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Steering Committee in the ministry -- that too after about 10 months since the technical committee approved the document.

According to DGHS officials, the delay for implementation was because the approved plan did not have the budgetary proposal for executing the tasks. The 2022-2026 plan now has a proposal for allocating around Tk 900 crore, according to DGHS officials.

NOT ENOUGH DOCTORS

The proposed drug act has a provision of fining Tk 20,000 for selling antibiotics and antimicrobials without receiving a prescription from a Bangladesh Medical and Dental Council (BMDC) registered doctor.

However, due to a massive shortage of doctors, the majority of the population go to quacks or the nearest drug store for healthcare advice, experts said.

There are around 1,04,644 registered doctors, according to the recently published Human Resources for Health datasheet of 2022. Of them, around 25,000 work at public hospitals. A 2011 study in Cox’s Bazar found that 67 percent of patients in Chakaria upazila went to quacks for their first line of care.

The survey calculated that 250 registered doctors are needed to serve Chakaria. Currently, there are 13 doctors at Chakaria Upazila Health Complex.

“Containing AMR requires an all-out and multifaceted approach. All community clinics should have at least an assistant doctor,” said Prof MA Faiz, former DG of DGHS.

NO LABS, PHARMACISTS IN HOSPITALS

Faiz said not having designated microbiology laboratories is a big weakness of public hospitals.

“At least all medical college hospitals [117] should have a well-equipped microbiology laboratory with the capacity to meet patients’ diagnosis needs,” Faiz said.

Hospitals, moreover, lack antibiotic waste-management and good pharmacy practices, according to health officials.

Besides, there are no graduate pharmacists for counselling patients and auditing prescriptions. The issue of medicine quality has not received proper attention during discussions on AMR, said experts.

“If the quality of medicines is not ensured and medicine wastes are not managed properly, only stopping irrational use will not be fruitful in containing AMR,” said Mehedi Hasan, technical officer at the US Pharmacopeial Convention, Bangladesh.

Over the last three years, Fleming Fund Country Grant has supported the refurbishing of 12 microbiology labs in different hospitals and livestock research centres.

“Everything should be integrated into the system. Otherwise, nothing will make a difference,” Prof Nitish Debnath, team lead of the Fleming Fund programme in Bangladesh, told The Daily Star.

Prof Ahmedul Kabir, additional director general (administration) at DGHS and co-chair of the national technical committee, said, “Fragmentation will not solve the problem. This is an entire system we need to work on collectively.”