The International Covenant on Economic, Social and Cultural Rights General Hospital 9 out of 33 posts including that of senior surgeon of child and ENT are vacant. Many patients are returning home without getting treatment due to lack of doctors (The Daily Star, 24.11.08). Absenteeism poses a chronic, but often unmeasured, problem in publicly financed health care, and can severely limit patient access to services and suggests corruption (DiTella and Savedoff, 2001). A study conducted by UNICEF (1992) showed that our doctors spend 54 seconds per patient at thana hospitals and rural dispensaries; they take 37 seconds per patient to dispense medicine. The qualified doctors are more inclined to ‘moonlight’ in private clinics where government employed doctors maintain a dual obligation with their responsibilities (Sobhan, 1998). Doctors are often criticized for neglecting their duties through absenteeism and private practice during office hours. Such malpractice generally starts from the moment of posting of a doctor to a rural THC or Union Health Centre. They are either unwilling to join, or they make delay within the loopholes of the system. Given the doctors who join the THCs in rural areas being dissatisfied with working conditions and career prospects, they look for alternative ways of earning extra money through private practice and provide service for less time than the scheduled working hours. Neglect of duties of the paramedics and domiciliary staff has also been affecting the policy implementation process (Osman, 2004). No positive affirmative action is seen to resolve this problem. i. Poor Management of Drug and Equipment: Misgovernance is prevailing in the management of drugs and equipment in the public hospitals. A huge quantity of supplied medicine and equipment is left unutilized and unconsumed due to poor management. Very often, it is alleged that doctors encourage the patients to purchase medicine from outside because of the lack of awareness of the medical officer about availability and quantity of medicine stocks in the store. Moreover, physicians are getting bribes from private medicine suppliers. Lack of transparency in management creates scope for the fourth class employees of the hospitals to sell drugs of hospital stores to outside pharmacies (Osman, 2004). Many pharmaceutical/drug shops admit buying medicine from the hospital staff at cheaper rates. Many private clinics admit procuring expensive equipment and supplies 54 from the public sector supply system (Jahan and Salehin, 2006). ii. Flow of Funds: Funds allocated for the health sector are scarce and also are not utilized and managed properly. In many places, bureaucratic problems, corruption and mismanagement lead to inadequate public funds at the point of service and the informal charging of patients. The allocated funds are disbursed very slowly and often at a reduced level. The slow disbursement of funds causes delayed completion and ineffective utilization of funds. In 1993-94, the national health expenditure by both public and private sectors amounted to 3.04 percent of the GNP. It has increased to 3.4 percent in 2003. Public expenditure on health as a percentage of total expenditure on health was 36.5 percent in 1998, which has declined to 25.2 percent in 2002. Government health expenditure as a percentage of the total government expenditure was 6.9 percent in 1998 but it has also declined to 4.4 percent in 2002. In 1998, the total government health expenditure per capita was US $ 4, which has increased to US $ 11 in 2002. iii. Mismanagement in Health Care Service Delivery: Irregularities and poor governance often simply stem from poor management. Where incentives for strong performance either do not exist or are undermined by ineffective management it is not surprising that productivity and performance suffer. Low wages also lead workers to seek additional employment outside government (Lewis: 1955). The promotion path in the Bangladesh public health sector is so long that employees usually retire before getting promoted to the highest level of hierarchy, which demoralizes them. Not only the doctors, but field workers also suffer from such stagnancy of service. There also exists a mismatch in distribution of human resources between urban and rural areas, which has a direct impact on the policy performance (Osman, 2004). Transfer, posting of the health professionals is another problematic area. In the absence of a clear guideline for transfer/posting, patronage and corruption is practised in this area. In many cases, transfer and posting become politically motivated. There is no central training institute for 55