[🇧🇩] Healthcare Industry in Bangladesh

[Saif]

Source : https://www.thedailystar.net/business/economy/news/full-fledged-cancer-treatment-facilities-need-the-hour-3655501

Full-fledged cancer treatment facilities need of the hour

High-quality cancer drugs are produced in Bangladesh. Oncologists and physicians are also available. However, the country is lagging in putting in place an adequate number of full-fledged facilities to treat patients suffering from such diseases.

The missing link exists although cancer patients are on the rise in Bangladesh in line with global trends and hospitals and clinics have flourished.

Cancer is already a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths. The most common cancers are breast, lung, colon, rectum and prostate cancers, according to the World Health Organisation (WHO).

Cancer cases are expected to rise 77 percent by the middle of the century, the International Agency for Research on Cancer (IARC), a specialised branch of the WHO, said in February, highlighting the growing burden of the disease.

There are predicted to be more than 35 million cancer cases during 2050, up from the estimated 20 million in 2022, the agency said.

The increase reflects both population ageing and growth, as well as changes to people's exposure to risk factors. Tobacco, alcohol and obesity are key factors, along with air pollution.

Currently, Bangladesh has 13 lakh to 15 lakh cancer patients, while around two lakh new patients are diagnosed with the diseases each year, figures from the National Center for Biotechnology Information showed.

There are around 240 oncologists in Bangladesh. Treatment is available in 19 hospitals, and 465 beds have been set aside for chemotherapy at the oncology and radiotherapy departments.

"There is no shortage of oncology surgeons or specialists in Bangladesh," said Prof Golam Mohiuddin Faruque, president of the Bangladesh Cancer Society.

Besides, locally manufactured generic versions of oncology drugs are similar to the products made by multinational companies in terms of quality.

"However, there is a lack of radiation therapy facilities at hospitals as it is very expensive," he said, adding that it costs around Tk 40 crore to set up such units.

Currently, 40 radiotherapy facilities, including those at government hospitals, are available against the need for 300, Faruque said. Private hospitals treat 67 percent of cancer patients while the rest receive services from state-run hospitals.

According to Faruque, patients could see an oncologist for only Tk 10 at a government hospital or for Tk 1,000 to Tk 1,500 at a private hospital.

Drugs have also become easily available during the last decade as pharmaceutical companies have taken initiatives to manufacture oncology products. "As a result, the cost of treatment has come down by two-thirds during the decade," Faruque said.

Since the number of cancer patients is rising, the government is building treatment facilities in eight divisional hospitals, which may be commissioned next year.

Training general physicians on cancer warning signs and setting up early detection centres at medical colleges and the district level are underway. Piloting of cervical cancer vaccination has recently been completed.

The International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), BRAC, Ahsania Mission Cancer Hospital, Bangabandhu Sheikh Mujib Medical University, Bangladesh Cancer Society, ASHIC Foundation, Amader Gram, AK Khan Healthcare Trust, and Chattogram-based Cancer Support Society (Cansup) run programmes for early detection.

Bangladesh has agreed to reduce premature mortality from cancer as part of the 2030 UN Agenda for Sustainable Development.

Industry people say improving the cancer treatment scenario overnight is not an easy task. However, policymakers should show their interest in expanding the facilities and pushing the agenda forward since cancer diseases have huge health and financial impacts.​

 

[Saif]

Bangladesh and Belgium sign MoU on cancer care and research

A Memorandum of Understanding on cooperation in cancer care and research has been signed between Bangladesh and Belgium.

en.prothomalo.com

Bangladesh and Belgium sign MoU on cancer care and research
Diplomatic Correspondent
Updated: 16 Jul 2024, 11: 51

A MoU on cooperation in cancer care and research has been signed between Bangladesh and Belgium.Courtesy

A Memorandum of Understanding (MoU) on cooperation in cancer care and research between the National Institute of Cancer Research and Hospital (NICRH), Bangladesh, and Bordet Cancer Institute at Hôpital Universitaire de Bruxelles (HUB), Belgium, was signed on Monday in Brussels, says a press release.

Bangladesh ambassador to Belgium, Luxembourg and the European Union, Mahbub Hassan Saleh, signed the MoU on behalf of NICRH.

Meanwhile, deputy chief executive officer, HUB Francis de Drée, chief medical officer, HUB Jean-Michel Hougardy and physician-in-chief of the Bordet Institute Chloé Spilleboudt signed the MoU on behalf of HUB.

The MoU aims to foster strong partnership between these two institutions for conducting joint research activities and bringing specific expertise on cancer care through capacity building and infrastructure development.

This MoU will be a tool for collaboration in cancer research, including basic, epidemiologic, prevention, diagnosis, screening, treatment, cancer control and survivorship research.

Bordet Cancer Institute has been an internationally reputed multidisciplinary medical institution in Belgium for more than 75 years, dedicated entirely to the fight against cancer.

This institute offers patients leading-edge diagnostic and therapeutic measures in the prevention, screening and active treatment of all types of cancer.

The Institute also carries out important research activities which every year leads to major discoveries, as well as providing high-level, specialized university training.

The MoU is the result of three years of discussion and negotiation between both sides, facilitated by the Bangladesh Embassy in Brussels.

Sharing details of the state-of-start facilities available at the Jules Bordet Institute, Francis de Drée said he and his team are very enthusiastic to start the collaboration with Bangladesh.

Expressing happiness at the signing of the MoU, ambassador Mahbub Hassan Saleh said that this MoU paves the way for Bangladesh to take a significant step forward in cancer treatment and research, as the country, under the dynamic and visionary leadership of Prime Minister Sheikh Hasina, moves towards building a knowledge-based society leading to achieving her vision of a 'Smart Bangladesh' by 2041.​

 

[Saif]

Healthcare accessibility in rural BD

Healthcare accessibility remains one of rural Bangladesh's most pressing and complex challenges. The country's rural population, which constitutes most of its populace, faces significant barriers to obtaining adequate healthcare services. These barriers stem from many factors, including geographica

thefinancialexpress.com.bd

Healthcare accessibility in rural BD
MATIUR RAHMAN
Published :
Jul 16, 2024 21:43
Updated :
Jul 16, 2024 21:43

Healthcare accessibility remains one of rural Bangladesh's most pressing and complex challenges. The country's rural population, which constitutes most of its populace, faces significant barriers to obtaining adequate healthcare services. These barriers stem from many factors, including geographical isolation, inadequate infrastructure, shortage of healthcare professionals, and socio-economic constraints. Despite various initiatives by the government and non-governmental organisations to address these issues, Bangladesh's rural healthcare landscape continues to struggle with these multifaceted problems.

Geographical and infrastructural challenges are not just obstacles but daily struggles for rural residents in Bangladesh. The rugged terrain, including rivers, hills, and poor road conditions, makes reaching healthcare facilities daunting. The underdeveloped transportation network and the lack of proper roads and reliable means of transportation in many villages further exacerbate the problem. This geographical isolation forces many rural residents to undertake long, costly, and time-consuming journeys to reach the nearest healthcare facility.

The inadequacy of healthcare infrastructure in rural areas is a problem and a crisis. Many rural health centres are poorly equipped and lack essential medical supplies and equipment. The buildings are often in disrepair, and there is a significant shortage of basic amenities such as clean water, electricity, and sanitation facilities. This inadequate infrastructure severely hampers the ability of these centres to provide quality healthcare services to the rural population.

Another significant barrier to healthcare accessibility is the stark disparity in the distribution of healthcare professionals between urban and rural areas in Bangladesh. Most doctors, nurses, and other healthcare workers prefer to work in urban areas, where they have better career prospects, higher salaries, and access to modern facilities. This preference has resulted in a severe shortage of qualified healthcare professionals in rural areas, exacerbating the healthcare accessibility issue.

The lack of healthcare professionals in rural areas means that many health centres are understaffed and unable to provide comprehensive healthcare services. Patients often have to wait for long periods to receive treatment, and the quality of care they receive is usually substandard. The shortage of healthcare professionals also means that rural health centres cannot provide specialised services, forcing patients to travel to urban areas for specialised care.

Socioeconomic barriers also play a significant role in limiting healthcare accessibility in rural Bangladesh. Many rural residents live in poverty and cannot afford the cost of healthcare services. Even when healthcare services are available, transportation, medication, and other related expenses can be prohibitive for many rural families. Additionally, many rural residents lack health insurance, further exacerbating their inability to access healthcare services.

Education and awareness also play a crucial role in healthcare accessibility. Many rural residents are unaware of the importance of seeking timely medical care and are often reluctant to visit healthcare facilities due to cultural beliefs and practices. There is also a lack of awareness about preventive healthcare measures, which leads to a high prevalence of preventable diseases in rural areas.

Despite these challenges, various initiatives have been taken by the government and non-governmental organisations (NGOs) to improve healthcare accessibility in rural Bangladesh. The government has launched several programs to improve healthcare infrastructure, increase the number of healthcare professionals in rural areas, and provide financial assistance to low-income families for healthcare services.

One notable initiative is the Community Clinic Project, which aims to establish community clinics in rural areas to provide primary healthcare services to the rural population. These clinics are staffed by community health workers who provide essential healthcare services, including maternal and child healthcare, immunisation, and treatment for common illnesses. The government has also implemented programs to train and deploy more healthcare professionals in rural areas and improve rural health centre infrastructure.

NGOs have also played a significant role in improving healthcare accessibility in rural areas. Many NGOs have launched programs to provide healthcare services to underserved rural populations, including mobile health clinics, telemedicine services, and health education programs. These initiatives have helped to bridge the gap in healthcare accessibility and have provided much-needed healthcare services to rural residents.

Technology has the potential to revolutionise healthcare accessibility in rural Bangladesh. Telemedicine, in particular, has emerged as a promising solution to the healthcare challenges faced by rural populations. Telemedicine allows healthcare professionals to provide medical consultations and treatment to patients in remote areas through digital platforms. This can help to overcome the geographical barriers to healthcare accessibility and ensure that rural residents have access to quality healthcare services.

Mobile health clinics are another innovative solution implemented in rural areas. These clinics travel to remote villages and provide essential healthcare services to rural residents. They are equipped with medical supplies and equipment and staffed by healthcare professionals who offer various services, including medical consultations, immunisations, and health education.

Mobile technology for health education and awareness is essential in improving healthcare accessibility. Mobile health applications can provide rural residents with information on preventive healthcare measures, treatment for common illnesses, and the importance of seeking timely medical care. These applications can also help raise awareness about government and NGO healthcare programs and services available to rural residents.

Community involvement and empowerment are crucial for improving healthcare accessibility in rural Bangladesh. Engaging the community in healthcare initiatives can help ensure that rural residents' healthcare needs are met and that they have a voice in the planning and implementing healthcare programmes.

Community health workers play a vital role in this regard. These workers are often members of the rural communities they serve and are trained to provide essential healthcare services and health education. They act as a bridge between the healthcare system and the community, helping to raise awareness about healthcare services and encouraging rural residents to seek medical care.

Empowering rural residents through health education and awareness programmes is also essential. These programmes can help educate rural residents about the importance of preventive healthcare measures, the benefits of seeking timely medical care, and the availability of healthcare services. Empowering the community in this way can help to overcome cultural barriers to healthcare accessibility and ensure that rural residents are better informed about their healthcare options.

Healthcare accessibility in rural Bangladesh remains a complex and multifaceted challenge. Geographic isolation, inadequate infrastructure, a shortage of healthcare professionals, and socio-economic barriers all contribute to the difficulties faced by rural residents in accessing healthcare services. However, various initiatives by the government and NGOs and the use of technology offer promising solutions to these challenges.

Improving healthcare accessibility in rural Bangladesh requires a concerted effort from all stakeholders, including the government, NGOs, healthcare professionals, and the community. By addressing the geographical and infrastructural challenges, increasing the number of healthcare professionals in rural areas, reducing socio-economic barriers, and leveraging technology, it is possible to bridge the gap in healthcare accessibility and ensure that rural residents have access to the quality healthcare services they need.

The journey to achieving healthcare accessibility in rural Bangladesh is long and challenging. Still, with continued effort and collaboration, it is possible to create a healthier and more equitable future for the rural population.

Dr Matiur Rahman is a researcher and development worker.​

 

[Saif]

The bane of out-of-pocket health expenditure

A study carried out recently by a researcher at the Bangladesh Institute of Development Studies (BIDS) shows that "Out-of-Pocket (OOP) expenditure is one of the most noteworthy payment strategies for healthcare in Bangladesh and the share of the same has been increasing alarmingly." The findings we

thefinancialexpress.com.bd

The bane of out-of-pocket health expenditure
SYED MANSUR HASHIM
Published :
Jul 16, 2024 21:47
Updated :
Jul 16, 2024 21:47

A study carried out recently by a researcher at the Bangladesh Institute of Development Studies (BIDS) shows that "Out-of-Pocket (OOP) expenditure is one of the most noteworthy payment strategies for healthcare in Bangladesh and the share of the same has been increasing alarmingly." The findings were presented at a programme titled "Catastrophic Health Shock and Improvement in Bangladesh: Insights HES-2022."

For several years, OOP has come up for discussion as patients in the country are constantly being squeezed out of their savings while trying to meet healthcare costs. Indeed, Dr. Razzaque who conducted the research stated at the event that "54.40 per cent of OOP money is spent on purchasing medicines while diagnostic cost is 27.52 per cent, 10.31 per cent cost for consultation and 7.77 per cent expenditure for transport cost." What the latest survey reveals is that due to this excessive OOP expenditure, about 6.13 million people were pushed below the national poverty line in 2022. It is a large number of people. While the health minister has stated that the government is working towards a law titled 'Health Protection Act', the question is how long will that take?

Granted that the minister has not been in the chair long, but experience shows that business interests and profit generation in the health sector is an entrenched practice that operates on the principle of maximising earnings at the cost of patients. Again, would a piece of legislation automatically translate into action? One can easily draw parallels with the market for foodstuffs across wholesale and retail markets in the country, where several laws exist to protect consumer rights, but have they been effectively enforced to protect consumers from wilful manipulation of prices? Sadly, the answer is no.

There has also been talk about introduction of healthcare insurance. This would be a move in the right direction. There are many examples of such insurance schemes that have worked in other parts of the world, but how would the authorities go about enforcing it? The problem in Bangladesh is not having requisite laws, but their enforcement. Again, as the minister has stated many times before, no radical change can be expected overnight. Agreed. But, the pace of change must be expedited because people are being made to suffer inordinately and these malpractices have been going on for decades. There are various stakeholders involved here from manufacturing of medicines to their prescription at heath institutions to the prices of drugs.

The lack of oversight on these and institutions that carry out tests and the fact that most of the Grade A health institutions and health practitioners are largely in urban areas, mean that patients living rural areas must travel from far and wide to come to the cities, pay hotel bills, transportation, etc. to get those services. These are all facts of life and every Bangladeshi knows the score. There is nothing that they can do about it. It is up to the state to care for its citizens in a manner that puts a patient over profit and above unbridled greed. Malpractices manifest themselves in every facet of the healthcare system in absence of a rule-based system. Yes, the minister is correct when he says the entrenched system of fleecing patients cannot be changed overnight, but at least he can try to do something. Time is money and people have been pushed beyond tolerance levels with runaway inflation affecting every facet of their lives. They need relief now.​

 

[Bilal9]

In the health and health systems ranking of countries worldwide in 2023, by health index score, Bangladesh scores well above most larger countries in South Asia (except Sri Lanka).

Health index of countries worldwide in 2023 | Statista

In 2023, Singapore ranked first with a health index score of 86.9, followed by Japan and South Korea.

www.statista.com

 

[Saif]

Healthcare costs mustn’t make people destitute

Holistic approach required to reduce out-of-pocket health expenditures

www.thedailystar.net

Healthcare costs mustn't make people destitute
Holistic approach required to reduce out-of-pocket health expenditures

A research finding has confirmed our fear that many people are facing poverty because of high healthcare costs in Bangladesh. A study by the Bangladesh Institute of Development Studies (BIDS), according to this daily, showed that approximately 6.13 million people were pushed below the national poverty line in 2022 because of out-of-pocket health expenditures.

The findings also revealed that more than half the population faces financial difficulties while seeking medical services in hospitals and that a large portion of the healthcare cost is spent on medicines. This is no surprise since many people in Bangladesh visit a pharmacy for basic ailments and buy medicine based on the shopkeepers' recommendations instead of consulting physicians, who are often not available at primary healthcare centres in unions and upazilas. Even when doctors are available, the poor quality of services at health facilities and the high cost of private ones often discourage people from seeking professional help. There is also a tendency among health professionals to overprescribe drugs and write brand names of medicine in prescriptions as a favour to pharmaceutical representatives who shower doctors with incentives.

The most disheartening part is that while out-of-pocket health expenditure continues to rise for the public (from 68 percent in 2020 to 73 percent in 2021), a portion of the health sector allocation remains underutilised. Plus, a significant portion of the allocation is spent on the salaries and wages of staff and health professionals, which often do not benefit patients directly. Although the health minister hinted at introducing a government-based health insurance system, many other ills in this sector need to be fixed to reduce people's healthcare burden. First, our focus needs to shift from curative to preventive care. Then the shortage of doctors and other health professionals must be resolved by instituting proper incentives and monitoring systems at duty stations. Policies and regulations should be introduced and implemented strictly to prevent the over-prescription of drugs, unethical practices of pharmaceutical companies, and regulate fees at private healthcare facilities. Corruption and inefficiencies in health sector procurement processes must be checked. Besides, a well-developed patient referral system will also decrease costs, stopping people from unnecessarily visiting specialists and paying higher fees. Only an overhaul of the entire sector, not just ad hoc measures, can re-establish people's trust in the health sector and reduce healthcare costs.​

 

[Saif]

Make healthcare an affordable dream

Why are out-of-pocket healthcare expenses still so high in Bangladesh?

www.thedailystar.net

Make healthcare an affordable dream
Why are out-of-pocket healthcare expenses still so high in Bangladesh?

VISUAL: STAR

There can be no excuse for why people's out-of-pocket (OOP) healthcare expenses are still so high in Bangladesh, except perhaps a lack of political will to match commitments with action. The situation warrants deeper scrutiny, especially after a report by the Health Economics Unit of the health ministry highlighted a stark contrast between government spending on healthcare and expenses borne by citizens. While the government is paying less and less, citizens are paying more and more, with about three-fourths of the overall health expenditure borne by the latter. This is really disturbing.

OOP expenses, it can be noted, are people's share of the expenses for medical care that aren't reimbursed by public or private insurances. A decade ago, the government had set a target of bringing OOP expenses down to 32 percent, and also increasing government expenditure to 30 percent by 2032. But halfway through that deadline, the situation has rather become worse. For example, in 2018, 2019 and 2020, the share of government in the national healthcare expenditure was about 28, 26 and 23 percent respectively, while the share of citizens was about 64, 66 and 69 percent respectively, as per the Bangladesh National Health Accounts (BNHA) 1997-2020 report. The World Health Organization (WHO) paints an even bleaker picture, saying OOP in 2020 was actually 74 percent of Bangladesh's national health expenditure.

This progressive downward spiral is the opposite of not just the government's own pledge in this regard but also the general practice in much of the comparable countries. The question is, why is the government so reluctant to spend in such a vital sector? Its reluctance was on full display when only 5.43 percent of the proposed budget for FY2022-2023 was earmarked for the health sector. The unfair burden imposed on citizens, as well as the rising cost of healthcare in general, means that many families are being pushed below the poverty line.

The rising cost of healthcare services is another worrying matter. The biggest contributor to this is the cost of medicine, followed by that of diagnosis. As per the BNHA report, of the total OOP expenses, about 64.6 percent is spent on medicine, 11.7 percent on laboratory charges, and 10.8 percent on doctors. The high prices of medicine are mostly propelled by unethical and unnecessary practices in the sector. Aggressive marketing, lavish packaging, and gifts for physicians are some of the reasons reportedly driving up prices. Unless the authorities take effective action to arrest this trend, the situation may worsen further in the coming years, especially as Bangladesh will have to pay more to import Active Pharmaceutical Ingredients as soon as it graduates into a middle-income country by 2026.

We must not let things deteriorate any further. Healthcare should be affordable for all, especially the poor, and the government has a huge role to play in this. Not only should it increase its own spending but it should also take steps to keep prices of medicine and diagnosis down, so that the overall cost of healthcare becomes bearable for citizens. The time to act is now.​

 

[Saif]

Healthcare in Bangladesh need not be so costly

The towering and ever-increasing cost of healthcare is a constant headache for people in the country.

www.thedailystar.net

Healthcare in Bangladesh need not be so costly

Solving the healthcare puzzle for Bangladesh's 170 million citizens is not a one-day job. FILE PHOTO: AMRAN HOSSAIN

The right to healthcare is enshrined in the Constitution of Bangladesh. However, despite considerable development in this sector over the last decade, the nation is still far from ensuring quality healthcare for all.

The towering and ever-increasing cost of healthcare is a constant headache for people in the country, making on-demand, quality healthcare virtually out of reach for most. The fact that almost 70 percent of all healthcare costs in Bangladesh are paid out of pocket, and that public spending on healthcare in this country as a percentage of GDP is the lowest in South Asia, only exacerbate this problem. In addition to low public spending, there are other factors contributing to the high cost of healthcare that need to be understood with their nuances.

A significant portion of the healthcare budget fails to reach target citizens due to corruption, wrong priority setting, and sub-optimal implementation. The combined effect is an acute lack of accessibility to points of care. A large number of facilities (such as community clinics) are sitting idle due to lack of resources, whereas a few specialty centres (such as public medical colleges or district hospitals) are beset with overcrowding and poor service delivery. This forces people, especially lower-income groups who are more likely to flock to subsidised government facilities, towards private healthcare providers, creating a heavy burden on their finances.

Meanwhile, every year, an average of 700,000 people travel abroad for healthcare needs, spending a mammoth Tk 350 crore. Although patients going abroad spend around Tk 5.5 lakh on average, in many instances this cost can be substantially higher, especially for complicated and lengthy procedures. Besides, treatment expense in countries like Singapore can reach up to 10 to 15 times of what it costs in Bangladesh, while in India it can cost two to three times more. So, pursuing treatment abroad can severely dent people's finances, even for those with higher incomes.

Also, for conditions requiring lengthy treatments, like cancer, patients and their attendants often have to stay away from family and work for extended periods of time, thus negatively impacting their professional positions. This is an indirect cost of seeking treatment abroad, which again adds to the burden of already high healthcare costs. Plus, especially among middle- and lower-income individuals, discontinuation of treatment due to socioeconomic reasons or a lack of awareness is common. Incomplete treatment means the patient, in all likelihood, will fall ill again from the same or related cause(s), thus incurring a huge waste of resources.

Due to the absence of a comprehensive and consistent regulatory regime surrounding healthcare and a national accreditation system for health service providers, the pricing of health services becomes arbitrary.

Also, due to the lack of national health insurance, there is no large purchaser (either insurance companies or the government) that can bargain with health service providers to set rational pricing of services. Thus, health service market in the country is dominated by providers who put individual consumers under a heavy burden of differing prices.

As individuals, we have important roles to play in acquiring control over healthcare costs, such as keeping all our medical and health records in one place, putting aside at least three percent of one's monthly income for future health needs, having a doctor or a healthcare worker as a friend to get advice from for sudden healthcare needs, getting a health check-up every year and focus on prevention, maintaining a proper lifestyle to prevent and manage lifestyle diseases like asthma, diabetes and hypertension, and adhering to doctors' advice from the early stages of any disease.

However, to solve the healthcare problem at the national level, the government needs to undertake some initiatives.

Making public sector spending efficient

It is important to bring transparency to the process by ensuring accountability and the involvement of stakeholders, especially health professionals. Similarly, introducing a healthcare official for the job and streamlining the regulatory structure surrounding healthcare will make the sector more transparent and efficient. If done properly, an additional one to two crore people, especially from lower-income strata, can be brought under healthcare services.

Health insurance and universal health coverage

This could be a system to which everyone contributes according to their means, while the government gathers both public and private resources in a unified manner to ensure on-demand, essential health services for all.

Activating community clinics

Managing thousands of community clinics spread across Bangladesh properly, with community involvement and proper training, can be a real game-changer.

Building and maintaining trust in our own healthcare system

A nationwide healthcare accreditation system could be implemented to monitor quality as well as classify providers into service bands (A, B, C, etc). This will ensure that services are provided as per the respective charter and also allow the government to set prices for healthcare services in a comprehensive manner.

Proper referrals and keeping electronic medical record (EMR)

Introducing a well-organised referral system backed by an NID-based, interoperable EMR will create a first line of health service providers in the form of community clinics and general physicians, who will be the primary custodians of individuals' health at the grassroots level. This will take care of the bulk of their healthcare needs at a minimal cost while only referring a small number of patients (who require specialised care) to the district- or national-level facilities.

Solving the healthcare puzzle for Bangladesh's 170 million citizens is not a one-day job. It will require clear-eyed national planning led by the government in conjunction with private and non-profit players—with national interest at its core—implemented in a sustained, transparent, and non-partisan manner over 5 to 10 years' time with the participation of individuals, who are our primary concern.

Dr AM Shamim is the founder of Labaid Group.​