Gender disparity in the physicians in public sector in Bangladesh: a mixed-method exploratory study

Abstract

Abstract Background Gender equality is needed in health service delivery systems to support universal health coverage (UHC). Women are reluctant to visit male doctors for medical problems. However, number of female doctors is inadequate in many low and middle income countries (LMICs) which is a challenge for establishing gender-sensitive health system. We explored the production and distribution of female physicians in the public sector in Bangladesh to support policy for actions. Methodology This is a mixed-method exploratory study using documentary review; Key Informant Interviews and secondary data analysis. Multiple stakeholder consultations and a policy dialogue were organized to validate the study findings. Results An increasing trend of female medical students was observed since 2011 in admission. In 2018, out of total 5528 students enrolled, 54% were female whereas 46% were male. However, fewer female doctors were enrolled in the public service compared to their male peers. The male-female ratio was almost 2:1 in the public sector. Out of 471 sub-district health managers, 52 were female; out of 64 district health mangers only one was female; and out of 8 Division Directors only one was female. Female doctors reported to face practical problems in rural settings with regard to housing, safety and security. There is no provision of deploying married couples at the same or nearby health facilities. All these compelled female doctors to quit rural posting or even the government service. Moreover, female physicians prefer certain specialties such as obstetrics and gynaecology, medicine and certain basic subjects which may create more gender imbalance in service delivery system. Conclusions In adequate number of female physicians in public sector and their retention in rural areas is a major concern for the health systems in Bangladesh. Policy attention is needed to take necessary steps to make gender-responsive health systems to improve health service to achieve UHC. Key messages Poor presence of female physicians in deployed doctors in public sector in Bangladesh creates problems in health service delivery and is becoming a major concern for the health systems in Bangladesh. Policy needs to take remedial measures to make women-friendly working environment in the public sector hospitals in Bangladesh to provide health service delivery for all leaving no one behind.