Public hospitals in at least 25 of the country’s 64 districts do not have any intensive care units, putting the lives of critical patients at risk.

Directorate General of Health Services data revealed that coronary care units are also absent in at least 40 districts.

The situation prevails despite an order passed by the High Court in June 2019 for setting up ICUs and CCUs in all district hospitals.

Apart from Dhaka, Mymensingh, and Rangpur, each district has a general hospital, the centre of treatment, where patients with any kind of illness can seek treatment.

A district, however, can have more than one public hospital.

The DGHS data showed that 35 districts did not have ICUs in their general hospitals.

After the Covid-19 pandemic exposed the vulnerability in the country’s healthcare system, prime minister Sheikh Hasina, in June 2020, directed the establishment of ICUs in every district hospital.

The director general of the DGHS, Abul Bashar Mohammad Khurshid Alam, could not be reached in person or over the phone for comment on the matter, despite repeated attempts.

The DGHS director for the hospital and clinic, Md Habibul Ahsan Talukder, appeared unaware of what took the ICUs so long to establish. The director asked the correspondent to learn from individual projects about the progress of the ICU installation.

In April 2020, the government initiated setting up ICU facilities in 50 districts and 20 medical college hospitals under the Covid-19 Emergency Responses and Pandemic Preparedness Project, with financial help from the World Bank and the Asian Development Bank.

Under the project, ICUs were set up in 13 districts, but none of them has become functional yet. ICUs established in the 10 medical colleges, however, are operating.

ICU installation at 30 district hospitals is currently underway, while ICU installation work has not yet begun in the rest of the seven hospitals, said project director Shah Golam Nabi Tuhin.

‘The project was delayed due to a revision of the project design,’ said Gilam Nabi, without explaining the need for the revision.

The project, which was supposed to end in June this year, was extended  until June 2025.

With the extension of the deadline, the cost of the installation of a 10-bed ICU unit at a district hospital went up from the initial budget of Tk 2.64 crore to Tk 4.30 crore. The budget excluded building construction costs.

The other part of the project, funded by ADB, saw ICUs set up in eight out of 10 medical colleges, but only one became functional. This part of the project launched in April 2020 was supposed to be complete by June 2023 but was extended until June 2024, said project director Md Nazrul Islam.

The project cost is Tk 1,400 crore.

Stressing the importance of ICU facilities, health experts said that many critical patients in the country die on the way to hospitals due to the lack of ICU facilities outside Dhaka, especially in districts and upazilas.

Half of the districts of Barishal, Sylhet, Rangpur, and Rajshahi divisions have no ICU facilities.

Other districts, including Shariatpur and Narsingdi of Dhaka division; Brahmanbaria, Khagrachari, Rangamati, and Lakshmipur of Chattogram division; Chuadanga, Jhenaidah, Magura, and Narail of Khulna division, and Netrakona of Mymensingh division, have no ICU facilities.

In June 2019, the HC issued the directive to set up 30 ICU and CCU beds within 30 days, after hearing a writ petition filed by Human Rights Lawyers and Securing Environmental Society of Bangladesh, and the deadline has been extended 40 times till now, said writ petitioner Bashir Ahmed, also a Supreme Court lawyer.

Healthcare environment specialist Md Hasmotuzzaman said that there were two phases to setting up an ICU.

‘One phase is building construction if required and the other is installing machineries. The construction part could take one year and the installation machines could take two months. So, installation of 10-bed ICU unit can be completed within 14 months,’ said Hasmotuzzaman.

Former Bangladesh Medical Association president Rashid-e-Mahbub said that ICU facilities were crucial for critical patients.

However, he thinks the government lacks the capacity to run ICUs across the country.

‘It is not enough to establish ICU facilities across the country. There has to be an adequate budget, logistical support, and human resources to make those operational,’ said the health expert.

An official of the project said that some employees were appointed under the WB-funded project to run the already-established ICUs.

The employees would work until December 31, 2024, and after that, DGHS would look after the matter, the official added.