Shishu Bikash centres: Govt cuts specialist care for children with special needs

For children with special needs, the 35 Shishu Bikash Kendras have been more than clinics -- they are lifelines offering hope in a country where proper, affordable care is rare.

Launched in 2008 to provide free treatment and therapy, these government-run child development centres have transformed countless families' lives.

Their future, however, now hangs in the balance, as the project's term expired last June and the government plans to run it on a shoestring budget.

As part of this plan, all developmental paediatricians -- doctors trained to manage complex neurodevelopmental conditions -- are to be removed and replaced with general paediatricians attached to hospitals.

With staffers unpaid for 14 months, doctors facing dismissal, and thousands of vulnerable children at risk, experts and parents say the government is abandoning children with special needs.

Under the Health, Population and Nutrition Sector Programme, the health ministry set up the 35 centres -- 24 in medical college hospitals and 11 in district hospitals -- staffed by developmental paediatricians, therapists, and child psychologists.

The centres treat children aged 0–16 with autism, Down syndrome, cerebral palsy, ADHD, epilepsy, delayed speech, intellectual disabilities and other disorders.

Patient numbers rose from under 10,000 in the first year to over 56,000 in 2022–23. In total, 243,000 children have received treatment, with more than 1,000 attending daily between 8:30am and 2:30pm.

To bridge the gap after the project's closure, the health ministry had proposed a two-year initiative titled "Implementation of Essential Activities of the DGHS, DGDA and Community Clinic Health Assistance Trust".

However, when the finance ministry sent the plan to the Planning Commission, posts for developmental paediatricians were dropped. Instead, it suggested outsourcing 35 therapists and 12 psychologists.

Experts warned that cutting specialist care may save money in the short term but will raise far greater costs later, as children deprived of early treatment risk growing up dependent on long-term state support.

Dr Shaidur Rahman Shohag, resident physician in Dhaka Medical College Hospital's paediatrics department, said that removing experienced specialists -- who need to spend nearly an hour with each child -- will harm both quality and access.

"An outpatient doctor already sees 70 patients a day. How can they spare the time or expertise for these children with special needs? The very purpose of the centres will be lost, and low- and middle-income families will be left with nowhere to go.

"We talk about universal health in line with SDG commitments. But true universal health is only possible if the quality of life of these children is improved."

Dr Toshiba Rahman, who has been running the Child Development Centre and Neurology Clinic at DMCH since 2009, said, "Neurodevelopment is a complex, stage-based process. Using scientific tools and evidence-based assessments, we evaluate motor, cognitive, language and socio-emotional growth -- allowing early detection and timely intervention that can transform a child's future."

From January to August this year, her centre treated over 5,000 children. "You can't just glance at a child for five minutes and write a prescription … Each case takes 30-45 minutes of observation, reviewing reports, listening to parents and consulting therapists. If we compromise on quality, diagnosis and planning will fail -- and the children will pay the price."

Parents are equally alarmed.

Speaking to The Daily Star, Sufia Akter, mother of a child with developmental delays, said, "This is not just about my child -- every child with developmental issues first goes to a general paediatrician, who blindly refers them to Shishu Bikash Kendras. If you remove the specialists and expect general doctors to handle it, what's the point?

"The government ignores low- and middle-income families, for whom 10-taka services are a lifeline."

However, finance ministry's Joint Secretary Rownak Jahan defended the government decision, saying staffing in development projects must follow strict regulations. "We've provided all that was possible within our purview and authority," she told The Daily Star.

But the move contradicts the Health Reforms Commission's recommendation to set up multidisciplinary child development centres in all district and medical college hospitals, supported by new legislation to ensure continuity.

Health Secretary Saidur Rahman acknowledged the limitations. "Since this is a project, it'll have to be discontinued at some point."

He added that integrating the centres into the mainstream system -- like other hospital units with revenue support -- could provide a permanent solution.

About hospital paediatricians replacing specialists, he said, "It may take some time for them to adapt, but their specialisation is in children." He insisted that quality care could be maintained with proper monitoring. "It actually depends on who is dedicated to it."

However, specialists fear otherwise. Professor Naila Zaman Khan, paediatric neurologist who pioneered the centres and is a member of the Health Reform Commission, said, "Removing any one component will collapse the service."

Even if general paediatricians are redeployed, she said, they would require at least three months of structured training.

She urged integrating training for paediatricians and child health physicians as a regular part of the Directorate General of Health Services's system.

"Dhaka Shishu Hospital earlier offered a three-month course for child health physicians, but it was discontinued in 2018. Since then, training has been piecemeal. We need a comprehensive approach. Establishing a centre in any major government specialised hospital could ensure continuity; otherwise, marginalised families will bear the loss."

The Health Reform Commission has also proposed a Child Development Centre Act to guarantee sustainability. Without it, Naila said, services remain prone to disruption, leaving hundreds of children referred from primary and secondary care facilities without support.

Ashrafun Nahar Mishti, executive director of the Women with Disabilities Development Foundation, said, "Our country already lacks initiatives for children with developmental needs. If the quality of existing services is also reduced, families will stop coming and their children's development will be shut down entirely."