Final Pestle

7/31/2019 Final Pestle

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PESTLE Analysis

As we are going to do our situational analysis on hospital industry inBangladesh we will have to conduct a thorough PESTLE analysis on hospitalindustry in Bangladesh. There are many factors in the macro-environment thatwill affect the decisions of the managers of any organization. Tax changes,new laws, trade barriers, demographic change and government policychanges are all examples of macro change. To help analyze these factorsmanagers can categorize them using the PESTLE model. This classificationdistinguishes between:

Political factors: These refer to government policy such as the degreeof intervention in the economy. What goods and services does agovernment want to provide? To what extent does it believe insubsidizing firms? What are its priorities in terms of business support?Political decisions can impact on many vital areas for business such asthe education of the workforce, the health of the nation and the quality

of the infrastructure of the economy such as the road and rail system.

Economic factors: These include interest rates, taxation changes,economic growth, inflation and exchange rates. As you will seethroughout the "Foundations of Economics" book economic changecan have a major impact on a firm's behavior. For example:

- higher interest rates may deter investment because it costs more toborrow- a strong currency may make exporting more difficult because it mayraise the price in terms of foreign currency- inflation may provoke higher wage demands from employees andraise costs- higher national income growth may boost demand for a firm'sproducts


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Social factors: Changes in social trends can impact on the demandfor a firm's products and the availability and willingness of individuals to

work. In the UK, for example, the population has been ageing. This hasincreased the costs for firms who are committed to pension paymentsfor their employees because their staffs are living longer. It also meanssome firms such as Asda have started to recruit older employees to tapinto this growing labor pool. The ageing population also has impact ondemand: for example, demand for sheltered accommodation andmedicines have increased whereas demand for toys is falling.

Technological factor: new technologies create new products and newprocesses. MP3 players, computer games, online gambling and highdefinition TVs are all new markets created by technological advances.Online shopping, bar coding and computer aided design are allimprovements to the way we do business as a result of better technology. Technology can reduce costs, improve quality and lead toinnovation. These developments can benefit consumers as well as theorganizations providing the products.

Legal factors : these are related to the legal environment in which firmsoperate. In recent years in the UK there have been many significantlegal changes that have affected firms' behavior. The introduction of age discrimination and disability discrimination legislation, an increasein the minimum wage and greater requirements for firms to recycle areexamples of relatively recent laws that affect an organizations actions.Legal changes can affect a firm's costs (e.g. if new systems andprocedures have to be developed) and demand (e.g. if the law affectsthe likelihood of customers buying the good or using the service).

Environmental factors : environmental factors include the weather and climate change. Changes in temperature can impact on manyindustries including farming, tourism and insurance. With major climatechanges occurring due to global warming and with greater environmental awareness this external factor is becoming a significantissue for firms to consider. The growing desire to protect the


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environment is having an impact on many industries such as the traveland transportation industries (for example, more taxes being placed on

air travel and the success of hybrid cars) and the general movetowards more environmentally friendly products and processes isaffecting demand patterns and creating business opportunities.

By using the PESTEL framework we can analyze the many different factors ina firm's macro environment. In some cases particular issues may fit in severalcategories. For example, the creation of the Monetary Policy Committee bythe Labor government in 1997 as a body that was independent of governmentbut had the ability to set interest rates was a political decision but haseconomic consequences; meanwhile government economic policy caninfluence investment in technology via taxes and tax credits. If a factor canappear in several categories managers simply make a decision of where theythink it best belongs.

Now all these factors which we are going to consider while starting our hospital project in Bangladesh are described below thoroughly:

1) Political Analysis:

The government is reducing its hold on subsidies.There are particular pressure groups which tend to have an influenceon government hospitals

The cost of medicines also tends to affect hospitals besides affectingthe pharmaceutical industriesRelationships between neighboring countries also affect the hospitalsector

The locally elected politicians and the local administration are weak both interms of human and financial resources and still heavily supervised andcontrolled by the central government and the system of patronage. Thedemocratic process is fragile and to a large extent dependent on the local

power structure, where patron-client structures, kinship and quasi-feudalsystems prevail in some areas. The rural elite in control of the political power


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have access to administrative institutions, including the police and judicialsystem. This is a major obstacle for the human and legal rights of the

population, not least the poor who lack connections, resources or fullknowledge and information of the political system.

Bangladesh has a rather broad and pluralistic press and media, whichcontribute to the political dialogue as a counterbalance to vested interests.The constitution guarantees fundamental human rights to all and the freedomof the press is also a fundamental right. Media has a political role by focusingon issues such as corruption, mismanagement and law and order and to

make it known to the public. The print media is fairly open, although manydaily newspapers are controlled by political groups. Certain restrictions on thefreedom of the press exist, which empowers the government to detaianybody, including journalists, in prison without a trial for six months.Furthermore, there is no law that ensures that the government will respond topublic requests for information.

The past decade has seen a marked policy focus upon Bangladesh, home to

nearly 150 million Muslims; it has attracted the attention of the world due toweak governance and the rising tide of Islamist violence. The politicalenvironment of Bangladesh, the appeal of Islamist ideology to the generalmasses and the dynamic adaptability of Islamist organizations all demonstratethat Bangladesh will continue to focus the attention of policy makers andanalysts alike. This is a timely, incisive and original explanation of the rise of political Islam and Islamic militancy in Bangladesh.

Taxation policy

In recent years, analysis of tax expenditures has received much attention inthe literature of public policy, particularly in the developing and transitioneconomies. This policy note attempts to introduce the concept and size of taxexpenditures in the context of Bangladesh with special references toexperiences of India and Pakistan. It shows that the amount of taxexpenditures in Bangladesh is 2.52 per cent of GDP in FY05, in whichexpenditures in the direct taxes and indirect taxes are 0.28 per cent and 2.24

per cent, respectively.


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The note identifies that tax expenditure accounting is necessary to establishan efficient and effective tax system as well as fiscal accountability and

transparency in the country, since tax expenditures are viewed as part of government expenditures. Thus, a detailed assessment of tax expendituresincluding an appropriate definition and a methodology for measuring taxexpenditures is essential along with restructuring the existing tax expendituremeasures in Bangladesh.

Government stability and policy

The struggle for democracy was still alive in Bangladesh as of the late 1980s.The single-party system of the 1970s and 1980s was unable to satisfy thevaried political movements and interest groups of the nation. Oppositionparties--although they represented conflicting views and were as unwilling asthe ruling regime to share power--remained a vital force that commanded theloyalties of a large proportion of the population.

The Political and Human Rights Challenge

Although the national political situation contains many negative sides, mostobservers believe Bangladesh will continue to improve its democratic process,albeit slowly and with possible drawbacks. Presently, there is an increase inpolitical clashes, as the country is getting closer to the next general elections,planned for the second half of 2001. Apart from the two national elections in

1991 and 1996, and the local elections held in 1997, which were positivesigns for democracy, Bangladesh finally put an end to twenty years of conflictin the tribal area of Chittagong Hill Tracts in 1997. However, the increase inpolitical violence and breakdown of law and order reduce the citizens trust inthe political system as well as the judicial system. There are also a number of political prisoners according to Amnesty International. Frequent incidents of police brutality and corruption within the judiciary system violate the citizenslegal rights. For the majority of the population the main human rights concernis the absence of basic human rights due to mass-poverty. The presentpolitical instability and the mistrust between the political parties are obstacles

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The Judiciary and Law Enforcement Systems

The law and order situation has deteriorated over the last twenty years, asindicated in official statistics, with the highest increase in murder, rape andother acts of violence against women32. Other crimes include highwayrobbery and physical assaults. In many cases, there are allegations of policeinvolvement in the crimes themselves. There is a general consensus inBangladesh that the state does not live up to one of its primary obligations;the protection of its citizens.

The police force is seen by Bangladeshis themselves as the most corruptinstitution in Bangladesh. In the 1996 study by Transparency International,96% of the respondents claimed that it was impossible to get policeassistance without paying bribes. Furthermore, police brutality is common andthere are frequent reports of people tortured to death and women raped whilein police custody. Another example of misconduct is the common illegaldemand from traffic policemen to pay toll in order to pass on highways inBangladesh. Some of the causes for this behavior are found in the poor

career prospects and low salary levels, which are incentives for corruptionwithin the police force. As mismanagement and corruption are prevalent in the judicial system and the police force, it has weakened their role as upholders of the law and order in the country. The capacity of the courts is notoriouslyweak and, according to the World Bank.

All these political factors must be revised to start the hospital project.

2) Economic Analysis:

Increase in income would lead to an increase in the standard of living.Thus peoples lifestyles changes and health is better understood. Thusthere is a room for specialized treatment, doctors, and hospitalsGovernment has made loans easily available and thus people withlimited means could avail better/specialized treatment


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The Challenge of a Global Economy

The total economic activities of the country are estimated to an annual valueof about 42 45 billion USD for 1999, which comes to an annual GDP per capita of 320 to 340 USD. Agriculture is the still the largest sector of theeconomy with around 25% of GDP and employing two-thirds of the labor force. The industrial sector has grown steadily during the last ten years withan annual rate of over 7%, mainly due to the textile and ready-made garmentindustry. However, industry contributes with only around 12% of GDP.Construction stands for 6 8%, transportation and communications for 12 15%, various services for more than 30% and public administration anddefense for 6 8% of GDP.

During the nineties, Bangladesh had a relatively stable macroeconomicsituation, based on gradual structural reforms in trade and commerce as wellas promotion of exports. Balance of payment pressures were reasonablymanaged, the current account deficit as a percentage of GDP decreased andinflation was kept under 10% per year. Furthermore, national savings haveincreased during the last ten years. Debt servicing has not been a major problem, compared to other Least Developed Countries (LDC), as thenational debt is modest relative to the economy and mostly based onconcessionary loans with soft conditions.

Significant foreign investments have taken place in the energy, gas andtelecommunications sectors, reaching an annual level of 700 million USD37.Bangladesh also has a substantial inflow of remittances from nationalsworking mainly in the Middle East and South-East Asia, which is of nationalimportance to the economy. During recent years, annual remittances havebeen larger than the total donor assistance as it comprises of more than twobillion USD per year.

To a large extent, Bangladesh has achieved its steady growth rates during thenineties due to an exploitation of its relatively cheap workforce, both within thegarment industry and through migrant labor contributing to the economy withlarge remittances from abroad. Only in the recent couple of years have their

been significant foreign financial investments in the country. Continuedeconomic growth through exports in hampered by severe infrastructural


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bottlenecks (ports, transportation, communications, energy etc) andgovernance the economy of Bangladesh is constituted by that of a developing

country.

Its per capita income in 2008 was est. US$1,500 (adjusted by purchasing). According to the International Monetary Fund, Bangladesh ranked as the 48thlargest economy in the world in 2009, with a gross domestic product of US$256 billion. The economy has grown at the rate of 6-7% p.a. over the pastfew years. More than half of the GDP belongs to the service sector; nearlyhalf of Bangladeshis are employed in the agriculture sector, with RMG, fish,

vegetables, leather and leather goods, ceramics, rice as other importantproduce. They have bad sewage treatment that contributes to disease andfamine.

Monetary policy

Monetary Policy Framework: It starts by articulating the monetary policy

framework (in terms of the goals, the instruments, and the analytic channelsof transmission) for greater clarity and transparency benefiting both the policymakers as well as the stakeholders. The appropriate monetary policy goal inthe Bangladesh context is to achieve price stability with the highestsustainable output growth. The overall goal will be to contain inflationaryexpectations, maintain currency stability and ensure smooth credit flow to thegrowth points of the economy in support of the targeted real output growth.

GNP trends

Bangladesh, small state of South-East Asia with the total area of 144,000 sqkm, cant still shake off the ill -reputation of being one of the least developedcountries, shadowed by miserable poverty, high illiteracy rate and a giganticpopulation of 141, 340,476 (July 2004 est.) Moreover natural disasters suchas seasonal inundation, cyclones, draughts etc. constantly pursue its lot everyyear, which break the backbone of the economy and frustrate future planning.Economy is sick with high inflation rate.


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Inflation rates (7 percent)

It is widely believed that moderate and stable inflation rates promote thedevelopment process of a country, and hence economic growth. Moderateinflation supplements return to savers, enhances investment, and therefore,accelerates economic growth of the country. This paper empirically exploresthe present relationship between inflation and economic growth in the contextof Bangladesh. Using annual data set on real GDP and CPI for the period of 1980 to 2005, an assessment of empirical evidence has been acquiredthrough the co-integration and error correction models. Further, it explores aninteresting policy issue of what is the threshold level of inflation for theeconomy.

The empirical evidence demonstrates that there exists a statisticallysignificant long-run negative relationship between inflation and economicgrowth for the country as indicated by a statistically significant long-runnegative relationship between CPI and real GDP. In addition, the estimatedthreshold model suggests 6-percent as the threshold level (i.e., structuralbreak point) of inflation above which inflation adversely affects economicgrowth. These results have important policy implications for both domesticpolicy makers and the development partners working for the country.Specifically, our conclusion is of direct relevance to the conduct of themonetary policy by the Bangladesh Bank.

Micro-Credits

Micro-credit to the landless and poor started in the seventies in Bangladesh,as the banking system was unable to meet the credit requirements of thepoorer segments of society. Grameen Bank, which is one of the most wellknown micro-finance institutions in the world, started as a small pilot projectby Professor Yunus to see if the poor villagers could handle a small credit.

Within a few years, its model of collateral free credit disbursements amongsttargeted groups of poor with weekly repayments and deposits became thenorm for other micro-credit organizations. Over ten million borrowers are


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today reached by some form of micro-credit as over 1,000 NGOs, GrameenBank itself, PKSF (a quasi-government lending institution) and several

commercial banks are involved. Various studies demonstrate that micro-credits have been able to improve the economic and social situation for thepoor. In a survey from 1998, it was indicated that as much as 45% of eligiblepoor households in Bangladesh participate in micro-credit programs.

More than two-thirds are women. The survey found that credit programs had apositive effect on several socioeconomic variables, including childrensschooling, the nutritional level, lower fertility and increased use of

contraception. Consumption increased for 5% of the participants, whichenabled them to rise above the poverty line.

Employment (wage rates)

Reducing poverty remains a formidable challenge for Bangladesh. Althougheconomic growth has improved in recent years, the better economic

performance has not translated into satisfactory poverty reduction.Recognizing this disjuncture between the countrys record on economicgrowth and progress in poverty reduction, current policies emphasize thatstrong economic growth alone is not adequate for sustained poverty reductionin Bangladesh. For successful poverty reduction, the strategies must alsoensure that the poor can get increasingly higher share of the benefits of growth. In Bangladesh, almost all households depend on employment as their primary source of income. This is especially true for the poor householdssince the only abundant productive resource that the poor have is their ownlabor.

Increasing employment opportunities and raising the returns to labor istherefore the most vi able option to reduce poverty and meet the countryshuman development goals. In this context, one important issue is to recognizethat simply having access to employment is not enough to lift the poor households out of poverty. For reducing poverty, both quantity and quality of employment need emphasis for which economic growth alone is notadequate. This requires an employment-centered strategy to growth in whichemployment opportunities would expand for the poor along with returnsadequate enough to raise the households out of poverty.


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Rapid and sustained poverty reduction in Bangladesh thus calls for integratingthree elements within the growth policy framework: first, sustained economic

growth at reasonably high rates; second, expansion of productive andremunerative employment opportunities; and third, expanding the access to

jobs for the poor. The governments development strategy recognizes theneed to orient growth policies toward creating decent employmentopportunities for which several options are emphasized, such as adoptingpolicies for making growth more employment-friendly, increasing overseasmigration of workers, and undertaking special employment creation programsthrough micro credit and employment based safety nets and public worksprograms.

Budget deficits

The Bangladeshi government is desperately seeking loans from overseaslenders to make up a big budget deficit of 395 billion taka in the ongoingfinancial year 2009-10 (July 2009 and June 2010) and retain the country'sforeign exchange reserve at a level of 10 billion U.S. dollars.

The government's Economic Relations Division (ERD), responsible for overseas loans and grants, is now engaged in hectic lobbying with thecountry's bilateral and multilateral lenders to procure at least 185 billion takafor deficit financing, leading English newspaper New Age reported Sunday.The remaining amount of budget deficit worth around 210 billion taka wouldbe met through local borrowings from commercial banks and state-run savinginstruments.

Apart from this, the government is facing the challenge of keeping thecountry's foreign exchange reserve at over 10 billion U.S. dollars to shore upits image. The foreign exchange reserve which has been hovering over 10billion U.S. dollars in last one year is under threat because of slow exportgrowth and downward inflow of remittances against the backdrop of delayedimpact of the global financial recession.

Changes in Economic Aspects: Between 2000 and 2005, total domesticproduction has increased by 5.7 per cent, which indicates an annual rise of


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about 1.14 per cent. Considering the growth of the manufacturing sector of the country during the same period (8.1 per cent), performance of the jute

mills was not satisfactory. The increase in total production, however, was dueto substantial growth in the production of yarn/twine (8.1 per cent per year).

Production of diversified products, though a small share in overall products,achieved a considerable increase of 24.3 per cent per year, particularly in theprivate sector. During this period, average production of BJMC and BJMAmills declined by 43 percent and 6 per cent respectively (Table 25). BJSAmills achieved a growth of 22.9 percent. Thus, spinning mills that produce

yarn and twine, performed very well during this period, and it is important toidentify the factors that were responsible for their growth.

Macroeconomic Stability

Macroeconomic stability is necessary, but not sufficient, for increasedeconomic growth. Bangladesh has managed to have a stable macroeconomic

situation during the last few years despite the crisis in the Asian region during1997 and the devastating floods in 1998. The rates of savings andinvestments have increased and the investment-GDP ratio is around 20%.Inflation has been kept at an annual rate of around 8 10% as a result of arelative control of the fiscal deficit. The countrys fiscal deficit during the lastfive years has averaged about 3.6% of GDP, which has been withinsustainable limits as the economy grows with around 5% per year. However,recent figures show an increase in the fiscal deficit and the domestic debt.

Furthermore, the balance of payments has been under strain, especially after the higher food imports after the flood of 1998. The exchange rate is stillcontrolled, but the government has a policy of flexible exchange ratemanagement, which involves frequent smaller adjustments of the exchangerate. The foreign exchange reserves fluctuate between 1.3 to 1.8 billion USD,which is equivalent to around two months imports.

Apart from the need for governmental monitoring of the balance of payment,the long term solution is to ensure that these huge investments are efficient


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and assist to further increase exports and overall economic growth in industryand commerce as well as in the still most important sector for the survival of

the population, agriculture.

Budgetary Constraints

Even though the macroeconomic situation has been fairly positive, it leaveslittle room for maneuver as state revenue is among the lowest in the world incomparison to GDP and further fiscal deficits would lead to higher inflation if

domestic borrowing continues at its current level. The fiscal situation musttherefore be seen as worrisome, especially if losses from state-ownedenterprises and the effects of non-performing loans at the nationalized banksare taken into account.

State-Owned Enterprises

Since the nationalization of large economic assets after the bloodyindependence war in 1971, Bangladesh has had a legacy of state dominationin industry and banking. Apart from national ownership of the power systemand railways, the government also acquired sections of manufacturing suchas textile, jute and sugar mills. The trade unions within the companies arevery strong and oppose most changes. Attempts to restructure the industryhave been made, but privatization of state-owned enterprises is still laggingbehind and only a few enterprises have been privatized and none of the largecompanies.

The Privatization Board is responsible for the privatization of fifty enterprisesand the government is working on improving the implementation as well as re-training retrenched workers, improving severance benefits and creating apublic opinion for privatization. State owned enterprises are still dominant inseveral sectors, for example in sugar and jute. The companies are inefficientand represent a huge drain on national resources. In 1999, the losses of thestate owned enterprises were over 300 million USD. The losses in the mid-nineties were equivalent to more than half of the spending of the social sector in the annual development budget.


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Industries and Commerce

The medical industry is based on healthcare and medications. In this sector increase in income would lead to an increase in the standard of living. Thuspeoples lifestyles changes and health is better understood. Thus there is aroom for specialized treatment, doctors, and hospitals. The informal sector ,including services, transportation, handicraft, and domestic work for womenetc, is by far the most important source for employment after agriculture.

Around 30 to 40 million people are engaged in agricultural activities,depending on the season. Official statistics are lacking, but millions of people

get their livelihood from self-employment, small trading, rickshaw pulling etc.The workforce within the informal sector flows regularly between variousactivities within agriculture, services and transportation.

3) Social Environment Analysis:

Medical facilities have increased since there is more awareness of healthcare among the population

Certain percentages of beds have to be kept for poor people. E.g. inBombay 20% of beds has to be kept reserved for poor people.

Look after the needs of local poor people.

Open counseling and relief centers.

Teach hygiene, sanitation among the poor masses.

Safe disposal of hospitals wastes like used injection needles, wasteblood etc. and taking due care of environment.

Spreading awareness about various diseases through campaigns andfree medical check ups.

Bangladesh has the highest population density in the world, excluding ahandful of city-states and small countries such as Malta. Most of the

demographic statistics below are from the CIA World Fact book, unlessotherwise indicated.


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Overall, improvement in women's access to education particularly the higher level of education opportunities would increase women's employment and

income. This could expand their ability to make decisions in the family andwould play a key role in the empowerment of rural women. Although thegrowth within the agricultural sector has been more or less just above thepopulation growth, rural poverty, especially for the extreme poor has shownsigns of decreasing during the last five years. This is attributed to severalfactors, firstly there has been a shift from rice production to commercial norice crops, and for example vegetables, livestock and fisheries have grownfaster than other agricultural activities as a response to a growing marketdemand.

Secondly, the opportunities for economic activities outside agriculture haveincreased substantially during the nineties as the road network has beenexpanded, electricity has been provided to at least some areas and micro-credits are available to the majority of the poor. Thirdly, an accelerated rural urban migration has shifted some of the surplus population to urban areas.This trend has been a livelihood strategy for many rural poor families.

Around 80% of the population lives in rural areas, even though urbanizationhas been a strong trend during the last thirty years. The urban population hasincreased fourfold over the last two decades and around 60% of the increasesare due to migration, mostly by young adults, from the countryside8. Thestrong urbanization has two causes, on the one hand people are pushed byrural poverty as agriculture can only provide employment to some of theincreasing number of available workers, and, on the other, urban centersprovide hope for easier access to education, health facilities and, not least, achance for a paid job. Most urban newcomers work in the informal sector or within the growing textile and ready-made garment industry.

Although rapid urbanization creates many social, infrastructural andenvironmental problems for the growing cities, there are also positive sides asurban centers are breeding grounds for business activities and offer alternative livelihoods and wider social and cultural choices than thecountryside.


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4) Technological Environment Analysis:

Breakthrough innovation in the field of specialized equipment

Communication has managed to bridge the gap between placeslocated at long distancesTest tube babies

Mobility of medical services

Mobile phones, credit cards (for payment purposes) etc have madedoctors and medical facilities easily available

Technological factors can lower barriers to entry, reduce minimum efficientproduction levels, and influence outsourcing decisions. Some technologicalfactors include:

R&D activityAutomation technologyincentives rate of technological change

Capacity Utilization: In hospitals we always need new kind of technologies.The machines that are going to diagnose the diseases should be very up-to-date and effective. Bangladesh most of the time have to buy these from the

foreign market, so in Bangladeshi perspective the breakthrough innovation inthe field of specialized equipment is a must and also communication hasmanaged to bridge the gap between places located at long distances. Testtube babies are the technological advancement procedure. Mobility of medicalservices and Mobile phones, credit cards (for payment purposes) etc havemade doctors and medical facilities easily available


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Productivity of Capital: In case of public sector Hospital machineries,machine-productivity declined in all major sections of operations, except in

weaving and calendaring. On the other hand, machine-productivity increasedin the private sector of health care, particularly in diagnosis machineries.

5) Legal (Legislation) Analysis:

Legislation

The Hospital industry has many regulatory and legislative restrictions.There is also a growing culture of litigation in many countries.The evolution of the internet is also stretching the legislativeboundaries with patients demanding more rights in their healthcareprograms.

Access to Health Care Services in Bangladesh:

Access to health services depends on the availability of service (i.e. theavailability of physicians, health centers, and hospitals) to the actual as wellas potential users. In Bangladesh, health facilities in both public and privatesector are distributed in an unjust way, which makes the services inaccessibleto low income and rural people. Along with such unjustified distribution of services between urban and rural areas, delivery of services also varieddepending on the level of income (rich and poor), which is evident indiscriminatory access to services. The poor in Bangladesh bear higher healthrisks and suffer the burden of excess mortality and morbidity. The poor ingeneral are more prone to illness and diseases than the non-poor. Thepoorest households are likely to use health care services and are less willingto pay for improved services compared to other socio-economic groups.

In Bangladesh public health system does not exist at its self-pose yet. Analysis of official statistics represents an unsatisfactory scenario. Thedoctor-population, doctor-nurse, nurse-population ratios remain far below the


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standard level. Though in terms of infrastructural health facilities, Bangladeshis one of the well resourced countries (CPD, 2001).

Though the he alth sectors achievement in recent days is remarkable, still thehealth care system have to go far to achieve the Millennium DevelopmentGoals. Most of the health indicators show low rates of achievement. Causesof failure of governance as mentioning below are responsible for theseshortfalls:

Voice and accountability : Citizens voices and demands result inimproved state responsiveness, transparency and accountability. Inreality, the state in Bangladesh like many developing countries is notsufficiently accountable to its citizens, whose voices often remainunheard or are simply too weak to have any influence. Voice andaccountability permit communities to be involved in decisions andoversight of health care services. In the field of governanceasses sment, voice and accountability is a key indicator encapsulatinga broad range of factors, from freedom of expression and respect for civil liberties to free and fair elections and the just rule of law (RIA,2007).

Peoples voice in Bangladesh is rarel y taken into account while making andimplementing health policies. The low confidence in government healthfacilities and their underutilization are caused by weak administration, lack of oversight over them, and poor accountability (Ahmad, 2000). Failure inenforcing a system of accountability in the health system is weakeninggovernance.

Centralized administration: In Bangladesh, health planning is solelythe responsibility of central government. Ministry of Health controls thehealth care system with de-concentration of some power at the locallevel. None but the higher level officials take the decisions that aredistant from policy implementation. Targets are set, activities areplanned, and resources are allocated by the Ministry without muchconsultation with those who know the local level conditions. For thiscentralized tendency, over-targeting is a common characteristic of our

health sector plan.


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The weak local government system of Bangladesh is acting as governmentsagents rather than representative bodies of the community. They areaccountable to the ministry rather to the people. Centralization of authority atthe Ministry acts as a major barrier to ensure accountability in administrationand to formulate a local health authority with adequate involvement of thecommunity.

Staffing and absenteeism: Staffing is arguably the single mostimportant element of health care delivery as little can be achievedwithout it. Training of the staff, their competencies and ability tofunction all determine whether the expected results can be achieved.Training typically is inadequate if not well beyond that needed inBangladesh, especially for physicians.

Among the most serious issues in Bangladesh is the high rate of absenteeism, which undermines service delivery. Therefore, when a patientcomes for the medical help to the public facilities, very often it is the case that

hospital has no specialists with appropriate skills or knowledge, or there is alack of staff which can give very basic help.No positive affirmative action is seen to resolve this problem.

Poor Management of Drug and Equipments : Mis-governance isprevailing in the management of drug and equipment in the publichospitals. A huge quantity of supplied medicine and equipment is leftunutilized and unconsumed due to poor management. Very often, it isalleged that doctors encourage the patients to purchase medicine fromoutside because of unawareness of the medical officer about

availability and quantum of medicine stock in the store. Moreover,physicians are getting bribe from the private medicine suppliers.

Lack of coordination among different levels of service creates duplication anddichotomy. Insufficient coordination between the Ministry and healthdirectorate has often created bottlenecks and unnecessary constraints andduplication of work. Unfortunately, there is no well defined role for theMOHFW to intervene in important health related issues in the sectors

controlled by other ministries. Nor there is any meaningful coordination amongthe executive bodies, particularly ministries to monitor public health.


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Moreover, the institutional arrangement for implementing health programs inBangladesh seriously suffers from the absence of an effective information

flow. Still the entire administration is mostly paper based. Shortage of data for evaluating the programs and correcting actions is difficult for this. Lack of coordination within units of Ministry of Health, lack of coordination betweendifferent ministries, lack of sufficient ICT facilities in all levels, inadequacy of trained manpower including inappropriate placement, inadequacy of up todate data and often unreliable data, inadequate use of health information atpolicy level are acting as impediments to good governance.

Existing policies need to be reviewed and revised for improving accessibility,affordability and quality of services and for further improvements inaffordability, quality and safety of drugs and rational use of drugs. Newpolicies on public and private sector mix and financing of services need to beformulated, protection and preservation of the environment; more traininginstitute for graduate and postgraduate study with proper practical facilitiesshould be established, decentralization of management through devolution of authority and the adoption and maintenance of healthy lifestyles and thedevelopment of a comprehensive people oriented plan to improve and assurethe quality of health services be provided.

6)Environmental Analysis:

There is a growing environmental agenda and the key stake holdersare now becoming more aware of the need for businesses to be moreproactive in this field.Hospitals need to see how their business and marketing plans link inwith the environmental issues.There is also an opportunity to incorporate it within their CorporateSocial Responsibility programs.Marketing and new service (Healthcare) development should identifyeco opportunities to promote as well.


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Environmental dreadful conditions and depletion of natural resourcesare often observed in Bangladesh due to poverty, over-population and lack of

awareness on the subject.

Bangladesh has a per capita consumption of energy, which is the third lowestin Asia, and most of it is biomass for household consumption. Commercialenergy is available to only 18% of the population as electricity and to about8% as natural gas and petroleum gas. Inadequate supply of electricity toindustry and commerce is a major constraint to economic growth. However,Bangladesh has a vast deposit of natural gas and some limited

hydroelectricity and coal. The potential is therefore great for substantialdevelopment of the power sector. This has attracted large foreign investmentsinto the country..

The policy includes guidelines for basin-wide planning, water rights andallocations, public and private involvement, public investment, water supplyand sanitation, fisheries, navigation, agriculture, industry and not least theeffects on environment. As water is needed for all areas of society, there is a

need for effective institutions and a legal framework. However, this is not thecase today as both central and local authorities lack human and financialresources to adequately manage the water resources.

The country has many environmental problems such as frequent naturaldisasters, industrial pollution, poor health and sanitation, deforestation,desertification, changes in climatic conditions, salinity and the overalldeteriorating habitat of flora and fauna. Intensive cultivation threatens soilfertility and agrochemicals endanger the soil. Excessive water extraction for irrigation depresses the water table and flood control measures block fishmigration paths. Deforestation, the highest in Asia, and the shrinking

Flooding Disaster Management

Bangladesh has experienced several major floods and other natural disasters

during the last twenty years. Although the human suffering and the physical destruction have been huge, there is a general consensus that Bangladesh


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has improved its resilience to natural disasters through disaster management.The government, non-governmental organizations and local communities

have responded in close collaboration during floods and cyclones andgradually learned from previous mistakes.

As a result, improvements in disaster management have taken place relatingto disaster prevention, during the natural calamities as relief operations, andafterwards as rehabilitation. Almost 65% of all land was under water duringalmost three months during the large flood of 1998. Although the flood, whichwas one of the largest during the century, was handled rather well, there are

lessons learned. There is a need to improve the regional network for earlywarning, improve co-ordination between meteorological experts and theauthorities and ensure a good maintenance of existing embankments, roadsand other infrastructure.

The Need for Clean Water and Sanitation

Water pollution is common and causes four of five illnesses and around230,000 deaths annually, according to the World Bank. As the populationincreases it is getting more and more difficult to provide clean water andsanitation, especially in the growing townships and cities. With an average of almost 900 persons per livable square kilometers, the natural environmenthas little chance to absorb and disperse human waste by traditional means.

Since the economic situation, both for the country as a whole and for the

average family, cannot allow for expensive networks of piped water andsewerage, other simple, cheap and yet effective solutions for water andsanitation need to be found both in rural and urban areas.

Our businesss one of the biggest potency is each of our s ervice must becompletely environmental friendly. In hospital sector we need to focus moreon cleanliness. The cleanliness of the hospital environment will make sure thesafety of the patients as well as the safety of the environment.

Final Pestle

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