[🇧🇩] Healthcare Industry in Bangladesh

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Universal health coverage: a reality or mirage?

The aspiration for universal health coverage (UHC), where everyone can access the necessary healthcare without facing financial hardship, remains a distant dream due to the excessive commercialisation of the health sector and a disproportionately high out-of-pocket healthcare expenditure. The UHC e

thefinancialexpress.com.bd

Universal health coverage: a reality or mirage?
Published :
Feb 16, 2025 23:00
Updated :
Feb 16, 2025 23:00

The aspiration for universal health coverage (UHC), where everyone can access the necessary healthcare without facing financial hardship, remains a distant dream due to the excessive commercialisation of the health sector and a disproportionately high out-of-pocket healthcare expenditure. The UHC envisions both comprehensive service coverage for the entire population and financial protection against the high costs of medical care. While Bangladesh has made significant progress in expanding healthcare facilities, financial protection remains a major challenge. According to a World Bank study, over 73 per cent of total health expenditures in Bangladesh are borne directly by households, one of the highest in the world. This extremely high out-of-pocket spending has severe consequences. According to a study by the Bangladesh Institute of Development Studies (BIDS) soaring out-of-pocket healthcare expenses pushed 61 lakh Bangladeshis, or 3.7 per cent of the population, into poverty in 2022. Experts in a recent view exchange meeting have called for implementing a robust regulatory framework, ethical pricing mechanisms, and stronger supply chains to address the issue.

For Bangladesh to progress on the financial protection agenda, two key actions are necessary. Firstly, a significant increase in the health budget is essential. The World Health Organization suggests allocating at least 15 per cent of the total budget to the health sector, but Bangladesh allocates only around 5.0 per cent. The country's health budgetary support is one of the lowest in the South-East Asia region. The less a government spends on health, the higher out-of-pocket payment is sure to be. So, increased budgetary allocation is indispensable, particularly for ensuring access to healthcare for the poor, vulnerable, young, old, and informal workers - in essence, the majority of the population.

Secondly, the government must ensure optimum utilisation of the health budget by increasing allocation for government hospitals, health centres and healthcare professionals. However, increased allocation will not translate into enhanced facilities if corruption and some other irregularities in the health sector are not properly addressed. Absenteeism of doctors in government hospitals, particularly in rural areas has been an endemic problem. Many doctors exhaust their time and energy attending private clinics which leaves them with hardly any time for government hospitals where they are appointed to serve. It is the poor patients who mostly seek treatment at government hospitals and bear the brunt of these irregularities. Moreover, facilities in these hospitals like free medicines are scarce and those that exist do not come to the benefit of the poor due to mechanisms of vested quarters. So, to protect the poor from skyrocketing healthcare costs, public healthcare facilities must be better equipped with the necessary resources and logistics, and healthcare providers must be held accountable.

The country's high out-of-pocket healthcare expenses are not only pushing more people into the vicious cycle of poverty but also widening the gap between the rich and the poor. Globally, countries with robust government healthcare systems have achieved more equitable growth. For Bangladesh, allocating more resources to the health sector and implementing a strong strategy for enhancing financial protection for the poor and vulnerable will be crucial in ensuring access to basic healthcare for all. Otherwise, the vision of achieving universal health coverage will remain a mirage, not a reality.​

 

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Hospitals need proper waste disposal

Medical waste problem at Rangpur Medical College Hospital is concerning.

www.thedailystar.net

Hospitals need proper waste disposal
Resolve the crisis at Rangpur Medical College Hospital

VISUAL: STAR

We are concerned about the medical waste problem at Rangpur Medical College Hospital where hazardous waste has been piling up inside the premises, posing health risks to both patients and visitors. According to a report by this daily, the planned construction of a waste management plant at the hospital has remained suspended for over five months due to protests from locals.

Locals are apparently worried that the plant's location, near the district's Bangladesh Medical Association building and adjacent residential areas, would cause odour pollution and pose health risks. They also allege that the plant does not have a location clearance certificate from the Department of Environment. Meanwhile, approximately 1.5 tonnes of waste, including 300 kilogrammes of hazardous waste generated daily by the hospital, are not being disposed of properly, which can have serious consequences.

Unfortunately, the situation at Rangpur Medical College Hospital is not an isolated one. Around 83 percent of hospitals in our country do not have a waste management system, according to a 2022 study by the Transparency International Bangladesh (TIB). The study also found that around 60 percent of hospitals do not have bins to store medical waste, let alone ensure basic segregation among reusable, recyclable, and non-recyclable waste—with hazardous medical waste being mixed with solid garbage in the bins that are available. In fact, at the Rangpur hospital, such waste is currently being dumped out in the open. Do the locals opposing the waste management plant not see the health risks of this uncontrolled dumping? A properly constructed waste management plant cannot pose more risks than the current situation.

Under these circumstances, hospital authorities must engage with locals, raise awareness with the help of experts if necessary, and ensure the plant's construction follows all due process. Meanwhile, all public hospitals in the country must take urgent action in line with the recommendations that came up in the TIB study. Simultaneously, the government must enforce the Medical Waste Management and Processing Rules 2008, penalising any non-compliance. The authorities also must ensure proper hygiene and cleanliness in public hospitals so that people do not fall sicker while undergoing treatment because of hospital-acquired infections.​

 

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What would the healthcare sector of the future look like?

Healthcare around the world is going through unique and dynamic changes.

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What would the healthcare sector of the future look like?

Photo: REUTERS

Healthcare around the world is going through unique and dynamic changes. Global megatrends like climate change, technological advancements, demographic shifts, and social changes are all impacting the stakeholders in healthcare—patients, practitioners and businesses—in significant ways. According to one estimate, the world population is likely to reach nine billion in another decade, with Bangladesh's population likely reaching 190 million. As a result, providing affordable healthcare services for such a large population will create both challenges and opportunities.

While there has been significant progress in reducing the incidence of malaria, tuberculosis (TB) and diarrhoeal diseases, ailments associated with the modern lifestyle, such as obesity, are rising exponentially. The risk of ailments caused due to environmental threats and natural disasters is also likely to rise in the coming years. At the same time, newer drug discoveries are making the cure of many diseases possible, and in certain instances, more affordable.

All these factors are forcing the healthcare delivery ecosystem to undergo a transformation that will be relevant for the future, while keeping patients and consumers at the centre. The entire care delivery ecosystem will be attributed by the capabilities of the ecosystem participants of being preventive, personalised, predictive, and by their points of healthcare delivery.

With the increasing focus on disease risk factors and self-directed healthier way of living, the need for curing many diseases associated with the lifestyle will decrease with time. A considerable number of businesses are likely to grow and lead this domain by delivering such services. On the one side, there will be providers of basic consultations on lifestyle, diet and physical exercise. On the other, there will be diagnostic service providers who would help in measuring the key health parameters to detect early indicators of life-threatening diseases or clinical incidents.

While such preventive care has significant impact in elevating the overall health of the population, it should be noted that the beneficiaries of such care are not sick individuals, but individuals who maintain a regular and good quality of life. Therefore, the patient experience—i.e. how such care gets delivered— would play a significant role in business success of the providers. Additionally, personalisation will be a key component in delivering unique patient experiences.

Personalisation of care also means bringing life sciences into the picture. Personalised medical examinations and clinical investigations result in better diagnosis of ailments and tailored prescriptions for cure. By deploying new generation biotechnology and genetic research findings, each patient's needs become unique and require unique treatment decisions. Some healthcare providers in the developed countries have already started offering such care to patients in areas like heart health, diabetic care, and metabolic activities.

In addition to biotechnology, other technological advancements, particularly in digital technologies and artificial intelligence (AI), are going to make a significant impact in the healthcare of the future. In fact, a prominent attribute is going to be predictive and proactive care for the patients. The vast amount of health data collected from a wide range of demographic populations is enabling the creation of tools that enable the prediction of many health accidents pre-emptively. Such predictive analysis can be used for the proactive treatment of the patients resulting in prevention of the same.

All of these suggestions can be implemented at a wide range of locations, including the homes of the patients. Technology has enabled care delivery points to become omnipresent with the use of telehealth services, community-based services, and remote interventions through robots. Access to healthcare has become easier with the advent of technology.

However, the inclusive access to healthcare will require a robust ecosystem of private-public partnerships to improve its reach and affordability. For private entrepreneurs, the business potential in highly populated countries like Bangladesh is enormous. At the same time, it's the collective responsibility of private-public partnerships to make such care delivery inclusive so that they are accessible to all levels of the economic pyramid.

Arijit Chakraborti is partner with PwC.​

 

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Reimagining primary healthcare through the GP system

Despite progress in Bangladesh’s health sector, primary healthcare (PHC) remains inadequate, particularly in rural areas where access to qualified doctors is limited.

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Reimagining primary healthcare through the GP system

FILE PHOTO: AMRAN HOSSAIN

The general practitioner (GP) system is the cornerstone of healthcare in many countries, providing individuals with their first point of contact for medical care. GPs are trained medical professionals who diagnose and treat various health conditions, from minor illnesses to chronic diseases, while emphasising preventive care through regular checkups, vaccinations, and health education. Acting as gatekeepers, GPs coordinate patient care, referring them to specialists when needed. Countries that have achieved universal health coverage—such as the UK, Australia, and Canada—rely heavily on GP systems to improve accessibility, ensure continuity of care, and enhance health outcomes.

Despite progress in Bangladesh's health sector, primary healthcare (PHC) remains inadequate, particularly in rural areas where access to qualified doctors is limited. Urban areas, on the other hand, lack a structured PHC delivery system, forcing citizens to rely on hospitals and informal healthcare providers. This leads to high out-of-pocket expenses.

UHC, which envisions accessible, affordable, and quality healthcare close to home, remains an elusive goal in Bangladesh. A well-structured GP system could take us one step ahead. It could revolutionise healthcare delivery by ensuring that every individual has access to a registered family doctor. A proposed GP model for Bangladesh would assign a medical team to every 5,000 people, led by a graduate doctor. Families would register with a GP team, with the flexibility to change providers every six months. GPs would be contractually appointed, with performance-based renewals tied to measurable outcomes like healthcare provision and patient satisfaction. Vulnerable populations would receive free or subsidised services, while emergency care, including ambulance services, would be universally free.

Under the system, the existing infrastructure, such as community clinics in rural areas, could minimise implementation costs. In urban areas, rented facilities could serve as GP centres. An integrated approach linking the GP system with the broader healthcare network would be essential for success. Public-private partnerships (PPPs) are essential for bridging gaps in the country's healthcare system. While current PPPs focus primarily on construction models, there is untapped potential in service-driven contracts, such as operation and maintenance, and greyfield upgrades.

However, the integration of the GP system into government structures requires a robust payment model. Salary-based systems may fail to motivate, whereas pay-for-performance or fee-for-service models incentivise quality. Bundled payments, capitation or global budgets offer flexibility, but payment models must prioritise comprehensive care, including promotion, prevention, treatment, and rehabilitation.

PPP agreements must include clear quality indicators. The private sector is adept at maximising profit; therefore, the government must skilfully set and enforce quality standards within contracts. Transparent performance reporting and strong monitoring frameworks are essential to maintaining accountability and ensuring that healthcare providers meet their obligations. The experience of integrating PPPs in other sectors offers valuable lessons for healthcare. By aligning community clinics, government structures, and private partnerships, Bangladesh can create a more equitable, efficient, and patient-centred healthcare system.

Even so, the financial viability of a GP system poses significant challenges. Bangladesh's low tax-to-GDP ratio, lack of social insurance frameworks, and predominantly informal workforce are major barriers. Global models, such as tax-based systems in the UK and Canada, performance-linked funding in Sweden and New Zealand, and mixed approaches like Singapore's, offer valuable lessons. Emerging economies like Rwanda and Thailand demonstrate the feasibility of community-based insurance and capitation-based funding for GP systems.

For Bangladesh, direct contributory mechanisms for the informal sector are impractical in the short term. Despite these challenges, several avenues could be explored, such as: i) redirecting unutilised funds within the health sector budget; ii) imposing targeted taxes on sugary beverages, luxury goods, and tobacco; iii) leveraging corporate social responsibility (CSR) funds; and iv) introducing minimal monthly charges or per-minute phone call fees. However, university students, formal workforce groups like garment workers, and other groups like bank account holders and microcredit beneficiaries, may be brought under compulsory health insurance schemes.

Bangladesh's COVID vaccination programme which successfully registered over 13 crore individuals using national identity cards (NIDs), highlights the potential for technology-driven healthcare solutions. A nationwide health card system could centralise patient data, enabling personalised, data-driven care. Additionally, artificial intelligence (AI) and the Internet of Things (IoT) could streamline healthcare processes by enabling real-time health data tracking, efficient referrals, and better care coordination.

The feasibility of these models has already been demonstrated through initiatives like UNICEF's Aalo Clinic programme in urban areas and Palli Karma-Sahayak Foundation's (PKSF) Samridhi programme in rural areas across Bangladesh. These examples highlight the scalability of the GP system in both rural and urban settings. By leveraging existing infrastructure, integrating advanced technology, and prioritising primary care, Bangladesh can build an equitable, efficient, and future-ready healthcare system.

Integrating the GP system into Bangladesh's broader healthcare infrastructure is a critical step toward achieving UHC. While it presents challenges, health experts generally agree that it is feasible with clear aspirations and a comprehensive, well-thought-out plan. Annual performance audits, based on defined quality metrics, will identify service gaps and areas for improvement, with public reporting enhancing transparency. A well-functioning complaint redress system will also be crucial for resolving patient grievances and maintaining satisfaction. It is important to avoid shortcuts and carefully consider the ground realities to prevent the common pitfalls that often arise during implementation.

The authors are members of UHC Forum and PPRC and experts in the health sector.​

 

[Saif]

Price ceiling should be priority health reform agenda

AS THE government discusses the reform strategy for the health sector, it should take into account findings of the Bureau of Statistics survey on public health services that reflect people’s demands and expectations. The survey report...

www.newagebd.net

Price ceiling should be priority health reform agenda
22 March, 2025, 00:00

AS THE government discusses the reform strategy for the health sector, it should take into account findings of the Bureau of Statistics survey on public health services that reflect people’s demands and expectations. The survey report published on March 20 says that more than 90 per cent of the people have urged the government to contain extremely high prices of health services, including medicine, physician’s visit costs and diagnostic charges. People have asked for fixed retail prices for all health services, medicines and medical accessories. The demands are more than justified when there is barely any stability in the drug market. The Directorate General of Drug Administration sets prices of 117 essential medicines while prices of all other drugs are determined based on proposals of manufacturers. A recent market analysis shows that prices of drugs greatly vary. The Bangladesh Association of Pharmaceutical Industries tries to justify the price difference, saying that the quality of drugs is different for different companies, yet substandard drugs flood the market, risking public health. The health reform should implement a price ceiling mechanism for drugs and also put in place an effective quality control mechanism for pharmaceutical industries.

The health services reform survey also reports a dependence on the private sector and talks about an effective decentralisation of health infrastructure. In Barishal, Chattogram and Dhaka, people are mostly dependent on private health facilities. Mismanagement, corruption and inadequate number of beds and physicians often compel people to seek health care from private facilities. There is approximately one hospital bed for every 990 patients. This translates to 0.96 beds per 1,000 people, which is significantly lower than the World Health Organisation’s recommendation. In district hospitals, many emergency facilities, especially dealing with non-communicable diseases, are absent. The treatment of the chronic diseases requires more resources than what is available with upazila health complexes. In the absence of such services, those who can afford seek services from private hospitals and people in poverty are left with no option but to suffer. At the moment, to establish private hospitals, clinics or diagnostic centres, it is not mandatory to obtain a licence. The price chart for medical services has not been recently revised. It is evident that the government has created a situation in which the private sector has more control over health services and the regulatory mechanism has failed the patients.

It is promising that the interim government has set up a commission to suggest reforms for the health sector. The commission, considering the findings of the survey, should prioritise a price ceiling and quality control mechanism for pharmaceutical industries as a reform agenda.​

 

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HEALTH SECTOR REFORM: Commission for referral, back-referral system

The health sector reform commission is set to recommend ‘effective’ referral and back-referral systems, connecting tertiary and grassroots health facilities.

www.newagebd.net

HEALTH SECTOR REFORM: Commission for referral, back-referral system
Sadiqur Rahman 29 March, 2025, 23:48

The health sector reform commission is set to recommend ‘effective’ referral and back-referral systems, connecting tertiary and grassroots health facilities.

According to the commission members, these systems would not only facilitate the full recovery of critical patients at minimised expenses but also lessen the burden on public and private hospitals in cities including Dhaka.

If the referral system functions effectively, insolvent patients from rural and remote villages could avail themselves of specialised medical care at tertiary hospitals, they said.

‘In our recommendation, there will be a referred-back system so that a patient, after receiving treatment at a tertiary hospital, can receive rehabilitation services at the health centre where he or she was initially admitted,’ said Professor M Muzaherul Huq, a member of the Health Sector Reform Commission.

He added that the patients would be issued a health card for sequential use.

On March 20, the Bangladesh Bureau of Statistics published a public opinion survey on Health Sector Reform 2025, revealing that 92.6 per cent of respondents supported the introduction of health cards for patients.

The BBS conducted the survey on 8,256 households across the country.

Explaining the planned referral and back-referral systems, another commission member, Syed Md Akram Hussain, said that patients’ out-of-pocket healthcare expenses would reduce significantly if the referral and the back-referral systems work effectively.

‘We are planning to develop a network of general health practitioners or family care physicians who will be the initial responders to patients. Without their referral, no patient, except in an emergency, would be allowed to visit a specialist or a specialised hospital,’ Akram said.

Such a restriction, however, would prevent patients from making unnecessary hospital visits and incurring avoidable diagnostic and medical care expenses.

‘Moreover, the fee of a family care physician will certainly be less than that of a specialist,’ he added.

According to Akram, the commission would propose the availability of at least two MBBS doctors as family care physicians, or one family care physician per 15,000 people, at union-level health centres.

Such family health physicians would also be available at the ward level in urban areas.

‘We are planning to transform all district-level general hospitals into tertiary hospitals,’ Akram said.

The BBS public opinion survey on health sector reform 2025 also revealed that 91.3 per cent of respondents wanted primary health care to be recognised as a constitutional right.

‘The constitution does not legally bind the state to ensure citizens’ primary health care. It should,’ said Faizul Hakim, convener of the Janaswastha Sangram Parishad, a public health advocacy platform.

On January 15, the Constitution Reform Commission, in its full report, recommended that the right to health, which requires ‘significant resources’ and ‘time to implement,’ should be implemented based on the ‘availability of resources,’ with a commitment to ‘progressive realisation.’

The World Health Organisation defines primary healthcare as a system that enables health services to support a person’s health needs, from health promotion to disease prevention, treatment, rehabilitation, and palliative care throughout their lifespan.

However, the Health Sector Reform Commission will propose legally binding the government to ensure citizens’ primary health care.

‘Additionally, the commission will recommend “basic emergency care” free of cost. The government will be bound to bear this cost even if a patient receives the service at a private hospital,’ Akram said.

The commission would also recommend the establishment of a separate service commission for health professionals, the formation of regional health services, the creation of a private hospital management board, the allocation of 10 per cent of private hospital beds for insolvent patients, and the prevention of pharmaceutical company owners from owning hospitals, among other measures.

On November 18, the interim government formed five reform commissions on health, media, local government, labour, and women’s affairs.

These five reform commissions were initially expected to submit their reports by mid-February. However, on March 27, all commissions were granted an extended deadline until April 30.​

 

[Saif]

Well-meaning health-sector reforms that call for will

A SOUND referral and back-referral system in health care potentially has several merits. It can ensure equitable access to specialised health care. It can optimise the use of resources. It can improve patient outcomes. It can also enhance coordination between levels of health care. This is...

www.newagebd.net

Well-meaning health-sector reforms that call for will
03 April, 2025, 00:00

A SOUND referral and back-referral system in health care potentially has several merits. It can ensure equitable access to specialised health care. It can optimise the use of resources. It can improve patient outcomes. It can also enhance coordination between levels of health care. This is, therefore, a welcome move that the health-sector reforms commission is set to recommend ‘an effective referral and back-referral system’ to link tertiary to primary health services. The commission’s members say that it would not only facilitate the full recovery of critical patients at minimised costs but also unburden public and private hospitals in cities. In a society where out-of-the-pocket expenditure of patients is too high and quality medical treatment is too costly, the likely move certainly appears a glimmer of light at the end of the tunnel. If the referral system works effectively, insolvent patients from remote, rural areas would receive specialised medical care in tertiary hospitals, which the commission envisages to be upgraded from district general hospitals. In the back referral part of the system, patients could receive rehabilitation services in the initial health centres after they receive specialised treatment in tertiary hospitals.

A commission member says that there are plans to develop a network of general practitioners to initially respond to patients. No patient but in case of emergencies can visit a specialist or specialised hospitals without referral. The restriction would save patients unnecessary hospital visits and money on avoidable diagnostic tests and medical expenditure. The commission also envisages the availability of at least two people with MBBS degrees to work as family care physicians or one family care physicians per 15,000 people at union health centres in rural areas and at wards in urban areas. The Bureau of Statistics in a survey made public on March 20 shows that 91.3 per cent of respondents want primary health care to be recognised as a constitutional right. And, experts believe that the constitution should make citizens’ primary health care legally-binding for the government. The commission on constitutional reforms on January 15 recommended that the right to health should be implemented based on the ‘availability of resources’ with a commitment to ‘progressive realisation.’ The commission on health-sector reforms notes that it would propose that the government should be legally bound to ensure citizens’ primary health care. And, the basic emergency care should be free even if the patients receive the services in private hospitals.

Most of the propositions that have come to light appear well-meaning steps towards an effective reform of the health care system, but the government needs to show the will to carry out the reforms in the first place.​