The International Covenant on Economic, Social and Cultural Rights iii. Centralized administration: In Hossainpur is a remote village of Kalapara upazilla in Patuakhali district. There is no health clinic in Bangladesh, health planning is this area. The villagers suffer from various diseases treatment. Some of them often tried to treat solely the responsibility of central without themselves by purchasing some medicines from government. The Ministry of Health nearby pharmacy without consultation with any doctor. Most of them are dependant on kobiraj, or controls the health care system on jhar fook. with de-concentration of some Honufa Begum, a woman of this area, has been power at the local level. None but suffering for a long time from a severe infection of But, she couldn't tell anything to anybody the higher level officials take the uterus. about her disease. Once she became very ill with her decisions that are distant from problem. Abdul Haque, her husband was a poor day labor. He didn't care her problem. Honufa felt very ill policy implementation. Targets with her infection and stay untreated. Annual Monitoring Report (Januaryare set, activities are planned, and Source: December 2008), Sustainable Assistance for Family resources are allocated by the Advancement in Livelihood Project, Speed Trust, Kalapara, Patuakhali. Ministry without much consultation with those who know the local level conditions. For this centralized tendency, over-targeting is a common characteristic of our health sector plan. For example in the fourth five year plan(1990-1995), the target to cover the population under essential health care as % of population was 80, whereas achievement was 45; delivery assisted by trained persons (% of pregnant women) was 50 and achievement only 12; the antenatal care target was set at 60 and achievement 35(Sobhan, 1998). The weak local government system of Bangladesh is acting as the government’s agent rather than representative bodies of the community. They are accountable to the ministry rather than to the people. Centralization of authority at the Ministry acts as a major barrier to ensuring accountability in administration and to formulating a local health authority with adequate involvement of the community. iv. Staffing and absenteeism: Staffing is arguably the single most important element of health care delivery as little can be achieved without it. Training of the staff, their competencies and ability to function all determine whether the expected results can be achieved. Training, typically, is inadequate if not well below that needed in Bangladesh, especially for physicians. Among the most serious issues in Bangladesh is the high rate of absenteeism, which undermines service delivery. Capturing low productivity and poor service poses greater difficulties; absenteeism already reflects reduced 52 output, and underperformance (DiTella and Savedoff, 2001). Bangladesh has only 18 doctors and 5 nurses per 100,000 people. The numbers are among the lowest in the world. As salaries from public hospitals are very low, and many of those doctors and nurses try to find jobs in private clinics, no wonder that public hospitals experience shortage of medical personnel. Therefore, when a patient comes for medical help to the public facilities, it is very often the case that the hospital has no specialists with appropriate skills or knowledge, or there is a lack of staff which can give very basic help( Rashid, Savchenko and Hossain,2005). Most of the public hospitals are Patari Union Health Centre is the only centre for treatment of people of Patari Union under underperforming due to lack of Sapahar Upazila of Naogaon district. The children, regular staff. A report published adolescents, aged men and women from the nearby villages of this Union are dependent on this centre for in the ‘Daily Prothom Alo’, dated health services. But there is no doctor at this centre the last two years. A health associate who doesn’t November 22, 2008 reflects the for regularly present at the centre provides services. sufferings of patients and worse Thus the patients wait from 10 am to 2 pm for the health associate and get back to home without situation in the hospitals. According getting health care and services. The Upazila Health is far from this Union and poor people to the report, the Kustia General Complex cannot afford to go there for treatment. Patari Union Hospital, with 250 beds has the health centre provides some medicines free of cost and some medicines they need to purchase. They provision of 150 doctors, but is run have to buy all medicines which are not given from by 26 doctors. Out of them 8 were the health centre from the Upazila town, which is also difficult for them to afford. transferred in the last six months Source: Barendra Development Organization (BDO) Barendrabhumi Samaj Unnayan Sangstha (BSDO), and no initiative was taken to fill up &Sapahar Appraisal, 2012 the vacant positions. One physician was absent for a long time and another one has been suspended. It becomes very difficult to treat, on average, 450 patients daily. As a result, patients are compelled to seek treatment from outside. In another case, with 109 of the 164 posts of doctors lying vacant in different health centres in Patuakhali district, there are only 55 doctors struggling to cope with health care service for about 1.7 million people in seven upazilas in the district. On average, one doctor is available for every 30,000 people in the district. Dasmina upazila is running with only two doctors as 13 of the 15 doctors’ posts are vacant. In Mirzzaganj upazila 12 of 15, in Kalapara 15 of 18, in Galachipa 21of 26, in Baufal 17 of 23, in Dunki 5 of 9, in Sadar upazila 15 of 18 posts are lying vacant. In Patuakhali 53