The International Covenant on Economic, Social and Cultural Rights providing in-service refresher training for all categories of health personnel (Osman, 2004). iv. Weak Management and Coordination Network: The management of the tertiary health care centers, i.e. district hospitals, medical college hospitals and referral hospitals is a major issue in public health governance. Abuse of trade unionism by the lower level employees makes the situation worst. Maltreatment of poor outdoor patients by the medical staff is very common. The class III and IV employees in every district level and medical college hospital are so strongly organized that doctors and hospital administration appear helpless to control them. They build homesteads in the open spaces within the hospital campus and also rent space to outsiders. Thus the whole environment of the hospitals has become unhygienic both physically and socially. These protected slum-like enclaves are safe havens for criminals in most of the medical colleges and district hospitals. Taking appropriate action against these unauthorized occupants was never taken seriously, and if, as seldom happened, plans were made to remove them, these failed due to lack of coordination between different executive bodies of the government (Sobhan, 1998). Payment of unofficial fees in these hospitals is very common. While official fees are minimal, patients are paying out substantial sums as unofficial fees, in the form of bribes and payments to staff to ensure that they receive the services they are technically eligible to receive free of cost (ibid). Sanitation facilities in the public hospitals are very poor. Food supply to the patients is another area of mismanagement and misuse of resources. Both the quality and quantity of food are inadequate to the needs of the sick. Lack of coordination among different levels of service creates duplication and dichotomy. Insufficient coordination between the Ministry and the Health Directorate has often created bottlenecks and unnecessary constraints and duplication of work. The Director General of Health Services and Health Ministry both oversee personnel matters including posting 56 and transfer of all class 1 Officers, resulting in dichotomy, duplication and delay in decision making (Hye, 1985 cited in Osman, 2004). Unfortunately, there is no well defined role for the MOHFW to intervene in important health related issues in the sectors controlled by other ministries. Nor is there any meaningful co-ordination among the executive bodies, particularly ministries, to monitor public health. People suffer from lack of health services information. A well co-ordinated public health system is not available to the public (Sobhan, 1998). Moreover, the institutional arrangement for implementing health programmes in Bangladesh seriously suffers from the absence of an effective information flow. The entire administration is still mostly paper based. Shortage of data means that evaluating the programs and correcting actions is difficult. Lack of coordination within units of the Ministry of Health, lack of co-ordination between different ministries, lack of sufficient ICT facilities in all levels, inadequacy of trained manpower including inappropriate placement, inadequacy of up to date data and often unreliable data, inadequate use of health information at policy level, are acting as impediments to good governance. 3.4 Right to Work: The Bangladesh Constitution, in Article 20, acknowledges ‘work as a right’ but does not guarantee to ensure this right. It has developed a number of policies including the National Labor Policy, the Domestic Worker conduct and Welfare Policy, the Occupational Safety and Health Policy, but all these policies are in draft form. Since the policies are drafted in the lens of the normative framework of the ICESCR and the General Comment no. 18 and 14, this study emphasizes the finalization of the policies and their implementation rather than researching the gaps which are not remarkable. However, in absence of the approved policies, the present scenario of ‘right to work’ in Bangladesh is discussed below. The generic state obligation under the right to work policy includes the state’s obligation to respect, protect and fulfill each person’s access to work to earn one’s living and the obligation to guarantee that this work 57