Rokeya is 10 and a half years old and lives in Sirajganj. Since birth, her arms and legs have been weak and stiff. Sometimes, her lips and tongue would turn bluish. As her condition got worse, her family took her to a specialist when she was just three months old. But the doctors couldn’t figure out what was wrong. After many tests and visits, they eventually learned that Rokeya had an intellectual disability.

A neuro medicine specialist prescribed medication and also recommended regular counseling. Since then, Rokeya has been receiving counseling at the Child Development Center at Shaheed M. Monsur Ali Medical College Hospital in Sirajganj. The sessions were helping her improve. But now, with the sudden closure of the center, her family is in distress.

Rokeya’s father, Rakibul Islam, a resident of Sirajganj town, told Bonik Barta, “When the local Child Development Center opened in 2021, it gave access to services for many children like my daughter. The counseling helped her improve. However, the center has been shut for the last 7–8 months, so she hasn’t been able to continue her therapy. Her condition is getting worse again.”

Stating that it is impossible to provide services at a private center for financial reasons, the child’s father said, “Where services were available for just BDT 10 tickets, private institutions cost BDT thousands. A family like ours can’t bear that. Therefore, I am urgently demanding the opening of a government service center to improve the developmental problems of children with special needs.”

It’s not just the Sirajganj hospital. Most of the 35 government-run Child Development Centers nationwide have also stopped services. According to a report by the Directorate General of Health Services, this has put over 50,000 children with special needs at serious risk of their health.

It has been found that the doctors, psychologists, and staff working at Child Development Centers—set up to provide physical and mental healthcare for children with disabilities and special needs—haven’t received their salaries for the past 10 months. There’s also no clear statement from the authorities about whether their jobs are still secure. As a result, many professionals, including doctors, have already resigned. Those still working have no idea when or if they’ll be paid. Because of this uncertainty, most healthcare workers at these centers have stopped providing services, according to project insiders.

The idea to establish these centers was first introduced in 2008 to support the physical and mental development of children with disabilities and sensory challenges. The full-scale program started in 2009 under the Ministry of Health and Family Welfare, as part of the hospital management operational plan within the 4th Health, Population, and Nutrition Sector Program. Initially, five centers were opened. Later, in 2010 and 2014, another ten centers were added. Finally, in March 2021, the project expanded with 20 more centers, bringing the total to 35 nationwide.

Among these, 24 are in government medical college hospitals and 11 in district-level hospitals.

Each center had a team of five: a pediatric specialist, a child psychologist, a developmental therapist, an office manager, and a cleaner. Additionally, there were 11 staff members—including instructors and coordinators—at the Multidisciplinary Training Center for Child Development. In total, 186 skilled staff members were employed under this project. But many staff have lost motivation without salaries for 10 months—including this month. So far, seven pediatric doctors, one child psychologist, and two developmental therapists have already resigned.

When asked about the situation, senior instructor (development therapy) Mohsina Sultana told Bonik Barta, “Due to non-payment of salaries, none of the five health workers at each center, from doctors to cleaners, are interested in working. Furthermore, the centers’ service activities are such that if one person does not work, the entire service chain is closed. As a result, there is a deadlock in all the centers.”

The lives of the Child Development Center staff have become incredibly difficult due to months of unpaid salaries. One heartbreaking example is Abu Taher, a cleaner at the Feni center. According to officials, he struggled to cover basic household expenses without income. The stress became too much, and in early December, he suffered a stroke. Sadly, on January 31, he passed away without receiving any treatment—his family simply couldn’t afford it.

Child development centers provide services to children with special needs such as autism, neurodevelopmental disorders (NDD), physical disabilities, mental disorders, visual impairment, speech delay and speech problems, intellectual disabilities, hearing impairment, cerebral palsy, Down syndrome, hyperactivity and attention deficit disorder, seizures and epilepsy, learning disabilities, and behavioral problems. The child’s normal development is determined according to age. In addition, learning disabilities, intelligence and behavior assessment, positive parenting, counseling (child and family), behavior therapy, trauma therapy (EMDR), cognitive behavior therapy (CBT), and transactional analysis therapy (TA) services are also provided.

According to the Directorate General of Health Services data, 44,442 children received care from these centers in the 2023–24 fiscal year. In the previous years—2021–22 and 2022–23—the numbers were even higher, with 53,817 and 56,172 children served, respectively.

Even during the peak of the COVID-19 pandemic, when social distancing was strictly enforced, the centers still managed to help 26,475 children in 2019–20 and 19,221 in 2020–21.

But since June of last year, all services have been suspended. That means over the past 10 months, more than 50,000 children with special needs have been at serious health risk.

A child may have multiple problems. As a result, multiple services have to be provided. Child health doctors, development therapists, and child psychologists provide these different services. Sometimes, a child has to receive the same service more than once. Accordingly, 164,569 services were provided in the child development centers in the 2023-24 fiscal year. Earlier, 148,163 and 160,278 services were provided in the fiscal years 2021-22 and 2022-23, respectively. However, the services of the child centers are currently closed due to non-payment of salaries to the staff.

When asked about the current crisis at the Child Development Centers, Supriyo Sarker, program manager of Hospital Services Management under the Directorate General of Health Services, explained the situation to Bonik Barta.

He said, “These 35 centers received an annual BDT 100 to 120 million budget under the 4th Health Sector Program. But now that the program has ended and the centers haven’t been moved into the national revenue budget, there’s no funding available. The last salaries we could pay were for the June 2023–24 fiscal year. Since then, doctors and staff at the centers haven’t been paid. That means it’s been 10 months without salaries, including this month.”

“In the beginning, many staff members continued working without pay. But over time, they stopped coming regularly. We can’t force them to work without payment. That’s why services have become irregular. Still, we’re hopeful the crisis will be resolved soon, and the centers will reopen,” Supriyo added.

According to the 2021 National Disability Survey, around 3 percent of the country’s total population lives with a disability. Experts warn that if these individuals are not allowed to reach their full potential, the country won’t be able to meet the Sustainable Development Goals (SDGs) for children with disabilities by 2030. That’s why a combined effort for both healthcare and rehabilitation is essential. The 35 Child Development Centers under the Ministry of Health, located in various district hospitals, can play a key role in this mission.

Experts also point out that children with special needs often face exclusion and neglect as they grow older. In many cases, even teachers treat them unfairly. As a result, more than half of these children don’t attend school. They often feel humiliated by family, relatives, and peers—and this rejection doesn’t always go away with age.

For these reasons, early care and counseling at a child development center are so important when any signs of disability appear in childhood. Usually, if the child is older than 10 or 12 years, the chance of effective treatment becomes much lower. To build a healthy society, experts say, these centers should be kept open all the time—for every child, everywhere.