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General Health

Matter, History
CHAPTER 1: Introduction of Bangladesh

1. INTRODUCTION
1.1 General Health Matter of Bangladesh
Bangladesh is considered a developing country with more than 75% of the total (142
million) population living in rural areas. About 36% of the population continues to live
below the national poverty line. Basic needs of living particularly health and education
remain largely unmet and only less than 40% of the population has access to basic
healthcare. Distribution of health workers (per 1000 population) in Bangladesh is
physicians 0.26, nurses 0.14and pharmacist 0.06. Per capita total expenditure on health
only US$ 2,84 in comparison to US$ 30-40 per capita, the minimum required for essential
health interventions in low-income countries. Though majority of the population lives in
rural areas, the government healthcare system remains a very minor source of '
health care there. Around 26% of professional posts in rural areas remain vacant and there
is high rate of absenteeism (about 40%). Treatments in the rural areas are mainly (about
45%) provided by unqualified health personnel including medical assistants, mid-wives,
village doctors, community health workers in comparison to that by qualified medical
graduates (only 10-20%). Over-prescribing and inappropriate prescribing are very common
in the country due to unethical practices of both health professionals and drug
manufacturers. Like most transitional societies, a wide range of therapeutic choices is
available in Bangladesh, ranging from self-care to traditional and western medicine

1.2 General Information about Bangladesh


Bangladeshis a small country in South Asia. It is situated between 20°34' and 26°38' |
North latitude and between 88°01' and 92°41' East longitude. The country is bounded in the
North and West by India, in the South by the Bay of Bengal and in the East by India and
Myanmar.

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Bangladesh has a total land area of 147,570 sq. km (56,977 sq. miles) and territorial
waters of 12 nautical miles. For administrative purposes the country is divided into 6
Divisions, 64 Districts and 495 Thanas (Local Government Areas). The country, called
a land of rivers, has a close network of many big and small rivers and their tributaries.
Notable among them are the Padma, Meghna, Jamuna, Brahmaputra, Madhumati,
Surma and Karnaphuli, most of which have their origin in the Himalayas in India and
flow down to the Bay of Bengal. The big rivers bring regular yearly monsoon floods so
vital for the fertility of the low lying cultivable lands of the country, although over-
flooding sometimes causes devastating damages to life and property.

Principal agricultural crops of the country are rice, jute, wheat, tea, tobacco, sugarcane,
pulses, oil seeds, spices, potatoes, vegetables, banana, mango, coconut and jack fruit.
Principal export items of Bangladesh include raw jute, jute products, ready-made
garments, tea, hides and skins, newsprint and fish. Bangladesh has a huge natural gas
reserve. Its other mineral resources are lignite coal, limestone, ceramic clay and glass
sand.

Bangladesh enjoys a typical tropical climate with three main seasons: Winter
(November-February), Summer (March-June) and Monsoon or Rainy season (July-
October). The minimum and maximum average temperatures in the Winter are 52.1°F
and 84°F, and in the Summer and Monsoon 69.6°F and 94.1°F respectively. Average
annual rainfall in the Monsoon ranges from 47" to 136". Humidity is highest in July
(99%) and lowest in December (36%).

Bangladesh has a population of about 125 million people, about 98% of which belong
to the same ethnic group sharing a common language (Bangla) and culture. This
linguistic group is called the Bangalees, which constitute the bulk population of the
main land. The rest 2% is constituted of tribal populations residing in the remote hilly
and forest areas of the country. There are six linguistic categories of such tribes in
Bangladesh who have their own language, culture and life style

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CHAPTER 1: Introduction of Bangladesh

Of the total population of the country only about 36% are literate and about 20-25% live in
the cities enjoying modern living facilities. The main profession of the village dwellers
(who constitute about 75-80% of the total population) is farming and the country's
economy is based on agriculture. The staple foods of the people are rice and wheat.
However, in recent years there has been a great change in the profession and life style of
the village people due to massive rural electrification and extension of some modern
facilities to the villages. These facilities include healthcare services with the establishment
of hospitals, health care centres, family planning clinics, Extended Programme on
Immunisation (EPI) clinics, etc. in the villages. But these services are totally inadequate for
such a big population of the country. On the average, only about 20-25% of the people
have access to modern health care facilities and the rest 75-80% of the rural population of
the main land of Bangladesh still receive health care services from the indigenous
traditional medicine practitioners.

1.3 Regulation of the therapeutic drugs in Bangladesh


In response to WHO's essential drugs concept such as access to essential medicines, quality
of all medicines and rational use of drugs, Bangladesh pioneered a National Drug Policy
(NDP) in 1982. Main objectives of this policy were to ensure easy accessibility to essential
drugs with affordable price, standard quality of drugs and rational use of drugs through
appropriate prescribing and dispensing the health care professionals. The Directorate of
Drug Administration (DDA) under the Ministry of Health & Family Welfare, Government
of the People's Republic of Bangladesh, is the drug regulatory authority of the country.
Mission of the DDA is to ensure that the common people have easy access to useful,
effective, safe and good quality essential and other drugs at affordable price. All matters
related to drugs and the Drugs Act 1940 and the rules made there under regulate medicines
in Bangladesh. In addition to that, the Government adopted the NDP in 1982 and The
Drugs (Control) Ordinance, 1982 was promulgated to implement it. The Ordinance controls
manufacture, import, distribution, sale, pricing, advertisement of all essential Allopathic
drugs and medicines and for prohibiting production, sale and use of non-essential and
unnecessary or less necessary drugs and medicines in the country. Drug Control Committee
(DCC), Standing Committee for procurement and import of raw materials and finished

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drugs, Pricing Committee and a number of other relevant Committees. To test the quality
of pre-registration and post-marketed drugs and medicines, there are two government Drug
Testing Laboratories in the country, one in Chittagong under the direct administrative
control of the DDA and the other in Dhaka under the control of the Institute of Public
Health (IPH) of the Directorate General of Health Services.

1.4 History of Allopathic medicine:


Allopathic medicine is an expression commonly used by homeopaths and proponents of
other forms of alternative medicine to refer to mainstream medical use of
pharmacologically active agents or physical interventions to treat or suppress symptoms or
pathophysiologic processes of diseases or conditions. The expression was coined in 1810
by the creator of homeopathy, Samuel Hahnemann (1755-1843). In such circles, the
expression "allopathic medicine" is still used to refer to "the broad category of medical
practice that is sometimes called Western medicine, biomedicine, evidence-based
medicine, or modern medicine".

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1.5 History of Traditional medicine:


1.5.1 Ayurvedic medicine
Ayurvedic medicine is one of the world's oldest medical systems. It originated in India
more than 3,000 years ago and remains one of the country's traditional health care systems.
Its concepts about health and disease promote the use of herbal compounds, special diets,
and other unique health practices. The term "Ayurveda" combines the Sanskrit words ayur
(life) and veda (science or knowledge). Ayurvedic medicine, as practiced in India, is one of
the oldest systems of medicine in the world. Many Ayurvedic practices predate written
records and were handed down by word of mouth. Three ancient books known as the Great
Trilogy were written in Sanskrit more than 2,000 years ago and are considered the main
texts on Ayurvedic medicine—Caraka Samhita, Sushruta Samhita, and Astanga Hridaya.
Key concepts of Ayurvedic medicine include universal interconnectedness (among people,
their health, and the universe), the body's constitution (prakriti), and life forces (dosha),
which are often compared to the biologic humors of the ancient Greek system. Using these
concepts, Ayurvedic physicians prescribe individualized treatments, including compounds
of herbs or proprietary ingredients, and diet, exercise, and lifestyle recommendations.

1.5.2 Homeopathy medicine


Homeopathy also known as homeopathic medicine is an alternative medical system that
was developed in Germany more than 200 years ago. The alternative medical system of
homeopathy was developed in Germany at the end of the 18th century. Supporters of
homeopathy point to two unconventional theories: "like cures like"—the notion that a
disease can be cured by a substance that produces similar symptoms in healthy people; and
"law of minimum dose"—the notion that the lower the dose of the medication, the greater
its effectiveness. Many homeopathic remedies are so diluted that no molecules of the
original substance remain.

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Homeopathic remedies are derived from substances that come from plants, minerals, or
animals, such as red onion, arnica (mountain herb), crushed whole bees, white arsenic,
poison ivy, belladonna (deadly nightshade), and stinging nettle. Homeopathic remedies are
often formulated as sugar pellets to be placed under the tongue; they may also be in other
forms, such as ointments, gels, drops, creams, arid tablets. Treatments are "individualized"
or tailored to each person—it is not uncommon for different people with the same
condition to receive different treatments.

1.5.3 Unani Medicine


Unani-tibb or Unani Medicine also spelled Yunani Medicine is a form of traditional
medicine practiced in middle-east & south-Asian countries. It refers to a tradition of
Graeco-Arabic medicine, which is based on the teachings of Greek physicians Hippocrates
and Galen, and developed into an elaborate medical system in middle age era by Arabian
and Persian physicians, such as Rhazes (al-Razi), Avicenna (Ibn Sena), Al-Zahrawi, and
Ibn Nafis.

Unani medicine is based on the concept of the four humours: Phlegm (Balgham), Blood
(Dam), Yellow bile (Safra1) and Black bile (Sauda1). The time of origin is thus dated at
circa 1025 AD, when Avicenna wrote The Canon of Medicine in Persia. While he was
primarily influenced by Greek and Islamic medicine, he was also influenced by the Indian
medical teachings of Sushruta and Charaka.

Unani medicine first arrived in India around 12th or 13th century with establishment of
Delhi Sultanate (1206-1527) and Islamic rule over North India and subsequently flourished
under Mughal Empire. Alauddin Khilji had several eminent Unani physicians (Hakims) in
his royal courts. In the coming years this royal patronage meant development of Unani
practice in India, but also of Unani literature with the aid of Indian Ayurvedic physicians.

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1.6 TRADITIONAL MEDICINE PRACTICE IN BANGLADESH


Bangladesh possesses a rich flora of medicinal plants. Out of the estimated 5000 species of
different plants growing in this country more than a thousand are regarded as
havingmedicinal properties. Use of these plants for therapeutic purposes has been in
practice in this country since time immemorial. Continuous use of these plants as items of
traditional medicine in the treatment and management of various health problems
generation after generation has made traditional medicine an integral part of the culture of
the people of this country. As a result, even at this age of highly advanced allopathic
medicine, a large majority (75-80%) of the population of this country still prefer using
traditional medicine in the treatment of most of their diseases even though modern medical
facilities may be available in the neighbourhood.

Although the use of traditional medicine is so deeply rooted in the cultural heritage of
Bangladesh the concept, practice, type and method of application of traditional medicine
vary widely among the different ethnic groups. Traditional medical practice among the
tribal people is guided by their culture and life style and is mainly based on the use of plant
and animal parts and their various products as items of medicine. But the method of
treatment and application of the medicament are greatly influenced by the religious beliefs
of the different tribes and their concept of natural and supernatural causes of diseases. For
that reason their medical practice also includes the use of a number of rituals like religious
prayers, sacrifices, offerings in the name of the spirits and gods, incantations and
sometimes tortures. The medicaments, prepared from plant materials and other natural
products sometimes also include some objectionable substances of animal origin. They are
dispensed in a number of dosage forms like infusions, decoctions, pastes, molded lumps,
powders, dried pills, creams and poultices. Diets are strictly regulated. Massages,
sometimes amounting to almost physical torture, are also prescribed as parts of treatment.
Treatments prescribing wearing of amulets, garlands of twigs of plants or animal bones and
teeth and drawing of images of supernatural creatures, gods and spirits on different parts of
the body are also in vogue among some tribes. While these items of treatment are almost

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common in the medical practice of most of the tribal groups, their individual weight age
and method of application vary from tribe to tribe.

Both the Unani and Ayurvedic systems of traditional medicine have firm roots in
Bangladesh and are widely practiced all over the country. Apparently the recipients of
these systems of medicine appear to be the rural people, but practically a good proportion
of the urban population still continues to use these traditional medicines, although
organized modern healthcare facilities are available to them. Medicinal preparations,
almost all of which are multicomponental, used in these two systems are invariably made
from plant materials, sometimes with the addition of some animal products and also some
natural or synthetic organic and inorganic chemical substances. Both indigenous and
modern technologies are employed in preparing the medicines of these systems. Plant
materials are used in these preparations in a variety of forms, such as small pieces, coarse
powders, as their extracts, infusions, decoctions or distillates. They are dispensed as broken
pieces, coarse and fine powders, pills of different sizes, in the form of compressed tablets,
as liquid preparations, as semi-solid masses and in the form of ointments and creams,
neatly packed in appropriate sachets, packets, aluminum foils, plastic or metallic containers
and glass bottles. The containers are fully labeled with indications/contraindications, doses
and directions for use and storage, just like modern allopathic medicinal preparations.

1.7 Official Status Of Traditional Medicine In Bangladesh


Unani and Ayurvedic systems of medicine were officially recognized by the Government
of Bangladesh immediately after independence and at the same time a Board of Unani and
Ayurvedic systems of medicine was constituted. After the introduction of a National Drug
Policy in 1982, Unani and Ayurvedic drugs have been brought under the control of the
Drugs Administration Department of the Ministry of Health and Family Welfare by
legislation to control and regulate the commercial manufacturing and marketing of quality
Unani and Ayurvedic drugs. The Board of Unani and Ayurvedic systems of medicine
performs the following specific functions: registration of the traditional medicine
practitioners, recognition of the relevant teaching institutions, holding of qualifying

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examinations, publication of text books, standardization of Unani and Ayurvedic drugs,


preparation and publication of Pharmacopoeias/Formularies and undertaking research and
development programmes. The Board has by this time published two National Formularies:
- one for Unani and the other for Ayurvedic drugs, which have already been approved by
the Government. They are now in use as official guides for the manufacture of all
recognized Unani and Ayurvedic medicinal preparations.

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1.8 Production Of Traditional Medicines

More than four hundred big and small manufacturers in Bangladesh are now engaged in
manufacturing traditional medicine preparations in various dosage forms using local and
imported raw materials. Some of the important raw materials of plant origin are derived
from the rich tropical flora of Bangladesh. Many of them are imported from India and
Pakistan. The Unani and Ayurvedic drugs manufactured in Bangladesh not only meet the
local requirements but are also exported to the neighbouring countries. Although many of
these manufacturers are still using the traditional methods of producing these drugs, some
of them, like Hamdard Laboratories (Waqf) Bangladesh, have substantially modernized
their factories by installing modern equipment and machinery. They use modern methods
and technology for the production and quality control of their traditional medicines. Some
of these factories can be compared with any modem pharmaceutical factory of this and
other countries. The presentation and quality of their products are as good as those of
modern allopathic drugs. Many traditional medicine preparations in Bangladesh are now
dispensed and sold from most of the modern allopathic drug stores, particularly those in the
rural and peri-urban areas, and some of them are even prescribed by the modem allopathic
medicine practitioners. Modernization and utilization of modern technology and
pharmaceutical knowledge in manufacturing and quality controlling of traditional
medicines are now rapidly increasing in Bangladesh.

Traditional medicine systems, particularly Unani and Ayurvedic systems are now
recognized and well accepted as good alternative systems of medicine in both rural and
urban areas of Bangladesh. Considerable research is now going on in this country both
privately and institutionally to improve the quality of these drugs. Establishment of a
separate Research & Development laboratory by the Hamdard Laboratories of Bangladesh,
a manufacturer of Unani medicines, in order to undertake research programmes to improve
the quality of its current products and to develop new drugs from indigenous natural
sources, bears clear testimony to that.

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The effort is not limited to that only. One of the objectives of the National Health Policy is
to encourage systematic improvement in the practice of the indigenous systems of medicine
and to utilize the additional manpower available in the Health sector. The Government is
also planning to incorporate traditional medicine in Primary Health Care (PHC) activities.
In order to achieve the goal of providing basic health needs to maximum of the rural people
in the shortest possible time with minimum expenditure, the Government is planning to
bring traditional medicine into the mainstream of the organized public health services and
health care delivery programmes of the country. In an attempt to integrate the traditional
and modern allopathic medicine practices, the Govt. has already started appointing
qualified Hakims and Kavirajes in the rural hospitals and health complexes along with
graduate allopathic medical doctors. With the encouragement and practical involvement of
the World Health Organization, efforts are now in vogue in Bangladesh to utilize
traditional medicine more and more in the health care programmes, particularly at the
Primary Health Care level. And this is imparting a positive effect on the overall health
management programmes of the country.

1.9 Production of Modern or Allopathic Medicines


Pharmaceutical Industry is one of the most developed high tech sectors in Bangladesh. It
is contributing a lot in the economy of the country. After the promulgation of Drug Control
Ordinance 1982, the development of this sector was accelerated. The growth was observed
at a considerable rate in the last two decades. This sector is also providing about 97% of the
total medicine requirement of the local market. Leading Pharmaceutical Companies are
expanding their business with the aim to expand export market. In Bangladesh there have
252 licensed pharmaceutical companies at present in total including nationals and
multinationals. Presently the national companies account for more than 75% of the
pharmaceutical business in Bangladesh. However, among the top twenty companies of
Bangladesh, six are multinationals. These multinational companies are channeling into and
marketing almost all the life saving imported products and new innovative molecules in
Bangladesh. Multinational and large national companies generally follow current Good
Manufacturing Practices (GMP) including rigorous quality control procedure of their
products. At present the national and multinational companies are manufacturing about

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19,830 brands of medicines under 1081 generics in different dosage forms. There were,
however, 2000 wholesale drug license holders and about 80,000 retail drug license holders
are involved in drug distribution and dispense in Bangladesh. Anti-infective is the largest
therapeutic class of locally produced medicinal products, distantly followed by antacids
and anti-ulcerants. Other significant therapeutic classes include Non-Steroidal Anti-
Inflammatory Drug (NSADD), vitamins, cardiovascular drug, Central Nervous System
(CNS) and respiratory products. A most remarkable progress the local industry has made in
recent time is the phenomenal increase in the local production of basic chemicals. Presently
top pharmaceutical companies in Bangladesh are also in the process of getting into bulk
drug production with collaborative technology, technology transfers and joint venture
basis. At least 21 companies are produce about 41 active pharmaceutical ingredients (API).
The large-scale players in the Bangladesh pharmaceutical industry currently include Square
Pharma, Beximco Pharmaceuticals, Nib Chemicals, Ganoshastha Pharmaceutical, Opsonin
Chemicals, ACI Pharmaceuticals, Globe Pharmaceuticals and others. The basic chemicals
include Paracetamol, Ampicillin Trihydrate, Amoxycillin Trihydrate, Cloxacillin,
Diclofenac Sodium, Aluminium Hydroxide Dried Gel, Magnesium Hydroxide dried gel,
Dextrose Monohydrate, Hard Gelatin capsule shell, Chloroquine Phosphate, Propranolol
Hydrochloride, Benzoyl Metronidazole, Ciprofloxacin Hydrochloride, Cephradine,
Pyrantel Pamoate, and others. However, most of these are confined to the last stage of
synthesis. To feed the local industry, more API industries are needed. The recent approval,
as was reported in a section of the media, to a 30 billion dollar API industrial park in
Munshiganj will inject fresh momentum to the pharmaceutical industry. Bangladesh can
save at least 70% of expenditure on raw materials when the API part goes into production.
At present Bangladesh imports 80% of its pharmaceutical raw materials. A good number of
skilled professionals from home and abroad are expected to join the industry to enrich its
human resources pool. Bangladesh has a large generic market, and companies such as
Square and Beximco are beginning to have success overseas. However, despite the country
possessing huge manufacturing capabilities, the complete lack of Research and
Development (R&D) in domestic companies could cause the market to stagnate. Very few
pharmaceutical companies have product development department. No collaborative
research exists between university and industry. For future development such link between
Industry and University is mandatory. The National Drug Policy of 2005 was a great step
forward for Bangladeshi pharmaceutical industry.

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1.10 Present Condition and educational status of Traditional medicine:


Government of Bangladesh pledges modernization of the unani, ayurvedic and
homeopathic medical care as an alternative to the widespread allopathic system.
Alternative medicine has been playing a significant role in the healthcare delivery system
in the developing countries of this region from time immemorial. Although tremendous
progress has taken place in the field of allopathic medicine, particularly in synthetic
Pharmaceuticals and antimicrobials, the practice and use of alternative medicines are
continued thought out the country even today. Bangladesh, due to its geographical location
and climatic condition, is a favorable home for the growth and use of herbal medicines. The
World Health Organization is providing financial and technical support for the
improvement of unani, ayurvadic and homeopathic systems of medical care in Bangladesh.
There are two medical colleges for alternative medicines in Dhaka. The Government Unani
and Ayurvedic Degree College and the Homeopathic Degree College. Each college has a
100 bed hospital. The duration of course for each is 5years, followed by one year of
internship. The degrees offerd by these colleges are: BUMS (Bachelor of Unani Medicine
and Surgery), BAMS (Bachelor of Ayurvedic Medicine and Surgery), and BHMS
(Bachelor of Homeopathic Medicine and Surgery). Diplomas are offered after completion
of 4years of academic courses and six months of internship. The Diploma certificates are
offered by the Board of Unani and Ayurvedic System of Medicine and Board of
Homeopathic Medicine. Bachelor's degrees in any of the above mentioned disciplines are
given by the University: e.g, Dhaka University and registration for Graduate Doctors are
given by DGHS.
To create opportunity for providing patient care services through alternative medicines, the
number of sanctioned posts of medical officer has been increased to 468, with 156 for
unani medicine, 156 for ayurvedic medicine and 156 for homeopathic medicine, posts of
487 support personnel have also been created.
To grow medicinal; plants and create awareness of the local people about medicinal plants,
467 demonstration herbal gardens have been established, one in each district hospital and
upazila health complex premise, one herbal gardener has been appointed each herbal
garden to take care of the garden. As of now, a total of 575 alternative medical care health
personnel and staff are working at different places. The total number

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of sanctioned posts is 1422. Apart from the government services, some of the graduates and
diploma-holders are working in different NGOs and private organizations. About 80,000
different categories of AMC doctors are practicing in our country and about 700 industries
are producing unani, Ayurvedic and Homeopathic drugs.
Table l: Summarizes the academic and training institutions for alternative
medicines in Bangladesh.
Name of Number Duration Duration of Degree Certifying
Institution of course internship offered authority
Total Governm Private
ent
Government 1 1 0 5years 1 year BUMS University of
Unani and & Dhaka
Ayurvedic BAMS
Degree
college
Homeopathic University of
Degree 2 1 1 Syears lyear BHMS Dhaka
College
Unani 12 1 11 4years 6months DUMS Board of Unani
Diploma and Ayurvedic
College System of
Medicine
Ayurvedic 8 0 8 4years 6months DAMS Board of Unani
Diploma and Ayurvedic
College System of
Medicine
Homeopathic Board of
Diploma 41 0 41 4years 6months DHMS Homeopathic
College Medicine

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