Transformative Education
for Health Professionals

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Bangladesh’s Sub-Assistant Community Medical Officer

M. ShafiqurRahman PhD, MPhil, MPH, MBBS, Nadia Cobb MS, PA-C

Bangladesh has a population of over 150 million people with 70% in the rural areas. It is ranked 8th in the world by population density (1). There are 3.5 physicians per 10,000 population (2). The Medical Assistant profession was established in 1979 to increase access to care.

Full project description: 

The Medical Assistant profession was started in 1979 to staff the rural health centers, as well as the Union and Family Welfare Centers. These providers were seen as the primary care providers in the communities alongside other health workers. They are seen as the ‘physicians helping hand’. (3) For about a decade, Medical Assistants have been designated as Sub-Assistant Community Medical Officers (SACMO) in the Family Planning sector under the Ministry of Health and Family Welfare. In the Health sector, Medical Assistants were ascribed the designation of SACMO in 2013.

Bangladesh is a leader in providing free medical services at the community level. The Community Clinics are the most basic level which coordinate with the Union and Family Welfare Centers. The SACMO serves at these levels as well is in the upazila facilities, which provide primary care as well as hospitalization services.

The training of the SACMO consists of 3 years of didactic and clinical rotations. There is a compulsory internship of 12 month after successful completion and testing by the State Medical Faculty of Bangladesh. After the internship the SACMO is registered and overseen by the State Medical Faculty of Bangladesh.

There are currently (as of 2013)7 public and about 134 private sector institutes producing Medical Assistants. In the public sector the total number of intake in the institutes is 2505.(4)In 2013, there were 5411 sanctioned post of SACMO in the public sector of which 4917 were filled up, and the rest were vacant.(5)

In the 2013 Human Resources for Health Country Profile the urban / rural ratio’s of medical doctors and SACMO’s was studied. It was reported that 55% of the medical doctors and 11% of the SACMO were working in urban areas. In the rural areas the distribution was different, with  45% medical doctors and 89% SACMO’s providing care. This made the ratios per 1000 in urban areas 0.239/1000 for medical doctors and 0.020/1000 for SACMOs. In the rural areas the ratio is 0.070/1000 for medical doctors and 0.05/1000 SACMOs.

Further in the 2013 report the SACMO/Medical Assistant is a defined workforce, as a medical practitioner. This is per the WHO South East Asia Regional Office. Unlike many nations this accelerated medically trained clinician type is not defined, and frequently not ‘counted’ although their workforce is wide spread. For human resources for health strategies Bangladesh has carefully taken note of  all the clinician types as well as where they are practicing which will greatly support their efforts to bring health care to all.

The geo-location of health facilities where these workforce are working can be seen in the interactive map.  Clicking the ‘facilities location’ icon in the map will show the types of facilities. 

References:

1. http://www.worldometers.info/world-population/bangladesh-population/

2. Government of the People’s Republic of Bangladesh, Ministry of Health and Family Welfare, Health Bulletin 2014

3. Rahman, M.S., Shaheen, R., Needs in the Curriculum for Medical Assistants’ Training School in Bangladesh: Curriculum Review and Users’ Insight, Journal of Health Management January/June 2003 vol. 5 no. 1 57-83

4. Government of the People’s Republic of Bangladesh. www.mohfw.gov.bd/index.php?option=com_docman&task.

5. Government of the People’s Republic of Bangladesh. http://www.dghs.gov.bd/images/docs/Publicaations/HB_2014_2nd_Edition_060115.pdf

6. Human Resource Management Unit, Ministry of Health and Family Welfare, (2013) People’s Republic of Bangladesh Human Resources for Health Country Profile

 

Image: SACMO demanding higher professional status and other benefits 

This case study relates to:

Case study addresses:

Quality: 
Yes
Quantity: 
Yes
Relevance: 
Yes
Sustainability: 
Yes