75% of health workers serve 38% of urban population, study finds

Despite only 32-38% of Bangladesh's population living in urban areas, nearly 75% of the country's health workforce is concentrated there, while the 62-68% living in rural areas are served by just 25% of health workers, according to a new study.

The findings, presented today (18 June) at a programme organised by the National Institute of Population Research and Training (Niport), suggest Bangladesh's healthcare challenge stems more from workforce distribution than an overall shortage of trained personnel.

The study, titled "Potentials of Health Workforce for Harnessing Demographic Dividend in Bangladesh: Opportunities, Challenges and Policy Implications," was conducted by the Department of Population Sciences at the University of Dhaka.

Distribution crisis

Bangladesh has only 12.78 health workers per 10,000 people, far below the World Health Organization's recommended 45.5. The country's doctor-nurse-midwife ratio stands at 1:0.74:0, compared with the WHO benchmark of 1:3:5.

Yet the study found Bangladesh has more doctors than the minimum required by WHO standards. Against a requirement of 88,906 doctors, the country currently has 1,29,629 doctors, or 0.72 per 1,000 people. With 136,895 doctors having graduated by 2026, researchers estimate a surplus of around 8,000 doctors.

However, only 0.18 of the country's 0.73 registered doctors per 1,000 people are employed under the Directorate General of Health Services (DGHS). Meanwhile, 28.6% of posts across health directorates remain vacant, including 22.5% of doctor positions.

Mismatch in workforce planning

The study highlighted major imbalances in employment and workforce composition. Around 68% of doctors reported remaining unemployed for at least 12 months after completing postgraduate studies.

Nurses face the opposite challenge. Bangladesh has only 0.549 nurses per 1,000 people against the WHO benchmark of 1.48, leaving a shortage of about 165,552 nurses. Although 113,126 nurses had graduated by 2026, the country still faces a deficit of nearly 150,000, while around 16,000 nurses remain unemployed.

Researchers also raised concerns about medical education quality. Of the country's 116 private medical institutions, 77 account for 60.27% of doctor graduates and 81.05% of nurse graduates.

Untapped overseas opportunities

The study found Bangladesh is failing to capitalise on overseas employment opportunities for health workers. Although 60-69% of graduates are aware of opportunities abroad, only 9.5% of doctors, 3.3% of nurses and 4.9% of medical technologists have taken language certification exams. Researchers recommended establishing a Foreign Information Desk for Job Placement Abroad at public and private medical college hospitals.

Speaking as the chief guest, State Minister for Health Dr MA Muhit said the country's doctor-population ratio is not inadequate and that the main challenge is distribution. He noted that most doctors are concentrated in cities and many work outside the government system. He also called for increasing the number of nurses and midwives and improving opportunities for physiotherapists.

Director General of Health Services Prof Dr Provat Chandra Biswas said efforts are underway to encourage city-based doctors to serve in rural areas, and that incentives for grassroots-level doctors would be increased.

A second study on health workers' preparedness to manage epidemics was also presented at the event.