifying and resolving social health needs and problems is
essential.

With considering these four basic aspects of Social Health Model, social workers perform their role in medical
and health care systems.

4. Problems in Practicing Medical Social Work in Bangladesh Medical social work can play a forefront role in
uplifting the health situation of the rural poor of Bangladesh. Most social work units in hospital are responsible
for at least the following functions:

(a) high-risk screening,

(b) psychosocial assessments and intervention,

(c) interdisciplinary collaboration for coordinated patient care,

(d) discharge planning, and (e) post discharge follow-up.

6

Despite the important relevance of these functions to the quality and effectiveness of medical care, social work
has not become a core health care profession.

Conclusion :

As the coronavirus outbreak quickly surges worldwide, many countries are adopting
non-therapeutic preventive measures, which include travel bans, remote office activities,
country lockdown, and most importantly, social distancing. However, these measures
face challenges in Bangladesh, a lower-middle-income economy with one of the world's
densest populations. Social distancing is difficult in many areas of the country, and with
the minimal resources the country has, it would be extremely challenging to implement
the mitigation measures. Mobile sanitization facilities and temporary quarantine sites
and healthcare facilities could help mitigate the impact of the pandemic at a local level.
A prompt, supportive, and empathic collaboration between the Government, citizens,
and health experts, along with international assistance, can enable the country to
minimize the impact of the pandemic. individual efforts from the citizens, direct
involvement of the nation's public health experts, and international help are urgently
needed. As the situation intensifies, the world is closely watching how Bangladesh will
navigate this crisis.