Analysis of Private Hospitals in Bangladesh

Submitted by: ID

SaahirMahbub 1110091030

AhnafTahmedFaiz 1110174530

Joy Saha 1030687030

Md. Faisal Ibna Awal 0930590030

Pratik Majumdar 1010163030

Submitted to:

Dilara Afroz Khan (DAK)

Course: Bus401, Section 2

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Table of Content

1. Introduction..............................................................................................................................3
2. Overview of the companies......................................................................................................4
3. Revised Labor Law..................................................................................................................8
4. Code of Ethics of the Industry................................................................................................12
5. Questionnaire..........................................................................................................................14
6. Data Presentation with Analysis.............................................................................................16
7. Recommendations..................................................................................................................26
8. Conclusion..............................................................................................................................27
9. References..............................................................................................................................28
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1. Introduction
According to the British Medical Journal Lancet, the pace of growth of Bangladeshs health

sector is most striking among South Asian countries despite spending less on this sector than

several neighboring countries. In its recent issue, the influential journal says Bangladesh made

enormous health advances despite a difficult start after 1971 War of Independence. Researchers

were particularly impressed with Bangladeshs achievement as they pointed out health systems

are complex and no simple recipe exists for success. It attributed the success in cutting

mortalities as well as the rate of childbirths to the high-level political commitment to health since

independence, the ability to innovate and adapt to resource limitations, transport infrastructure,

female empowerment and education. For Bangladesh, it says the high-level of political

commitment in health has endured despite major political changes, including transition from

military to civilian rule. In specific they identified four health policies in Bangladesh for the

striking success. First, they noted prioritizing family planning in the population policy. A

separate directorate was created within the ministry of health and family welfare that secured

sustained investment and developed innovative community-based interventions.

Second, the first drug policy in 1982, that Lancet says, established a list of mainly generic

essential drugs, and the Gonoshasthaya Kendra NGO provided a model for small-scale

integrated primary care.

After the drug policy, the government established an essential drugs company in 1983 to produce

and distribute drugs within the public sector. This investment eventually led the booming of

private pharmaceutical industry, Lancet says, by the 1990s, more than 80 percent of essential

medicines were produced locally resulting in price stability that ensured essential medicines are

affordable.

The journal also noted the governments effort to coordinate donors projects by introducing
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sector-wide approach in 1998. The third policy it noted was the human resources particularly the

creation of health assistants and family-welfare assistants. The Lancet says Bangladesh also

pursued progressive policies outside the health sector, including education and female

empowerment. Strengthening of the transport infrastructure and widening of access to electronic

media facilitated access to health facilities and information. Bangladesh's disaster preparedness,

based on inter-sectoral planning, has also improved health system resilience.

2. Overview of the companies

Square Company:

Square group of industries have decided to launch their new service providing company Square

Hospitals Ltd. to serve the people of Bangladesh. Before that, Square Group of Industries has

served Bangladeshis by providing medicine from their Square Pharmaceuticals Ltd. organization.

Now they are going to open brand new private hospital in the heart of Dhaka City. They are

targeting the upper class people to serve their best services. Although they are providing some

packages for the upper middle class people who can afford this services. Their main goal is

Deliver QUALITY health care within 5 CORE standards. Square provides health care services.

There is various kind of health care centre for different kind of patient. They feature with the

health problem of the particular patient:

Square heart Center

Intensive Care Center

Safe Surgery Center

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Radiology and Imaging Center

Pathology and Lab Center

Liver and Gastric Center

Women Center

Pediatric and Neotology Center

Execuchek Center

Fertility Center

Orthopedics and Trauma Center

Skin and Laser Center

Oncology and Radiotherapy Center

There are also some facilities for the patient. They are following:

Accommodations

Meal Provision

Pharmacy

Cafeteria
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Roof Top Garden

Room Category

Play Ground

Bill of Rights

Apollo Hospitals: Apollo Hospitals Dhaka has all the characteristics of a world-class

hospital with wide range of services and specialists, equipments and technology,

ambience and service quality. The hospital is a showcase of synergy of medical

technology and advances in IT through paperless medical records. The skilled nurses,

technologists and administrators of Apollo Hospitals Dhaka, aided by state-of-the-art

equipments, provide a congenial infrastructure for the medical professionals in providing

healthcare of international standards. Dedicated to providing multidisciplinary medical

care and backed by state-of-the-art facilities, Apollo Hospitals Dhaka offers team-based

quality patient care that is widely acknowledged to be amongst the best in Bangladesh. At

Apollo Hospitals Dhaka, patients have ready access to more than 29 specialized

departments and services, which are established as national referral centers. We have five

Centers of Excellence and five Strategic Business Units. Modern lithotripsy service, i.e.

the treatment of kidney and ureter stones without surgery, is provided by the hospital

using extracorporeal shock wave. The hospital also offers a complete Dialysis Unit for
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the treatment of patients with kidney disorders. The hospital has 1.5 Tesla MRI, 64 Slice

CT Scan, Color Doppler, Ultrasound, and Gamma Camera, which have created the most

modern Radiology and Nuclear Medicine service in the country, with equipment that is

faster and capable of conducting a wide range of examinations with a higher degree of

detail. This is in addition to EEG, EMG, neurophysiology, ECG, stress test, pulmonary

function test, etc. Our international standard Lab Medicine conducts External Quality

Control Program with Bio-Rad, USA and offers a variety of modern tests and diagnostic

tools, some of which are not available anywhere else in Bangladesh, with regular

additions.
United Hospital : United Hospital Ltd was borne out of a vision to provide a complete

and one-stop healthcare solution to the people of Bangladesh. Opening its doors in

August 2006 and situated besides the picturesque Gulshan Lake, this hospital is one of

the largest private sector healthcare facilities in Bangladesh. With a capacity to house

over 450 patients and established across a total covered area of over 400,000 sft, the

hospital has 11 state of the art operation theatres to cater to the needs of our varied patient

base. Our departments of cardiology, gynecology, orthopedic and pediatrics are staffed by

the most esteemed doctors in their respective fields. As an example, a glimpse at our

cardiology department would reveal that till date we have conducted over 2300 open

heart surgeries and over 8300 angiograms and angioplasty operations. Thats over 12

heart related surgeries per day alone since our inception. With our technology and their

expertise, and with the support of our friendly staff, we strive each day to be the number

one healthcare provider, not only within Bangladesh but within the Asia-Pacific region.
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3. Revised Labor Law

Under domestic and international pressure, on July 15, 2013, the Bangladeshi parliament enacted

changes to the Labor Act. The impetus for a reformed labor rights law sprang from the collapse

of the Rana Plaza building in greater Dhaka in April, which killed more than 1,100 garment

factory workers. The Rana Plaza tragedy followed many other workplace tragedies that resulted

in large loss of life. Bangladesh has ratified most of the core International Labor Organization

labor standards, including Convention No. 87 on freedom of association and Convention No. 98

on the right to organize and bargain collectively. However, important sections of the Labor Act

still do not meet those standards. The new amendments deal with only some problematic

provisions of the existing law, while leaving others untouched. For example:

At least 30 percent of the workers in an establishment, which can comprise many

factories, would still have to join a union for the government to register it.
Unions will be allowed to select their leaders only from workers at the establishment.

This will enable employers to force out union leaders by firing them for an ostensibly
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non-union-related reason, a common practice globally. Workers in export processing

zones, which cover a large percentage of Bangladeshs work force, would remain legally

unable to form trade unions.

The amended law adds more sectors, including non-profit education and training

facilities, as well as hospitals, clinics and diagnostic centers, to a lengthy list of types of

employment in which workers are not permitted to form unions. The right to strike will

remain burdened by a cumbersome bureaucratic process and the requirement that two-

thirds of the unions membership would have to vote for a strike, a small improvement

over the previous requirement of three-quarters of the membership.

The government will be able to stop a strike if it decides it would cause serious hardship

to thecommunity or is prejudicial to the national interest, terms that are not defined

but can easily be misused. Discriminatory anti-strike provisions in the law favor foreign

investors by prohibiting strikes in any establishment during the first three years of

operation if it is owned by foreigners or is established in collaboration with foreigners.

The amended law also seeks to redirect attention to so-called Participation Committees

and Safety Committees, largely powerless bodies made up of management and

workers. Workers at non-union workplaces would directly elect their representatives to

Participation Committees and Safety Committees, which would be created in factories

with more than 50 workers. However, the role of these committees is not clearly defined.

Both types of committees fulfill duties that should be handled by a union acting as the

duly organized and elected representative of the workers.

The revised Labor Act could also have a major negative impact on unions by expanding

government control over unions access to foreign funding. The law would require prior approval

from the Labor and Employment Ministry before either trade unions or employer organizations
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could receive technical ,technological, health & safety and financial support from international

sources. By controlling access to foreign funding, the government would have a stranglehold

over assistance to unions, just as it has with devastating effect over other nongovernmental

groups. The law contains important provisions prohibiting discrimination based on sex and

disability, including equal wages for equal work. However, the revised law includes no measures

to tackle sexual harassment of women, who make up the vast majority of workers in the ready-

made garment sector, Human Rights Watch said. In offering amendments to the labor law, the

government has missed an important opportunity to carry out 2009 High Court guidelines against

sexual harassment in the workplace. The government has failed to develop specific regulatory

rules to carry out various provisions of the previous law, adopted in 2006, raising concerns about

its willingness to implement new measures. For instance, the government has failed to carry out

adequate factory inspections. The International Trade Union Confederation (ITUC) estimated in

2008 that the country had as few as 80 inspectors. The Bangladesh government, European Union,

and International Labor Organization recognized this problem in a memorandum of

understanding signed on July 8, 2012, which called for recruiting an additional 200 inspectors

before the end of 2013. It set a long-term goal of upgrading the Department of the Chief

Inspector of Factories and Establishments to a Directorate with a strength of 800 inspectors,

having an adequate annual budget allocation, and the development of the infrastructure required

for its proper functioning.In the proposed law, the group insurance of the workers has been made

mandatory for companies with minimum 100 workers. The cabinet secretary said in the case of

the death of a worker, the employer will realize the insurance claim from concerned insurance

company and hand over the money to the dependent of that worker directly. As per the new law,

he said, a worker with minimum 12 years of service length would get one-month gratuity for
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every year of service at the time of retirement or leaving the job. However, in the case of more

than 12 years of service, he/she would get one and a half months gratuity for every year of

service at the time of retirement or leaving job. The cabinet secretary said the law has a provision

to keep consistency between the structural design and outlay of a factory, while welfare fund will

have to be constituted for the workers of the export-oriented garment industries. In the proposed

law, he said, there are provisions of healthcare facilities, direct payment of salary through

account, NGOs and trade union dealings, seeking assistance of experts by the CBA and the

participation committees. The cabinet secretary said the council of ministers also Okayed in

principle the draft of the Bangladesh Council of Scientific and Industrial Research (BCSIR) Act,

2013 to replace the 1978 ordinance in this regard. The ordinance of 1978 automatically scrapped

following the annulment of the Fifth Amendment to the constitution by the apex court. The

existing law of the BCSIR, a traditional research organization, was enacted in English in 1978

and now it will be made in Bangla. Besides, some new definitions have been added to the

proposed law. The bill was passed keeping the provisions of allowing trade unionism in factories,

ensuring safety measures for workers at their workplace, introducing compulsory group

insurance and stopping children to be involved in hazardous works. To make the law time-

befitting, a total of 87 sections of the 2006 labour law, first of its kind in the country, have been

amended. According to the amendments, employees would no longer need approval from factory

owners to form trade unions. With the passage of the bill, workers would just need to apply to the

labour directorate for authorization The amendment also allows trade unions to be formed in the

different administrative wings of a factory, something not permitted under the existing law. The

law stipulates that 5% of annual profit be deposited in provident and welfare funds. It also has
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the provision of paying compensation for the workers in case of their death, termination from

services and accidental deaths during duty hours.

4. Code of Ethics of the Industry

Healthcare ethics represent moral values that are generally regarded as acceptable by society.

Certain medical professions, such as physicians, have a code of ethics that is expected to be

followed by every member of the industry. Hospitals and large healthcare systems often have a

code of ethics that they expect all members of their staff to follow related to the health, safety,

and well-being of patients and family members. In general, ethics are a standard of behavior. The

standards of conduct are summarized below.

Treat all patients with dignity and respect at all times

Listen to patients, families, visitors to understand any concern or complaints and

involve patients in the decision making process about their care

Continually monitor the clinical quality of the service and strive to improve the

quality of service provided

Protect our patients from real or perceived mental, physical, sexual or verbal abuse,

neglect, or exploitation from anyone, including staff, other patients, visitors or family
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members. We will immediately report any alleged abuse, neglect or exploitation to a

supervisor.
Respond to patient questions, concerns, and needs in a timely and sensitive manner.
Respond to patients safety concern, questions and needs more quickly and efficiently
Not offer, accept, or provide personal gifts or favors, such as tips meals,

transportation, or entertainment that create a conflict of interest.

Not use the position, or knowledge gained in the position, in any way that could

personal benefit
Prohibit unauthorized sales and solicitation of orders for any type of product or

service to anyone
Comply with all applicable laws, regulations and policies and procedures that govern

employment matters.
Provide equal employment opportunities to employees and applicants for

employment and require that all employment actions be made without regard to

color, race, religion etc

Not knowingly communicate or transfer any information or documents to any

unauthorized persons.
Safeguard the personal and human resources information of our employees and

information retained within the human resources system as required by law.

Not falsify or inappropriately alter information on any record or document.
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5. Questionnaire
Q1. Are you satisfied with the quality of service hospitals provide?

a) Yes
b) NO

Q2. Do the doctors and other stuff members of the hospital communicate openly about the matter to the
people so that you are clear about the problem?
a) Yes
b) No
c) Others

Q3. Do you have to pay extra money for the cabin or bed?

a) Yes
b) No

Q4. What do you think about the quality of food provided by the hospitals?

a) Satisfactory
b) Neutral
c) Very satisfactory
d) Unsatisfactory

Q5. How is the environment of the hospital?

a) Good
b) Poor
c) Bad
d) Very good

Q6. Do doctors prescribe unnecessary medicines and tests so that they can get commission?

a) Agree
b) Neutral
c) Disagree

Q7. Do you think doctors and nurses neglect patients as they are busy with their own work or gossiping
with each other?

a) Disagree
b) Neutral
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c) Agree
d) Partially Agree

Q8. Are you satisfied with the performance of nurses and ward boys?

a) Yes
b) No

Q9. Do you think doctors accept bribe in order to get extra privilege?

a) Yes
b) No

Q10. Do the doctors and other staff members treat you and your family with dignity?

a) Yes
b) No
c) Others _______________________________________________________________________
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6. Data Presentation with Analysis

Q1. Are you satisfied with the quality of service hospitals provide?

c) Yes
d) NO

Are you satisfied with the quality of service hospitals provide?

25

20

15
Number of respondents
10

0
Yes No

Our main research analyses were about the healthcare industry and chose Apollo, United, &

Square as a sample to determine the services provided by these leading hospitals. Our total

sample size was 39. From these hospitals, we got our results and presented our findings on a

column chart.

From the graph, it can be seen that 22 people out of 39 answered yes and satisfied with the

quality of service these hospitals are providing. They said that they are happy with the service

and doctors are treating them pretty well. On the other hand, 43.5 % of the respondents are

dissatisfied with the service and claimed that doctors dont come on time and make them wait for

long periods.
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Q2. Do the doctors and other stuff members of the hospital communicate openly about the
matter to the people so that you are clear about the problem?
a) Yes
b) No
c) Others

Do the doctors and other staff members of the hospitals communincate openly about the matter to the people so that they can be clear about the problem?
25

20

15

Number of respondents
10

0
Yes NO Others
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The next question was about the doctors and other staff members communicating to the people

so that they can be clear about the problem. All the findings are given above and described

below.

It can be seen that 38.4 % of the respondents agree that doctors and staff members communicate

openly about the matter to the people. In this way, all their problems, any queries, confusions are

getting cleared and are satisfied with their behavior too. However, 53.8 % of the respondents

dont agree at all. They said that doctors and staff members mislead them at times and sometimes

behave rudely with them. Thereby they face lot of problems and dont get their desired service

from them.

Q3. Do you have to pay extra money for the cabin or bed?

c) Yes
d) No

Do you have to pay extra money for the cabin or bed?

25

20

15
Number of respondents
10

0
Yes No
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This question was about paying extra money for the cabin or bed. All the findings are given

above and described below.

From the graph, it can be seen that 58.97% of the respondents claimed that they had to pay

extra money for the cabin or bed. Paying this high extra money is beyond the means of

common people. Not many people can afford to pay this extra money if one wants to have

access to a cabin or bed. However, 41.02 % of the respondents said that they dont have to pay

extra money for the cabin or bed.

Q4. What do you think about the quality of food provided by the hospitals?

e) Satisfactory
f) Neutral
g) Very satisfactory
h) Unsatisfactory
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What do you think about the quality of food provided by the hospitals?
16
14
12
10
8
6
4
Number of respondents 2
0

The next question was about the quality of the food. All the findings are described above and

described below.

From the graph, it can be seen that 15 respondents out of 39 said satisfactory about the quality of

the food provided by hospitals. 20.5% of the respondents are very much satisfied and happy

about the quality of food. There were some respondents who did not wish to comment and

decided to stay neutral. On the other hand there were respondents who are very much not all

satisfied about the quality of food at all i.e. around 20.5 %.

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Q5. How is the environment of the hospital?

e) Good
f) Poor
g) Bad
h) Very good

How is the environment of the hospital?

25

20

15
Number of respondents
10

0
Good Poor Bad Very good

This question was regarding the environment of the hospital. All the findings are given above

and described below.

From the graph it can be seen that 56.41% of the respondents said good about the environment of

the hospital. They said that the environment over there is very neat & clean. 25.64% and 10.25

of the respondents said poor and bad respectively. The percentage over here is so small indicate

that they went on the day when the hospital wasnt properly cleaned and had few dust and dirt

lying everywhere. The rest said very good and was very much satisfied to see a clean and tidy

environment.
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Q6. Do doctors prescribe unnecessary medicines and tests so that they can get commission?

d) Agree
e) Neutral
f) Disagree

Do doctors prescribe unnecessary medicines and tests so that they can get commision?
25

20

15
Number of respondents
10

0
Agree Neutral Disagree

The above is a column chart which shows the different results of how the total number of

respondents has answered to the question Unnecessary medicines and tests.

As it can be seen that the highest number of respondents goes to the option of Agree with 22

respondents choosing this option. 30.7% of respondents chose neutral and declined to comment.

Only a mere 12.82% have disagreed completely.

Therefore out of total sample of 39, majority have agreed that hospitals do charge them and make

them accounted for unnecessary tests and medicine. Thus we can say hospitals are involved in

such kind of unethical practices.

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Q7. Do you think doctors and nurses neglect patients as they are busy with their own work or
gossiping with each other?

e) Disagree
f) Neutral
g) Agree
h) Partially Agree

Do you think doctors and nurses neglect patients as they are busy with their own work or gossiping with each other?
16
14
12
10

Number of respondents 8
6
4
2
0
Disagree Neutral Agree Partial y Agree

This question is about the doctors and patients neglecting with their own work or gossiping with

each other.

This chart shows that majority of the respondents chose the option Agree and are not really

happy with the way doctors neglect them. They also claimed that doctors spend majority of the

time gossiping with each other. 33.33% of the respondents said partially agree. Only a mere

10.25% & 20.5% of the respondents chose the option disagree and neutral respectively.
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Q8. Are you satisfied with the performance of nurses and ward boys?

c) Yes
d) No

Are you satisfied with the performance of nurses and ward boys?
30

25

20

Number of respondents 15
10

0
Yes No

The column chart shows the performance of nurses and ward boys. All the findings are given

above and described below.

From the graph, it can be seen majority of the respondents are not at all happy with the

performance of nurses and ward boys. It can be said that the hospitals have the lowest quality of

nurses & ward boys. They lack proper skill and dont have proper training to deal with the

equipments and also dont know how to treat the patients. Only a mere 28.2% of the respondents

chose the option yes.

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Q9. Do you think doctors accept bribe in order to get extra privilege?

c) Yes
d) No

Do you think doctor accept bribe in order to get extra privelege?

25

20

15
Number of respondents
10

0
Yes No

The next question is about the doctors accepting bribes to get extra privileges. All the findings

are given above and described below.

From this chart, it can be seen that majority of the people agree that doctors accept bribes so that

patients can avail extra privileges. The doctors over there dont attend patients so seriously.

Therefore if they do get bribes, then they can help patients to get extra cabin or bed or even give

them special treatment. On the other hand 43.5% of the respondents dont agree at all and claim

that these 3 hospitals have strict law enforcement which eventually eliminate the extra bribes.
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Q10. Do the doctors and other staff members treat you and your family with dignity?

d) Yes
e) No
f) Others
______________________________________________________________________

Do the doctors and staff members treat you and your family with dignity?
25

20

15
Number of respondents
10

0
Yes No Other

This charts talks about the doctors and staff treating patients and family with dignity. All the

findings are given above and described below.

It can be seen that majority of the respondents i.e. 51.28% agree that doctors treat them with

respect and dignity. They are happy with the way the doctors treat them and look after their well-

being. On the contrary, 43.58% of respondents completely disagree and even asserted that

doctors at times did not treat them very well at all.

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7. Recommendations

Based on our analysis, we already noticed that doctors dont communicate openly

regarding any matter to the patients. Therefore doctors and other staff members

are advised to treat their patients nicely and should always be there in case they

face any problem or any dilemmas from the hospital. After all it is patients right

to get proper treatment and service from hospitals.

In this case it is better for the private hospitals not to charge extra money if the

patients want to avail any extra bed or cabin. Not many people can afford this

extra high charge fee.

It is the right of every patient to get the proper and timely service from the doctor,

as they are spending money for it. However doctors are neglecting them and are

usually seen spending most of the time gossiping among themselves. So the

authority should form a strict code of conduct and should penalize the anyone

who are found guilty of neglecting their patients during their working hours.
The authority should take strict action if any doctors found guilty of accepting

bribes.
The hospitals should have a proper training program and a screening process

before hiring the nurses and the ward boys.

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8. Conclusion

Healthcare is now the leading industry in Bangladesh. There is growing public

expectation for health care institutions to provide quality services. For the betterment of

hospitals, code of ethics should be maintained properly. Ethical behaviour in the health

care industry is essential and desirable; however, determining which behavioural actions

are ethical and which are unethical is difficult. Although never will everyone agree on

specific ethical standards, everyone should agree that setting ethical standards is vital.

Therefore, administrators of health care institutions and health care providers should

work together to establish codes of ethics which define boundaries for ethical behaviours

in the health care industry. In our country a doctor must always maintain the highest

standards of professional conduct. A doctor must practice his profession uninfluenced by

motives of profit.
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9. References

(n.d.). Retrieved April 12, 2014, from http://bdnews24.com/health/2013/07/20/bangladeshs-

health-sector-growth-striking

(n.d.). Retrieved April 22, 2014, from http://www.mole.gov.bd/index.php?

option=com_content&task=view&id=475&Itemid=543

(n.d.). Retrieved April 24, 2014, from http://www.ncbi.nlm.nih.gov/pubmed/10157835

(n.d.). Retrieved April 17, 2014, from http://www.bma.org.bd/index.php