[🇧🇩] Healthcare Industry in Bangladesh

[Saif]

Health commission gets it right but execution matters

The recommendations, as reported primarily in the print media, made by the Health Sector Reform Commission look radical and ambitious. But the sector needs such a reconstructive surgery rather than a cosmetic one to cure the system. One of the basic human rights is right to health but this is gross

thefinancialexpress.com.bd

Health commission gets it right but execution matters
FE
Published :
May 07, 2025 23:44
Updated :
May 07, 2025 23:44

The recommendations, as reported primarily in the print media, made by the Health Sector Reform Commission look radical and ambitious. But the sector needs such a reconstructive surgery rather than a cosmetic one to cure the system. One of the basic human rights is right to health but this is grossly undermined almost everywhere, only more so in countries like Bangladesh, because of the outrageous social disparities. So the health reform commission has done the right thing by recommending legal coverage for every citizen's primary healthcare irrespective of his/her social standing. Incorporation of such a legal provision will guarantee that no one is denied medical attention. But this cannot be implemented automatically unless the medical infrastructure and other allied paraphernalia are attuned to the proposed healthcare act. Happily, the commission has focused on such details meticulously in order to make the medical marvel happen in the country through gradual implementation of its suggestions.

The first bold step would be higher health allocation initially at 15 per cent of the national budget. On the infrastructure side, the union level health and family planning centres have to be transformed into primary healthcare centres. What about upazila health complexes? In urban areas, their counterparts would be established at the ward level. Clearly, the emphasis is to take healthcare to the doorsteps of people at the grassroots level. If the programme can be made effective, it will be decentralisation of healthcare at its very best. The referral system suggested by the commission will then screen the patients with various acute or complicated ailments to district-level hospitals which will have specialised healthcare arrangements. Will the upazila health complexes serve as referral points? But how the medical facilities at the district level will improve their healthcare system is critical. Medical colleges and universities have to be restructured, according to the suggestion, to make them aligned to the World Federation for Medical Education (WFME). For overall supervision a permanent body to be named as the Bangladesh Health Commission will be assigned the job.

In fact, the whole gamut of medical system has been brought under the scanner. Medicines will have to be prescribed under the generic names, 25 per cent of which immediately and the rest within next five years in order to end the anarchy in the pharmaceutical sector. Alongside, the hawkish promotional activities by medical representatives, as prevailing now, will be banned. Additionally, establishment of a separate facility to be named a National Institute of Women's Health has also been recommended.

Clearly, a comprehensive analysis of the problems facing the health sector has been made. But still a few things need to be clarified. There is no guideline of taming the vested interest quarters including the big pharmaceutical sharks and commercial private practice. Although higher remuneration and special financial benefits have been suggested, those are unlikely to match the income from private practice by senior medical consultants. Similarly, streamlining the operation of pharmaceutical industries may not be any easy job unless a political government has the motivation and determination to do so. Finally, underlying the health reform commission's exercise is a highly appreciable intent to transform the healthcare system by revolutionising the process of accessing at least primary medical treatment on an equal basis. But the next level of healthcare will still remain unreachable to the poor and low-income people. Yet if the system offers medical treatment on a par with that offered abroad where $4.0-5.0 billion is spent annually by Bangladesh patients, the money thus saved can be reinvested for free treatment of at least a certain percentage of the poor and vulnerable.​

 

[Saif]

The alarming state of private healthcare

Licence renewal failures are undermining healthcare integrity

www.thedailystar.net

The alarming state of private healthcare
Licence renewal failures are undermining healthcare integrity

It is deeply concerning that thousands of private hospitals, clinics, and diagnostic centres across the country continue to operate without renewing their licences, largely due to inadequate monitoring by the Directorate General of Health Services (DGHS). Reportedly, out of 19,627 registered private hospitals and clinics, only 914, or just 4.66 percent, renewed their licences as of April 27. The previous year saw slightly better compliance, with 2,754 facilities renewing their licences. Likewise, only 1,790 of the 35,597 registered private diagnostic centres—around 5 percent—have completed their renewals this year, compared to 5,735 last fiscal year. This situation poses serious risks to patient well-being and safety, treatment quality and overall service standards, as well as hygiene in these facilities. A lack of oversight by the authorities could also lead to the use of substandard medical equipment or unsafe practices, as experts have warned.

According to the acting president of the Bangladesh Private Hospital, Clinic, and Diagnostic Owners Association, 90 percent of hospitals and diagnostic centres have applied for renewal this fiscal year. However, the process faces delays due to the limited inspection capacity of the DGHS. The requirement for environmental and narcotics clearance further slows down the renewal process. Previously, facilities could submit proof that they had applied for clearance, which was considered sufficient for licence renewal. However, a recent policy change now mandates the submission of an environmental clearance certificate, adding another obstacle to timely renewals.

The authorities' failure to conduct inspections efficiently has also allowed some healthcare providers to exploit the system, submitting renewal applications without necessary or up-to-date documents while continuing operations unchecked. This issue demands immediate attention. Over the past two decades, private healthcare facilities have proliferated across the country, mainly due to gaps in the public healthcare system. Unfortunately, many of these hospitals prioritise profits over patient care, treating healthcare as a secondary concern. Some even operate without the required credentials, a situation made worse by the inefficiency of the regulatory bodies. Without regular renewals, maintaining quality healthcare will become increasingly difficult.

A renewed licence ensures that a healthcare facility has the necessary manpower, equipment, and operational standards in place. Therefore, we urge the DGHS to expand its inspection team and improve resource allocation to ensure thorough evaluations of these institutions. While the renewal process should be simplified to avoid unnecessary hassles, private hospitals, clinics and diagnostic centres must still comply with standard procedures and submit proper up-to-date documents. Additionally, the DGHS must proactively scrutinise the thousands of private healthcare facilities that have mushroomed across the country over the years. And institutions failing to meet required standards should have their licences revoked to uphold healthcare integrity and protect patient welfare across the country.​

 

[Saif]

Health budget cut runs counter to reform ambition

The education and health sectors have historically been neglected in government budget allocations, resulting in excessive commercialisation and high out-of-pocket expenses for citizens. Many had high hopes that the interim government would break this trend by prioritising these two critical sector

thefinancialexpress.com.bd

Health budget cut runs counter to reform ambition
Atiqul Kabir Tuhin

Published :
May 22, 2025 00:05
Updated :
May 22, 2025 00:05

The education and health sectors have historically been neglected in government budget allocations, resulting in excessive commercialisation and high out-of-pocket expenses for citizens. Many had high hopes that the interim government would break this trend by prioritising these two critical sectors through increased funding and meaningful reforms. Unfortunately, that hope now appears to be fading as allocations for both education and health are set to decrease in the upcoming fiscal year. Compared to the current fiscal year's Annual Development Programme (ADP), funding for education will be reduced by approximately 30 billion taka, while the health sector will see a cut of around 25 billion taka.

The funding cut for the health sector comes at a time when the Health Sector Reform Commission is advocating for an increase in health spending to 15 per cent of the national budget and 5 per cent of GDP. This recommendation reflects the magnitude of systemic investment needed to revitalise the country's ailing health sector.

Yet, it is perplexing that the government is moving in the opposite direction. . Although the reform proposals have yet to be formally approved, the government could have at least signaled that, starting this year, health and education would be treated as priority sectors. If the current government ignores the reform commissions' recommendations, chances are high that all the well-meaning proposals, no matter how promising, will be shelved and forgotten under future political administrations.

The Health Sector Reform Commission, headed by National Professor Dr. AK Azad Khan submitted a fairly comprehensive report to Chief Advisor Dr Muhammad Yunus just two weeks back. The commission has put forward a bold and ambitious set of measures aimed at transforming the country's healthcare system into a more inclusive, accessible, and pro-people framework. At the heart of the Commission's recommendations is a call to recognise primary healthcare as a legally enforceable fundamental constitutional right, to be provided free of cost. It is unfortunate that, even after 54 years of independence, the state has failed to ensure basic rights such as healthcare for all citizens.

Although Article 15 of the Constitution enshrines food, clothing, shelter, education, and medical care as fundamental rights, there is no legal mandate to enforce it, rendering the basic rights largely ornamental. Recognising primary healthcare as a legal right, therefore, would mark a significant step forward, especially at a time when social disparities have been increasingly undermining equal access to these basic services. However, legal recognition alone is not enough. Such a shift demands concurrent investments in healthcare infrastructure, staffing, training, and logistics to become meaningful in practice.

To support this transformation, the Commission recommends making union-level health and family planning centres into fully functional primary healthcare centres, attended by at least two MBBS doctors and other necessary staff. In urban areas, equivalent facilities are to be established at the ward level. Once implemented, the people will receive free primary treatment at these facilities at ward or union levels. Facilities at this tier will function as referral points in the proposed system. According to the Commission's plan, a structured referral mechanism would direct patients with more chronic or acute conditions to Upazila or district-level hospitals.

The commission also proposes providing initial essential medicines ree of cost, then at subsidised prices from pharmacies at public healthcare facilities to be established under a National Pharmacy Network. Equally important is the proposed exemption of VAT on medicines for life-threatening and chronic conditions such as cancer, diabetes, hypertension, and essential antibiotics, which would significantly benefit low-income populations.

However, without sufficient budgetary support, even the most well-intentioned policies will remain nothing more than words on paper. Over the past decade, health sector budgetary allocations have remained stagnant at around five per cent of the national budget. Compounding the issue, the Ministry of Health has consistently failed to fully utilise its allocated funds. This lack of budget implementation capacity has often been cited as a reason for slashing allocation for health. Without enhancing the government's ability to plan, execute, and monitor spending effectively, increased allocations alone will not yield improved health outcomes. Deep-seated issues like corruption, administrative inefficiency and political interference must also be addressed for any reform measure to succeed. At the same time, good governance and oversight are essential to ensure that increased spending translates into improved outcomes for citizens.

Meanwhile, concerns about the feasibility of the Commission's proposals were raised during a recent webinar hosted by the South Asian Network on Economic Modeling (SANEM), titled "Health Reform Commission Report: Quick Fixes or Transformation?" Leading health economists pointed out that the report lacks a phased, time-bound roadmap. It offers limited guidance for policymakers on sequencing reforms, estimating costs, or identifying financing strategies. While the recommendation to increase health spending to 5 per cent of GDP is laudable, it would remain ambitious without a clear mechanism to fund such an expansion. They said the report does not address crucial options such as national health insurance, public-private partnerships (PPPs), or diaspora contributions-recourses that could help close the funding gap without unduly burdening taxpayers.

Bangladesh's healthcare sector stands at a pivotal crossroads. The country has made notable progress in several development indicators, yet the health sector continues to lag-not due to a lack of potential, but because of a lack of sustained priority. This trend must be reversed. A healthy population is not only a matter of social justice but also a cornerstone of economic productivity and national development. A universal healthcare system cannot be built on a fragile fiscal foundation. The government must take the Health Sector Reform Commission's recommendations seriously and act with urgency and commitment. Health is not a luxury-it is a fundamental necessity that must be enshrined and upheld in the national development agenda.

​

 

[Saif]

How young citizens of Bangladesh can transform the future of its healthcare

Students are uniquely positioned to act as catalysts for transformation.

www.thedailystar.net

How young citizens of Bangladesh can transform the future of its healthcare

Beyond the classroom, students would engage in hands-on, community-oriented activities designed to translate knowledge into action. Photo: FREEPIK

In Bangladesh, seeking healthcare services is marked by profound challenges that stem from a complex interplay of demand- and supply-side barriers. On the demand side, pervasive low health literacy severely limits individuals' ability to make informed decisions about their well-being. Sociocultural norms, often deeply entrenched, discourage proactive engagement with healthcare systems. At the same time, misconceptions about medical care, such as equating medicine with treatment, or assuming that costly interventions guarantee superior outcomes, further complicate the issue. Affordability remains a significant hurdle as many families struggle to access even basic services. Additionally, the readiness of public health facilities is often inadequate, undermining trust and discouraging utilisation. On the supply side, the healthcare system is a fragmented, pluralistic mix of providers, ranging from trained allopathic practitioners to unregulated traditional healers. This diversity, coupled with weak regulatory oversight, results in inconsistent care quality and frequent instances of inappropriate treatment.

For decades, efforts to address these issues have centred on behaviour change communication (BCC) campaigns, which aim to educate communities and shift attitudes towards healthier practices. While these initiatives have achieved some success in raising awareness, their impact is often fleeting. Top-down messaging struggles to resonate with our diverse population, failing to account for regional, cultural, or socioeconomic variations. Moreover, these campaigns rarely address deeper systemic issues, such as widespread mistrust in public health services or the absence of robust regulatory frameworks. As a result, the gains from such interventions tend to dissipate quickly, leaving communities vulnerable to the same barriers. To break this cycle, Bangladesh requires a transformative, community-driven solution, one that harnesses the potential of its youngest citizens to lead a paradigm shift in health literacy and behaviour.

Imagine a classroom in a rural Bangladeshi village where third-graders are not only learning foundational subjects like mathematics and language but also absorbing critical lessons about hygiene, the importance of vaccinations, and the value of clean water. Picture high school students stepping into leadership roles, organising health fairs to dispel myths about generic medicines or teaching their parents how to recognise early symptoms of common illnesses. This vision forms the core of an innovative proposal to train students from classes 3-12 as health ambassadors, equipping them with the knowledge, skills, and confidence to drive meaningful change in their families, peer groups, and broader communities.

Students are uniquely positioned to act as catalysts for transformation. As trusted members of their households, especially in rural areas, school-going children have a remarkable ability to share knowledge in ways that resonate deeply, often bypassing the resistance that external campaigns encounter. A young girl explaining the importance of antenatal care to her mother might inspire timely visits to a clinic, improving maternal and child health outcomes. A teenage boy challenging myths about traditional healers in his village could shift community perceptions, encouraging reliance on qualified providers. Through their peer networks, students can amplify these messages, normalising behaviours such as seeking care from licensed practitioners or prioritising preventive measures like regular check-ups. In communities where scepticism towards public health services runs high, students can serve as bridges, rebuilding trust by sharing evidence-based information about the benefits of government-run clinics and programmes.

The proposed approach is both practical and adaptable to the developmental stages of students. Children in classes 1-5 would focus on foundational health concepts, such as the importance of handwashing, safe drinking water, and balanced nutrition. These lessons would be integrated into their existing curriculum, making them accessible and engaging through interactive activities like storytelling or games. Older students, in classes 6-12, would tackle more complex topics, including maternal and child health, the management of non-communicable diseases like diabetes, and the dangers of self-medication or reliance on informal providers. To deliver this education, schools would establish well-being clubs—student-led groups supported by trained teachers. These clubs would serve as platforms for peer learning, fostering a sense of ownership and responsibility among participants.

Beyond the classroom, students would engage in hands-on, community-oriented activities designed to translate knowledge into action. Peer health clubs would encourage students to share what they have learnt with friends, creating a ripple effect of awareness. Community outreach initiatives, such as health fairs or door-to-door campaigns, would allow students to directly engage with neighbours, promoting local health services and addressing common misconceptions.

This strategy offers a sustainable, cost-effective alternative to traditional campaigns. By leveraging existing school infrastructure, the programme minimises the need for additional resources while maximising reach. Teachers, already embedded in the education system, can be trained to deliver health lessons, ensuring consistency and scalability. Local health workers can complement these efforts by providing technical support, such as guest lectures or materials for student-led campaigns. The ripple effect of this approach is profound: a single child educating their family can spark generational change, while peer-to-peer sharing builds a network of informed advocates. Over time, these efforts can reshape community norms, fostering a culture of accountability where citizens demand quality care and providers are incentivised to deliver it.

Evidence from similar initiatives underscores the potential for success. In India, school-based health education programmes have significantly improved hygiene practices, leading to measurable reductions in waterborne diseases. In sub-Saharan Africa, youth-led campaigns have increased awareness of HIV/AIDS, driving higher rates of testing and treatment adherence. These examples demonstrate that young people, when equipped with the right tools, can affect meaningful change. In Bangladesh, implementation would begin with the development of a tailored curriculum, designed in collaboration with health and education experts to align with national priorities. Teachers and students would undergo training to ensure effective delivery, while partnerships with local health offices would provide logistical support. Successful pilots could be scaled up through integration into national education policies, with backing from government agencies and development partners.

The challenges facing Bangladesh's healthcare system are formidable, but they are not insurmountable. By investing in students as health ambassadors, the country can cultivate a generation of informed, empowered leaders who redefine how communities engage with healthcare. This approach taps into the energy, creativity, and influence of young people, transforming them into agents of change. As students share knowledge, challenge misconceptions, and advocate for better care, they lay the foundation for a healthier, more equitable society. The voices of confident, knowledgeable young ambassadors could ignite a healthcare revolution, ensuring that every citizen has the tools to seek, demand, and access quality care. Through this innovative strategy, Bangladesh has the opportunity to not only address its immediate health challenges but also build a resilient, informed population capable of sustaining progress for generations to come.

Dr Syed Abdul Hamid is professor at the Institute of Health Economics of Dhaka University and convener at Alliance for Health Reforms Bangladesh (AHRB).​