Activists are calling for stronger action to address rising levels of corruption in Bangladesh's troubled public health care system.
"The government must strengthen its monitoring system to check corruption in public hospitals to ensure health access to under-privileged people," said Nitai Kanti Das, member secretary of the Health Rights Movement, a forum of 92 organizations working to establish community health rights.
There are longstanding and widespread allegations against doctors, nurses and other health professionals in Bangladesh's more than 500 public hospitals that they demand bribes for services that should be free of cost, he alleged.
According to Corruption in Service Sectors: National Household Survey 2012 conducted by Transparency International Bangladesh (TIB), 40.2 percent of surveyed people fell victim to various irregularities and corruption in receiving services in public hospitals, compared to 33.2 percent in 2010.
Of more than 7,500 households surveyed nationwide - half of whom received services through government hospitals - 21.5 percent reported paying for services they never got a receipt for.
Officially, the government is meant to provide services at the primary level (community clinics), secondary level (district general hospital) and at the tertiary level (medical college hospitals and specialized hospitals) free of charge.
According to patients interviewed by IRIN, however, even in emergency situations, many said they were unable to access services, including medicine, unless a bribe was paid first - and in a country where 31.5 percent of people live below the poverty line, according to the World Bank, many cannot pay.
"My sister had an accident last month. I rushed her to the National Institute of Traumatology & Orthopaedic Rehabilitation. However, the ward boy told me they would only admit her if I paid a bribe. Only when I gave him 200 taka (US$2.50) did they enter her into the operating room," Rustom Ali, a 35-year-old rickshaw puller, who earns just $4 per day, claimed.
While Ali's sister, who suffered from fractured bones and needed surgery, was in hospital for 15 days, he continued to pay bribes to the ward boy, nurses, doctors and even a night guard to ensure adequate services, he said.
"Whenever we receive any allegation, we take strong action," Abdul Awal Rizwi, the director of the hospital, said. "We have taken measures to make patients aware about our services."
Poor hit hardest
"While corruption affects everyone, the poorer sections of society suffer more," TIB's executive director, Iftekharuzzaman, who goes by only one name, said. "The poor will be affected if we cannot stop corruption in the health sector." He called on doctors and other health professionals in public hospitals to be held accountable.
Das said a client association involving local government officials and representatives from all groups should be created for each public hospital to better establish how a hospital is functioning.
A.M. Badrudduza, additional secretary for the Bangladesh Ministry of Health and Family Welfare, declined to comment on the Transparency International survey.