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PESTLE Analysis

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

Political factors: These refer to government policy such as the degree of intervention in the economy. What goods and services does a government want to provide? To what extent does it believe in subsidizing firms? What are its priorities in terms of business support? Political decisions can impact on many vital areas for business such as the 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 see throughout the "Foundations of Economics" book economic change can have a major impact on a firm's behavior. For example: - higher interest rates may deter investment because it costs more to borrow - a strong currency may make exporting more difficult because it may raise the price in terms of foreign currency - inflation may provoke higher wage demands from employees and raise costs - higher national income growth may boost demand for a firm's products

Social factors: Changes in social trends can impact on the demand for a firm's products and the availability and willingness of individuals to work. In the UK, for example, the population has been ageing. This has increased the costs for firms who are committed to pension payments for their employees because their staffs are living longer. It also means some firms such as Asda have started to recruit older employees to tap into this growing labor pool. The ageing population also has impact on demand: for example, demand for sheltered accommodation and medicines have increased whereas demand for toys is falling.

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

Legal factors: these are related to the legal environment in which firms operate. In recent years in the UK there have been many significant legal changes that have affected firms' behavior. The introduction of age discrimination and disability discrimination legislation, an increase in the minimum wage and greater requirements for firms to recycle are examples of relatively recent laws that affect an organizations actions. Legal changes can affect a firm's costs (e.g. if new systems and procedures have to be developed) and demand (e.g. if the law affects the 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 many industries including farming, tourism and insurance. With major climate changes occurring due to global warming and with greater environmental awareness this external factor is becoming a significant issue for firms to consider. The growing desire to protect the

environment is having an impact on many industries such as the travel and transportation industries (for example, more taxes being placed on air travel and the success of hybrid cars) and the general move towards more environmentally friendly products and processes is affecting demand patterns and creating business opportunities.

By using the PESTEL framework we can analyze the many different factors in a firm's macro environment. In some cases particular issues may fit in several categories. For example, the creation of the Monetary Policy Committee by the Labor government in 1997 as a body that was independent of government but had the ability to set interest rates was a political decision but has economic consequences; meanwhile government economic policy can influence investment in technology via taxes and tax credits. If a factor can appear in several categories managers simply make a decision of where they think 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 influence on government hospitals The cost of medicines also tends to affect hospitals besides affecting the pharmaceutical industries Relationships between neighboring countries also affect the hospital sector

The locally elected politicians and the local administration are weak both in terms of human and financial resources and still heavily supervised and controlled by the central government and the system of patronage. The democratic process is fragile and to a large extent dependent on the local power structure, where patron-client structures, kinship and quasi-feudal systems prevail in some areas. The rural elite in control of the political power

have access to administrative institutions, including the police and judicial system. This is a major obstacle for the human and legal rights of the population, not least the poor who lack connections, resources or full knowledge and information of the political system.

Bangladesh has a rather broad and pluralistic press and media, which contribute to the political dialogue as a counterbalance to vested interests. The constitution guarantees fundamental human rights to all and the freedom of the press is also a fundamental right. Media has a political role by focusing on issues such as corruption, mismanagement and law and order and to make it known to the public. The print media is fairly open, although many daily newspapers are controlled by political groups. Certain restrictions on the freedom of the press exist, which empowers the government to detai anybody, including journalists, in prison without a trial for six months. Furthermore, there is no law that ensures that the government will respond to public 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 to weak governance and the rising tide of Islamist violence. The political environment of Bangladesh, the appeal of Islamist ideology to the general masses and the dynamic adaptability of Islamist organizations all demonstrate that Bangladesh will continue to focus the attention of policy makers and analysts 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 in the literature of public policy, particularly in the developing and transition economies. This policy note attempts to introduce the concept and size of tax expenditures in the context of Bangladesh with special references to experiences of India and Pakistan. It shows that the amount of tax expenditures in Bangladesh is 2.52 per cent of GDP in FY05, in which expenditures in the direct taxes and indirect taxes are 0.28 per cent and 2.24 per cent, respectively.

The note identifies that tax expenditure accounting is necessary to establish an 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 expenditures including an appropriate definition and a methodology for measuring tax expenditures is essential along with restructuring the existing tax expenditure measures 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 the varied political movements and interest groups of the nation. Opposition parties--although they represented conflicting views and were as unwilling as the ruling regime to share power--remained a vital force that commanded the loyalties of a large proportion of the population.

The Political and Human Rights Challenge

Although the national political situation contains many negative sides, most observers believe Bangladesh will continue to improve its democratic process, albeit slowly and with possible drawbacks. Presently, there is an increase in political 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 positive signs for democracy, Bangladesh finally put an end to twenty years of conflict in the tribal area of Chittagong Hill Tracts in 1997. However, the increase in political violence and breakdown of law and order reduce the citizens trust in the 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 citizens legal rights. For the majority of the population the main human rights concern is the absence of basic human rights due to mass-poverty. The present political instability and the mistrust between the political parties are obstacles .

The Judiciary and Law Enforcement Systems

The law and order situation has deteriorated over the last twenty years, as indicated in official statistics, with the highest increase in murder, rape and other acts of violence against women32. Other crimes include highway robbery and physical assaults. In many cases, there are allegations of police involvement in the crimes themselves. There is a general consensus in Bangladesh 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 corrupt institution in Bangladesh. In the 1996 study by Transparency International, 96% of the respondents claimed that it was impossible to get police assistance without paying bribes. Furthermore, police brutality is common and there are frequent reports of people tortured to death and women raped while in police custody. Another example of misconduct is the common illegal demand from traffic policemen to pay toll in order to pass on highways in Bangladesh. Some of the causes for this behavior are found in the poor career prospects and low salary levels, which are incentives for corruption within 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 notoriously weak 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. Thus there is a room for specialized treatment, doctors, and hospitals Government has made loans easily available and thus people with limited means could avail better/specialized treatment

The Challenge of a Global Economy

The total economic activities of the country are estimated to an annual value of 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 the economy with around 25% of GDP and employing two-thirds of the labor force. The industrial sector has grown steadily during the last ten years with an annual rate of over 7%, mainly due to the textile and ready-made garment industry. However, industry contributes with only around 12% of GDP. Construction stands for 68%, transportation and communications for 12 15%, various services for more than 30% and public administration and defense for 68% of GDP.

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

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

To a large extent, Bangladesh has achieved its steady growth rates during the nineties due to an exploitation of its relatively cheap workforce, both within the garment industry and through migrant labor contributing to the economy with large remittances from abroad. Only in the recent couple of years have their been significant foreign financial investments in the country. Continued economic growth through exports in hampered by severe infrastructural

bottlenecks (ports, transportation, communications, energy etc) and governance 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 48th largest 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 past few years. More than half of the GDP belongs to the service sector; nearly half of Bangladeshis are employed in the agriculture sector, with RMG, fish, vegetables, leather and leather goods, ceramics, rice as other important produce. They have bad sewage treatment that contributes to disease and famine.

Monetary policy

Monetary Policy Framework: It starts by articulating the monetary policy framework (in terms of the goals, the instruments, and the analytic channels of transmission) for greater clarity and transparency benefiting both the policy makers as well as the stakeholders. The appropriate monetary policy goal in the Bangladesh context is to achieve price stability with the highest sustainable output growth. The overall goal will be to contain inflationary expectations, maintain currency stability and ensure smooth credit flow to the growth 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 sq km, cant still shake off the ill-reputation of being one of the least developed countries, shadowed by miserable poverty, high illiteracy rate and a gigantic population of 141, 340,476 (July 2004 est.) Moreover natural disasters such as seasonal inundation, cyclones, draughts etc. constantly pursue its lot every year, which break the backbone of the economy and frustrate future planning. Economy is sick with high inflation rate.

Inflation rates (7 percent)

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

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


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 the poorer segments of society. Grameen Bank, which is one of the most well known micro-finance institutions in the world, started as a small pilot project by Professor Yunus to see if the poor villagers could handle a small credit.

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

today reached by some form of micro-credit as over 1,000 NGOs, Grameen Bank itself, PKSF (a quasi-government lending institution) and several commercial banks are involved. Various studies demonstrate that microcredits have been able to improve the economic and social situation for the poor. In a survey from 1998, it was indicated that as much as 45% of eligible poor households in Bangladesh participate in micro-credit programs.

More than two-thirds are women. The survey found that credit programs had a positive effect on several socioeconomic variables, including childrens schooling, the nutritional level, lower fertility and increased use of contraception. Consumption increased for 5% of the participants, which enabled them to rise above the poverty line.

Employment (wage rates)

Reducing poverty remains a formidable challenge for Bangladesh. Although economic 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 economic growth and progress in poverty reduction, current policies emphasize that strong economic growth alone is not adequate for sustained poverty reduction in Bangladesh. For successful poverty reduction, the strategies must also ensure 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 households since the only abundant productive resource that the poor have is their own labor.

Increasing employment opportunities and raising the returns to labor is therefore the most viable option to reduce poverty and meet the countrys human development goals. In this context, one important issue is to recognize that 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 not adequate. This requires an employment-centered strategy to growth in which employment opportunities would expand for the poor along with returns adequate enough to raise the households out of poverty.

Rapid and sustained poverty reduction in Bangladesh thus calls for integrating three elements within the growth policy framework: first, sustained economic growth at reasonably high rates; second, expansion of productive and remunerative employment opportunities; and third, expanding the access to jobs for the poor. The governments development strategy recognizes the need to orient growth policies toward creating decent employment opportunities for which several options are emphasized, such as adopting policies for making growth more employment-friendly, increasing overseas migration of workers, and undertaking special employment creation programs through micro credit and employment based safety nets and public works programs.

Budget deficits

The Bangladeshi government is desperately seeking loans from overseas lenders to make up a big budget deficit of 395 billion taka in the ongoing financial year 2009-10 (July 2009 and June 2010) and retain the country's foreign 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 the country's bilateral and multilateral lenders to procure at least 185 billion taka for deficit financing, leading English newspaper New Age reported Sunday. The remaining amount of budget deficit worth around 210 billion taka would be met through local borrowings from commercial banks and state-run saving instruments.

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

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

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 due to 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 the private sector. During this period, average production of BJMC and BJMA mills declined by 43 percent and 6 per cent respectively (Table 25). BJSA mills 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 to identify the factors that were responsible for their growth.

Macroeconomic Stability

Macroeconomic stability is necessary, but not sufficient, for increased economic growth. Bangladesh has managed to have a stable macroeconomic situation during the last few years despite the crisis in the Asian region during 1997 and the devastating floods in 1998. The rates of savings and investments have increased and the investment-GDP ratio is around 20%. Inflation has been kept at an annual rate of around 810% as a result of a relative control of the fiscal deficit. The countrys fiscal deficit during the last five years has averaged about 3.6% of GDP, which has been within sustainable 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 still controlled, but the government has a policy of flexible exchange rate management, which involves frequent smaller adjustments of the exchange rate. 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

and assist to further increase exports and overall economic growth in industry and 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 leaves little room for maneuver as state revenue is among the lowest in the world in comparison to GDP and further fiscal deficits would lead to higher inflation if domestic borrowing continues at its current level. The fiscal situation must therefore be seen as worrisome, especially if losses from state-owned enterprises and the effects of non-performing loans at the nationalized banks are taken into account. State-Owned Enterprises

Since the nationalization of large economic assets after the bloody independence war in 1971, Bangladesh has had a legacy of state domination in industry and banking. Apart from national ownership of the power system and railways, the government also acquired sections of manufacturing such as textile, jute and sugar mills. The trade unions within the companies are very strong and oppose most changes. Attempts to restructure the industry have been made, but privatization of state-owned enterprises is still lagging behind and only a few enterprises have been privatized and none of the large companies.

The Privatization Board is responsible for the privatization of fifty enterprises and the government is working on improving the implementation as well as retraining retrenched workers, improving severance benefits and creating a public opinion for privatization. State owned enterprises are still dominant in several sectors, for example in sugar and jute. The companies are inefficient and represent a huge drain on national resources. In 1999, the losses of the state owned enterprises were over 300 million USD. The losses in the midnineties were equivalent to more than half of the spending of the social sector in the annual development budget.

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. Thus peoples lifestyles changes and health is better understood. Thus there is a room for specialized treatment, doctors, and hospitals. The informal sector, including services, transportation, handicraft, and domestic work for women etc, 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 various activities 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. in Bombay 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, waste blood etc. and taking due care of environment. Spreading awareness about various diseases through campaigns and free medical check ups.

Bangladesh has the highest population density in the world, excluding a handful of city-states and small countries such as Malta. Most of the demographic statistics below are from the CIA World Fact book, unless otherwise indicated.

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 and would play a key role in the empowerment of rural women. Although the growth within the agricultural sector has been more or less just above the population growth, rural poverty, especially for the extreme poor has shown signs of decreasing during the last five years. This is attributed to several factors, firstly there has been a shift from rice production to commercial no rice crops, and for example vegetables, livestock and fisheries have grown faster than other agricultural activities as a response to a growing market demand.

Secondly, the opportunities for economic activities outside agriculture have increased substantially during the nineties as the road network has been expanded, electricity has been provided to at least some areas and microcredits 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 urbanization has been a strong trend during the last thirty years. The urban population has increased fourfold over the last two decades and around 60% of the increases are due to migration, mostly by young adults, from the countryside8. The strong urbanization has two causes, on the one hand people are pushed by rural poverty as agriculture can only provide employment to some of the increasing number of available workers, and, on the other, urban centers provide hope for easier access to education, health facilities and, not least, a chance 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 and environmental problems for the growing cities, there are also positive sides as urban centers are breeding grounds for business activities and offer alternative livelihoods and wider social and cultural choices than the countryside.

4) Technological Environment Analysis:

Breakthrough innovation in the field of specialized equipment Communication has managed to bridge the gap between places located at long distances Test tube babies Mobility of medical services Mobile phones, credit cards (for payment purposes) etc have made doctors and medical facilities easily available

Technological factors can lower barriers to entry, reduce minimum efficient production levels, and influence outsourcing decisions. Some technological factors include:

R&D activity Automation technology incentives 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-todate and effective. Bangladesh most of the time have to buy these from the foreign market, so in Bangladeshi perspective the breakthrough innovation in the field of specialized equipment is a must and also communication has managed to bridge the gap between places located at long distances. Test tube babies are the technological advancement procedure. Mobility of medical services and Mobile phones, credit cards (for payment purposes) etc have made doctors and medical facilities easily available

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 increased in 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 legislative boundaries with patients demanding more rights in their healthcare programs.

Access to Health Care Services in Bangladesh:

Access to health services depends on the availability of service (i.e. the availability of physicians, health centers, and hospitals) to the actual as well as potential users. In Bangladesh, health facilities in both public and private sector are distributed in an unjust way, which makes the services inaccessible to low income and rural people. Along with such unjustified distribution of services between urban and rural areas, delivery of services also varied depending on the level of income (rich and poor), which is evident in discriminatory access to services. The poor in Bangladesh bear higher health risks and suffer the burden of excess mortality and morbidity. The poor in general are more prone to illness and diseases than the non-poor. The poorest households are likely to use health care services and are less willing to 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. The doctor-population, doctor-nurse, nurse-population ratios remain far below the

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

Though the health sectors achievement in recent days is remarkable, still the health care system have to go far to achieve the Millennium Development Goals. Most of the health indicators show low rates of achievement. Causes of failure of governance as mentioning below are responsible for these shortfalls: Voice and accountability: Citizens voices and demands result in improved state responsiveness, transparency and accountability. In reality, the state in Bangladesh like many developing countries is not sufficiently accountable to its citizens, whose voices often remain unheard or are simply too weak to have any influence. Voice and accountability permit communities to be involved in decisions and oversight of health care services. In the field of governance assessment, voice and accountability is a key indicator encapsulating a 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 rarely taken into account while making and implementing health policies. The low confidence in government health facilities and their underutilization are caused by weak administration, lack of oversight over them, and poor accountability (Ahmad, 2000). Failure in enforcing a system of accountability in the health system is weakening governance.

Centralized administration: In Bangladesh, health planning is solely the responsibility of central government. Ministry of Health controls the health care system with de-concentration of some power at the local level. None but the higher level officials take the decisions that are distant from policy implementation. Targets are set, activities are planned, and resources are allocated by the Ministry without much consultation with those who know the local level conditions. For this centralized tendency, over-targeting is a common characteristic of our health sector plan.

The weak local government system of Bangladesh is acting as governments agents rather than representative bodies of the community. They are accountable to the ministry rather to the people. Centralization of authority at the Ministry acts as a major barrier to ensure accountability in administration and to formulate a local health authority with adequate involvement of the community.

Staffing and absenteeism: Staffing is arguably the single most important element of health care delivery as little can be achieved without it. Training of the staff, their competencies and ability to function all determine whether the expected results can be achieved. Training typically is inadequate if not well beyond that needed in Bangladesh, especially for physicians.

Among the most serious issues in Bangladesh is the high rate of absenteeism, which undermines service delivery. Therefore, when a patient comes 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 a lack 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 is prevailing in the management of drug and equipment in the public hospitals. A huge quantity of supplied medicine and equipment is left unutilized and unconsumed due to poor management. Very often, it is alleged that doctors encourage the patients to purchase medicine from outside 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 and dichotomy. Insufficient coordination between the Ministry and health directorate has often created bottlenecks and unnecessary constraints and duplication of work. Unfortunately, there is no well defined role for the MOHFW to intervene in important health related issues in the sectors controlled by other ministries. Nor there is any meaningful coordination among the executive bodies, particularly ministries to monitor public health.

Moreover, the institutional arrangement for implementing health programs in Bangladesh 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 between different ministries, lack of sufficient ICT facilities in all levels, inadequacy of trained manpower including inappropriate placement, inadequacy of up to date data and often unreliable data, inadequate use of health information at policy 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 in affordability, quality and safety of drugs and rational use of drugs. New policies on public and private sector mix and financing of services need to be formulated, protection and preservation of the environment; more training institute for graduate and postgraduate study with proper practical facilities should be established, decentralization of management through devolution of authority and the adoption and maintenance of healthy lifestyles and the development of a comprehensive people oriented plan to improve and assure the quality of health services be provided.

6)Environmental Analysis:

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

Environmental dreadful conditions and depletion of natural resources are 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 lowest in Asia, and most of it is biomass for household consumption. Commercial energy is available to only 18% of the population as electricity and to about 8% as natural gas and petroleum gas. Inadequate supply of electricity to industry 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 substantial development of the power sector. This has attracted large foreign investments into the country..

The policy includes guidelines for basin-wide planning, water rights and allocations, public and private involvement, public investment, water supply and sanitation, fisheries, navigation, agriculture, industry and not least the effects 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 the case today as both central and local authorities lack human and financial resources to adequately manage the water resources.

The country has many environmental problems such as frequent natural disasters, industrial pollution, poor health and sanitation, deforestation, desertification, changes in climatic conditions, salinity and the overall deteriorating habitat of flora and fauna. Intensive cultivation threatens soil fertility and agrochemicals endanger the soil. Excessive water extraction for irrigation depresses the water table and flood control measures block fish migration 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

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 and gradually learned from previous mistakes.

As a result, improvements in disaster management have taken place relating to disaster prevention, during the natural calamities as relief operations, and afterwards as rehabilitation. Almost 65% of all land was under water during almost three months during the large flood of 1998. Although the flood, which was 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 early warning, improve co-ordination between meteorological experts and the authorities and ensure a good maintenance of existing embankments, roads and other infrastructure.

The Need for Clean Water and Sanitation

Water pollution is common and causes four of five illnesses and around 230,000 deaths annually, according to the World Bank. As the population increases it is getting more and more difficult to provide clean water and sanitation, especially in the growing townships and cities. With an average of almost 900 persons per livable square kilometers, the natural environment has 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 and sewerage, other simple, cheap and yet effective solutions for water and sanitation need to be found both in rural and urban areas.

Our businesss one of the biggest potency is each of our service must be completely environmental friendly. In hospital sector we need to focus more on cleanliness. The cleanliness of the hospital environment will make sure the safety of the patients as well as the safety of the environment.