More medical colleges won't fix Bangladesh's healthcare

Bangladesh continues to face an inadequate doctor-population ratio per the World Health Organization (WHO) standards. This reality is often cited as the primary justification for establishing new medical colleges across the country. While increasing the number of physicians is undoubtedly important in principle, it is time to critically examine whether this strategy is compatible with the country’s socioeconomic realities and institutional capacity. Pursuing numbers without ensuring the necessary infrastructure and system capacity is likely to produce results contrary to the intended objective.

At present, government and private medical colleges in Bangladesh offer nearly 11,000 MBBS seats, producing around 10,000 new medical graduates every year. The critical question is: can the country’s health system absorb this growing number of doctors?

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Government physicians are recruited through the Bangladesh Civil Service (BCS). A regular BCS recruitment cycle typically takes 2.5-3 years to complete, while even a special BCS usually takes up around 1.5 years. If approximately 5,000 doctors are recruited over three years, nearly 30,000 new doctors would have obtained registration during the same timeframe, leaving around 25,000 outside the government health system.

On the other hand, most private hospitals and clinics in the country have been developed around a limited range of routine surgical services, primarily Caesarean sections, gallbladder surgery, hernia repair, and appendectomies. These small and medium-sized hospitals largely depend on specialist physicians employed in the public sector. As a result, stable employment opportunities for newly graduated MBBS doctors remain extremely limited.

This severe mismatch between the supply of and demand for doctors has pushed physicians’ remuneration to an alarming low. Many young doctors, while preparing for postgraduate examinations, work at private hospitals in major cities on an on-call or contractual basis. They are often paid only Tk 2,600-4,000 for a continuous 24-hour emergency and inpatient duty shift. Such extreme undervaluation of highly skilled professionals reflects a profound neglect of some of the nation’s brightest talents by both the state and society.

Political influence and local lobbying have played a significant role in establishing many medical colleges across the country. Almost every influential local leader seeks to found a medical college in their constituency, believing it will improve healthcare services for residents. This assumption is fundamentally flawed. A medical college is primarily an educational institution, not a dedicated mass healthcare facility. Its affiliated teaching hospital exists primarily to provide hands-on clinical training for medical students. International standards require an adequate number of hospital beds and a sufficient patient load for effective medical education: for example, approximately 500 teaching beds for every 100 medical students. In Bangladesh, however, teaching hospitals have increasingly been treated as healthcare providers for entire regions. Consequently, district and upazila hospitals have gradually lost both their importance and institutional focus.

If the objective is genuinely to improve healthcare access for local communities, upgrading district hospitals with adequate patient capacity, staffing, equipment, and functional services would be a far more practical, efficient, and timely solution. By contrast, establishing and fully operationalising a new medical college often takes several years, frequently extending beyond the tenure of the policymakers who initiate the project. Medical graduates are fundamentally different from graduates of most other academic disciplines. Even minor deficiencies in medical education can directly affect patient safety and human lives later on.

Unfortunately, the reality inside many newly established, and even some older, medical colleges is deeply concerning. Many institutions lack adequate faculty members in foundational disciplines such as anatomy, physiology, microbiology, and pharmacology. Consequently, students are graduating and entering clinical practice without gaining sufficient education in core medical sciences. Several medical colleges, such as those in Magura, Netrokona and Rangamati, still don’t have permanent campuses or fully functional teaching hospitals. Students from Rangamati travel to Chattogram for practical training, while students in Sunamganj have staged protests because, even though academic buildings have been built, their teaching hospital remains non-functional. Despite securing admission through highly competitive national examinations, many talented students are deprived of qualified instructors, student accommodation, laboratories, and an appropriate academic environment. Nevertheless, they graduate and receive licences from the Bangladesh Medical and Dental Council (BMDC).

This raises a profound ethical question: who will ultimately receive treatment from doctors whose medical education has been compromised by systemic deficiencies? The answer is obvious: the ordinary people of Bangladesh.

Those who approve these institutions or formulate national health policies rarely rely on such facilities for their own medical care. Even for relatively minor illnesses, they often seek treatment in Singapore, Thailand, or leading corporate hospitals in Bangladesh. During the interim government’s tenure, the public witnessed substantial state expenditure on overseas treatment for influential individuals. Policymakers themselves often don’t place their trust in the healthcare system they oversee.

To break this self-defeating cycle, the government must urgently adopt several firm and practical policy measures.

First, admissions should be suspended to any medical college that lacks a permanent campus, academic buildings, qualified faculty, and a teaching hospital that meets internationally accepted standards for bed capacity and clinical training.

Second, students currently enrolled in institutions with inadequate infrastructure and faculties should be transferred to nearby, better-equipped medical colleges—for example, from Magura to Jashore—to safeguard the quality of their education and future professional competence.

Third, although new medical colleges may receive policy approval, student admissions must not begin until the project proposal has been fully implemented, ensuring complete physical infrastructure, modern laboratories, teaching hospitals, and the recruitment of qualified faculty.

A medical college is not an ordinary school where classes can begin in a temporary building with limited resources while waiting for future improvements. Medical education demands rigorous standards from the very beginning because its graduates will ultimately be entrusted with human lives. By producing licensed physicians from institutions lacking adequate educational quality and without simultaneously ensuring meaningful employment opportunities, we are pushing Bangladesh’s health sector towards long-term and potentially irreversible decline. Today’s graduates from weak educational foundations will become tomorrow’s specialists, medical educators, and policymakers.

Unless this cycle of poorly planned medical college expansion is halted, the future of Bangladesh’s healthcare system will remain deeply uncertain. The current government has the opportunity and responsibility to break this cycle and formulate a sustainable, high-quality policy for medical education that prioritises excellence over expansion.

Dr Syed Abdul Hamid is professor in the Institute of Health Economics at Dhaka University.

Views expressed in this article are the author's own. 

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