Sayema Naznin
BRAC University
The Health Minister has said the government is considering an additional afternoon or evening shift at public hospitals, and will discuss it with the Prime Minister shortly. He spoke at a specialized ENT institute, where an extension will raise bed capacity from 135 to 250. The goal is fuller use of facilities and care for more patients, though he made the shift conditional on recruiting new doctors, nurses and technologists.
The diagnosis is sound. Outpatient services mostly close by noon, so working people, daytime caregivers and patients travelling from distant districts often arrive to find the doors shut, while costly buildings and diagnostic machines sit idle. Many patients turn to private clinics that charge far more. Extending hours is among the cheapest ways to add capacity, since the infrastructure already exists, and it could ease the dawn queues.
The strongest argument is better use of fixed assets, as longer operation spreads the cost of imaging machines, laboratories and theatres across more patients. Evening clinics would also help low-income households who cannot afford to lose a day’s wage, and could draw some patients away from informal, unregulated providers.
The practical problems
The announcement falls short exactly where it counts most, in execution. This idea has circulated for years without ever being put into practice, and the statement offers no explanation for why previous attempts stalled. Framing it as something to be discussed with senior government figures makes it look more like a political gesture than a ready operational plan.
Staffing is the immediate problem. Public hospitals already struggle with vacant posts, absenteeism, and doctors concentrated away from rural areas, and training new medical staff takes years. Adding an evening shift without new hires would simply overstretch existing workers. Pay matters too, since many public doctors earn most of their income from private evening practice, and an underpaid shift will meet resistance while a well-paid one raises budget concerns.
Support systems matter just as much: reliable staffing of nurses and technicians, steady utilities, sterilization, and safe transport home. Without enough medicine to cover longer hours, patients will still be sent elsewhere. Urban hospitals would likely adopt this first, even though rural facilities need it more, potentially widening existing gaps. Finally, tired junior staff working unsupervised evening shifts could raise error rates and hurt care quality.
Intent and reality
The goal of the proposal is admirable and its logic is straightforward, but its success depends on inputs the government has not yet demonstrated it can supply. The benefit is large in theory and modest in practice if the shift is introduced by order rather than built through preparation. The minister’s conditional phrasing is honest, yet it reveals that the policy is currently a wish attached to a hiring plan that does not yet exist.
Auxiliary reforms
The reform is best introduced gradually, beginning with a small group of carefully chosen hospitals spread across different divisions. Patient load, staff attendance and running costs should be tracked closely during this trial, and the scheme should be widened only once the evidence shows what works and what does not. Participation will depend on a transparent incentive package that combines overtime pay, rotating schedules and compensatory leave, so that the extra hours feel both attractive and fair to those who work them. Behind this sits the harder task of building the workforce itself. Nurses and technologists are the real bottleneck, so recruitment and training need to be accelerated, and an enforceable posting and retention policy is needed to keep qualified staff in remote areas rather than clustered in the capital.
Extended hours will mean little if patients leave without the care they came for, so supply chains for medicines and diagnostic consumables must be strengthened, ideally with digital stock tracking that flags shortages before they occur. An appointment and queue management system would help evening capacity to be used efficiently and would reduce the crowding that currently defines outpatient departments. Late hours also bring safety concerns, particularly for women on the staff, which calls for investment in secure facilities, protected premises and reliable transport for those travelling home after dark.
Finally, the relationship between public duty and private practice needs a clearer rulebook. Dual practice by public doctors is a long-standing reality, and regulation should be designed so that formal evening services complement private chambers rather than compete with them. Accountability should complete the picture, with performance data published regularly so that the public can judge for itself whether the evening shift is delivering real improvement or remaining an announcement on paper.
Conclusion
An evening shift is a sensible and potentially valuable idea, but hours alone do not create care. Unless staffing, incentives, supplies and accountability are planned together and funded in advance, the initiative risks becoming another well-meant announcement that stalls at the stage of discussion.
