[🇧🇩] 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

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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.

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[Saif]

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

Students are uniquely positioned to act as catalysts for transformation.

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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).​

 

[Saif]

Underfunding cripples public health sector

Health facilities are the places where the two most important events of life for a large number of humans - birth and death - take place. In today's world parents want their babies are born in a hospital, not at home, to avoid childbirth complications that might risk the life of baby or mother or b

thefinancialexpress.com.bd

Underfunding cripples public health sector

Shiabur Rahman
Published :
May 30, 2025 00:05
Updated :
May 30, 2025 00:05

Health facilities are the places where the two most important events of life for a large number of humans - birth and death - take place. In today's world parents want their babies are born in a hospital, not at home, to avoid childbirth complications that might risk the life of baby or mother or both. People prefer hospital care for themselves and their dear ones whenever they fall sick, particularly when they are terminally ill. Budgetary allocation and government's attitude to healthcare, however, do not reflect the priority the sector deserves.

There is no denying that the country's public healthcare system is grappling with chronic underfunding, misplaced priorities, inefficient management, and structural rigidity. Budgetary data in the last decade suggest that successive governments consistently allocated an average of just 5.0 per cent of the national budget for health. The allocation accounted for 2.0 per cent of the Gross Domestic Product (GDP). The figures are alarmingly low when compared with the recent Health Sector Reform Commission's recommendations, which suggest an allocation of at least 5.0 per cent of GDP and 15 per cent of the national budget to improve the country's healthcare system. More concerning is the fact that despite increasing public health demands the health ministry cannot fully utilise whatever allocation it receives. It is subjected to major cuts during mid-year revisions.

A critical yet often overlooked issue contributing to poor budget utilisation is the lack of administrative and financial skills among hospital managers. Most public health facilities in the country are headed by physicians. These doctors may be highly skilled in clinical care, but lack experience in financial management, project planning or administrative governance as most of them do not receive any formal training in these fields. Such skill mismatch leads to significant inefficiencies, resulting in a struggle for directors or chief executive officers with planning expenditures, preparing detailed project proposals, and executing development funds. As a result, significant portions of the development budget or Annual Development Programme for the ministry remain unused, prompting the finance ministry to downsize it towards the end of the fiscal year. Poor implementation performance affects infrastructural development, equipment procurement, and system upgrades, delays service delivery and deters international development partners from channelling aid through government systems.

Another administrative bottleneck lies in the highly centralised nature of health financing. Public health facilities are not allowed to retain or reinvest their earnings, no matter how significant they are. Government health facilities are legally bound to deposit almost all their revenues to the national exchequer within a limited time frame, leaving facility managers with no flexibility to address urgent local needs or improve service delivery. Such rigidity discourages initiative at the local level. A government hospital that earns revenue from different services cannot use that money to repair essential equipment, purchase emergency medicines or procure other emergency supplies.

The underfunding and low budget implementation in the health sector lead to overcrowded hospitals, overworked doctors, inadequate medical supplies and poor infrastructure. People often have to rely on out-of-pocket (OOP) expenditures for even basic health services, deepening inequalities. According to several surveys, Bangladesh consistently ranks among the countries with the highest OOP spending on health globally. In 2021, the World Bank reported that Bangladesh's OOP expenditure was 73 per cent while health economists estimate that the current real OOP expenditure has reached 83 per cent. Low government investment in health sector and a lack of health insurance result in so high OOP, causing financial burdens on families.

The Health Sector Reform Commission has put forward a roadmap to reverse the current state of public healthcare. It is now up to policymakers to demonstrate the will to follow through. Ensuring adequate funding, building administrative capacity of health facility managers, and decentralising financial authority are not merely technical reforms; they are essential steps towards securing the health and dignity of every Bangladesh citizen.​

 

[Saif]

We need an efficient healthcare system

Unimplemented health budget remains a major concern

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We need an efficient healthcare system
Unimplemented health budget remains a major concern

At a time when healthcare experts are urging the government to increase the allocation for the health sector to 15 percent of the national budget or five percent of the GDP, it is deeply concerning that the two government divisions responsible for healthcare delivery have not even been able to utilise their Annual Development Programme (ADP) allocations. Reportedly, over the past 10 months, these two divisions—Medical Education and Family Welfare Division and Health Services Division—spent only a small portion of the funds allocated to them, making them the poorest performers in utilising their development budget. One of them spent only 2.34 percent of its Tk 2,283.16 crore budget by April this year—the lowest among all ministries and divisions—while the other used 14.9 percent of its Tk 5,673.51 crore budget, also nearing the bottom of the list. Unless the government addresses the factors behind such dismal performance and seriously considers the recommendations of the Health Sector Reform Commission, the much-needed change in our health sector will not come.

Reportedly, the factors identified by experts for poor ADP execution include the implementing agencies' lack of capacity, inexperienced project directors, dependence on the Public Works Department for construction, outdated budgeting methods, and leadership changes following the July uprising. In addition, government agencies often lack the necessary managerial and administrative capacity and experience to implement projects in the health sector. Many implementing agencies also lack financial autonomy, requiring them to seek the ministry's intervention, which is often a lengthy and bureaucratic process.

One crucial health project that has been delayed over the years is the one to establish fully fledged treatment centres at eight divisional headquarters for cancer, heart, and kidney patients. The project, approved in July 2019 and originally scheduled for completion by 2022, has undergone several revisions but still remains unfinished. Many other infrastructure development projects—for hospitals, medical colleges, universities, diagnostic facilities, and medical research centres—as well as the procurement of medical equipment are also facing similar delays. This means that the budget allocated for these projects remains unutilised.

While successive governments' neglect has completely crippled our health sector over the years, the situation has sadly remained the same during the interim government's tenure. We urge the government to address the issues hampering the health sector budget utilisation. The health budget must also address sector-specific needs, ensuring that adequate funds are allocated for the most-needed areas. The health sector must also have efficient leadership to ensure these projects are designed properly from the very beginning. The reform commission has put forward some pragmatic recommendations to overhaul our healthcare system, which should be implemented to make it efficient, pro-people, and accessible to all.​

 

[Saif]

Unveiling the hidden truths of Bangladesh’s public health sector

The second hidden reality is the monetised cost of wastage within the public health system.

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Unveiling the hidden truths of Bangladesh’s public health sector

Budget allocations for health remain among the lowest in the region, with per capita health spending lagging behind global benchmarks. FILE VISUAL: HEALTH REFORM
Bangladesh's public health system, a lifeline for millions, is a paradox of resilience and dysfunction. The challenges are well-documented: low budget allocations, pervasive corruption, absenteeism, inadequate infrastructure, and overcrowding. These issues, coupled with systemic bottlenecks within and beyond the Ministry of Health and Family Welfare, paint a grim picture of a sector struggling to meet the needs of a growing population. Yet, beneath these known realities lie two critical unknowns that, if addressed, could transform the system's efficiency and public perception: the true value of health services provided and the monetised cost of systemic wastage. By shining a light on these hidden truths, Bangladesh can unlock the potential for meaningful reform and a healthier future.

The known struggles of the public health system

The public health sector in Bangladesh operates under severe constraints. Budget allocations for health remain among the lowest in the region, with per capita health spending lagging behind global benchmarks. Corruption erodes trust and resources, manifesting in both monetary forms—such as irregularities in procurement—and non-monetary forms, like absenteeism among healthcare providers. Infrastructure deficiencies, from poor medicine storage to inadequate diagnostic facilities, further exacerbate the system's inefficiencies. Patients endure long waits, substandard care, and limited access to essential services, while healthcare providers grapple with outdated systems and insufficient training.

Systemic hindrances amplify these challenges. The health ministry operates within a bureaucratic ecosystem where apex ministries—such as the Ministry of Public Affairs, Ministry of Finance, and Ministry of Planning—treat health no differently than other sectors, often prioritising fiscal conservatism over human lives. Within the health ministry, disparities in expertise and experience create a disconnect between secretariat-level managers, directorate-level officials, and field-level staff. Procurement processes, governed by the Public Procurement Act (PPA) and Public Procurement Rules (PPR), are riddled with ambiguities, leading to delays and inefficiencies.

The Essential Drug Company Ltd (EDCL) and Central Medical Stores Depot (CMSD) struggle with capacity constraints, undermining the supply chain for medicines. Governance issues, coupled with questions about the competence and sincerity of managers across the health ecosystem, further erode the system's effectiveness.

At the facility level, managerial inefficiencies and inadequate staffing compound these problems. The lack of the right skill mix and input mix, coupled with insufficient training, leaves facility managers and operational plan directors ill-equipped to address local challenges. The result is a public health system that, despite its critical role, fails to deliver consistent, high-quality care to those who need it most.

The value of public health services

Amid these challenges, one critical reality remains obscured: the true value of health services provided by the public sector. Neither patients, healthcare providers, nor the state have a clear understanding of this value, and this gap has profound implications.

Patients accessing public health facilities benefit from highly subsidised services, often paying nominal fees for consultations, diagnostics, or treatments. While this affordability is a cornerstone of equitable access, it obscures the actual cost and value of these services. Patients, unaware of the resources invested in their care, may undervalue the system, leading to a lack of appreciation and, in some cases, misuse of services. For example, a patient receiving a subsidised surgical procedure may not recognise the costs of skilled labour, equipment, and infrastructure that underpin it, fostering a perception that public health services are inherently low-quality or disposable.

Healthcare providers, too, lack insight into the value of their outputs. Hospitals and clinics do not systematically quantify the resources—human, financial, and material—required to deliver specific services. Without this knowledge, providers are less incentivised to address inefficiencies, such as wastage of medicines. The absence of a value-based framework also hinders accountability, as facilities cannot measure their performance against the resources they consume.

The state, meanwhile, tracks only budgetary inputs and expenditures, with little understanding of the value added by these investments. This blind spot limits the government's ability to make informed decisions about resource allocation, prioritise high-impact interventions, or advocate for increased health funding. In a country where private healthcare providers offer similar services at market rates, it is feasible to estimate the value of public health services by benchmarking against private-sector prices, adjusted for quality. By bundling services based on diagnostic-related groups and assigning quality-adjusted values, the government could illuminate the true worth of its health system. This knowledge would empower policymakers to optimise resource use, enhance accountability, and communicate the system's value to the public.

The cost of wastage

The second hidden reality is the monetised cost of wastage within the public health system. While the types of wastage—corruption, absenteeism, supply chain bottlenecks, and inefficient resource use—are widely recognised, their financial toll remains unquantified. This lack of clarity undermines efforts to address inefficiencies and allocate resources effectively.

Corruption, a pervasive issue, manifests in both monetary and non-monetary forms. Procurement irregularities, such as inflated contracts or substandard purchases, drain public funds, while absenteeism reduces the availability of skilled providers, forcing patients to seek costlier private care. Supply chain inefficiencies, including poor medicine storage and dispensing systems, lead to spoilage and stockouts, further eroding resources. The inability to control "fake" patients—individuals exploiting free medicines without medical need—adds to the burden. Additionally, the lack of an optimal input mix (e.g., equipment, staff, and supplies) and skill mix (e.g., trained personnel) results in underutilised facilities and missed opportunities for care.

Quantifying these losses is methodologically challenging but achievable. For instance, the cost of absenteeism could be estimated by calculating the salaries of absent staff and the value of forgone services. Procurement-related corruption could be assessed by comparing contract prices with market benchmarks. Supply chain wastage could be monetised by tracking spoilage rates and stockout impacts. By aggregating these costs, the government could gain a comprehensive picture of the financial toll of inefficiencies, providing a compelling case for targeted reforms.

Harnessing knowledge for reform

Unveiling these two unknowns—the value of services and the cost of wastage—could catalyse transformative change in Bangladesh's public health sector. By quantifying the value of services, the government can foster greater appreciation among patients, enhance accountability among providers, and make a stronger case for increased health funding. Public awareness campaigns could highlight the subsidies that enable affordable care, building trust and encouraging responsible use of services. Providers, armed with data on service value, could prioritise efficiency and quality, reducing wastage and improving outcomes. Policymakers, with a clearer understanding of the system's contributions, could advocate for health as a national priority, securing greater budgetary support.

Monetising wastage, meanwhile, would provide a roadmap for addressing inefficiencies. By identifying the most costly bottlenecks—whether corruption, absenteeism, or supply chain failures—the government could implement targeted interventions, such as stricter procurement oversight, digital attendance tracking, or investments in storage infrastructure. These measures, grounded in data, would maximise the impact of limited resources and restore public confidence in the system.

Bangladesh's public health sector stands at a crossroads. The challenges are daunting, but the opportunities for reform are immense. By addressing the two unknown realities—the value of services and the cost of wastage—the government can unlock the system's potential and deliver equitable, high-quality care to all citizens. This requires a commitment to transparency, rigorous data collection, and bold policy decisions. The health of a nation is its greatest asset, and Bangladesh cannot afford to let these hidden truths remain in the shadows. It is time to act, to quantify, and to transform, ensuring that every taka invested in public health delivers maximum value for the people it serves.

Dr. Syed Abdul Hamid is professor at the Institute of Health Economics, University of Dhaka and convenor of Alliance for Health Reforms Bangladesh (AHRB) and Initiator of Network for Healthcare Excellence (NHE).​

 

[Saif]

Rangamati needs improved healthcare

Sadar hospital needs proper infrastructure, manpower to serve patients

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Rangamati needs improved healthcare
Sadar hospital needs proper infrastructure, manpower to serve patients

It is deeply concerning that people in Rangamati are being deprived of critical medical services due to the absence of basic facilities and a shortage of doctors and staff at the Rangamati General Hospital. Reportedly, critically ill patients are being transferred to Chattogram regularly as the district hospital does not have the capacity to treat them. Established in 1984, the hospital still lacks vital facilities such as an ICU, CCU, or even a dialysis unit. As a result, patients suffering from heart disease, kidney failure, or other serious conditions are referred to the Chattogram Medical College Hospital, located about 60 kilometres away. In many cases, patients even need to travel to Dhaka for better treatment. Reportedly, 100 to 150 critical patients are sent to Chattogram for treatment every month. These patients have to face high medical expenses including additional costs of transportation, accommodation, and food, along with the physical strain of travel. This is unacceptable.

As per an estimate, Rangamati General Hospital serves approximately 650,000 residents across the 10 upazilas. Although it has only 100 beds, 200 to 250 patients are often admitted at a time. Due to overcrowding, patients frequently receive treatment on the floor. Moreover, shortages of doctors and support staff have been a persistent issue, causing many to be denied care. Reportedly, despite there being 31 sanctioned positions for doctors, only 22 are currently serving. Furthermore, the hospital lacks the infrastructure needed to provide intensive care. A six-storey building constructed near the hospital in 2009—to house a CCU for cardiac patients—is now being used by Rangamati Medical College, as its permanent campus is yet to be built. In 2021, another initiative was undertaken to introduce ICU, CCU, and dialysis units, and increase the number of hospital beds, with the foundation of an 11-storey building laid. However, that project remains incomplete.

This situation mirrors the long-standing mismanagement and systemic irregularities witnessed across our healthcare sector, and has real impacts for struggling districts like Rangamati. We, therefore, urge the government to ensure the General Hospital is fully equipped to provide comprehensive care. The authorities must establish ICU, CCU, and dialysis units there to serve critically ill patients, while the ongoing crisis of doctors and medical staff must also be resolved. For the overall improvement of our health sector, the reform proposals forwarded by the Health Sector Reform Commission must be implemented.​

 

[Saif]

CA urged to take action to implement health sector reform proposals

Public health experts, mostly members of the health reform commission, in an open letter to the chief adviser on Saturday demanded immediate actions to implement reform proposals and to incorporate those into the ‘July Charter’.

www.newagebd.net

CA urged to take action to implement health sector reform proposals
Staff Correspondent 03 August, 2025, 00:11

Chief adviser Muhammad Yunus.

Public health experts, mostly members of the health reform commission, in an open letter to the chief adviser on Saturday demanded immediate actions to implement reform proposals and to incorporate those into the ‘July Charter’.

In the letter, they stated that the recommendations made by the Health Reform Commission provided a strategic and timely blueprint for a structural change in health governance.

They said that these recommendations offered more than just improvements in service coverage or quality — they lay out a broader framework for institutional reform and system-level transformation.

The signatories stressed the importance of prompt action, warning that without timely and strategic implementation, critical policy recommendations risk being left in official documents with little real-world impact.

They called for a nationally prioritised and time-bound road map, and proposed that incorporating the core health reforms into the July Charter 2025 would signal a serious and future-focused commitment to structural transformation.

While acknowledging the limitations of an interim government’s mandate, the letter said several actions remained within the government’s administrative scope.

The letter urged to consider first step action that is an immediate administrative and legal steps to establish a Permanent Health Commission.

This commission should be an independent, publicly accountable, and high-powered institution that will provide strategic direction and leadership in formulating and implementing a long-term road map for sustainable health sector reform.

The letter suggested initiating a quality-assured public health infrastructure, saying that steps should be taken to establish a functional and universally free primary health care service with mandatory referral mechanisms in both rural and urban areas.

The public health experts urged to form a time bound, task-oriented steering committee comprising members of the advisory council to oversee the implementation of the above initiatives.

This committee should operate under the direct supervision of the Office of the Chief Adviser, they said.

Among others, Health Sector Reform Commission members Syed Akram Hussain, professor Abu Muhammad Zakir Hussain, professor Liaquat Ali, professor Naila Zaman Khan, Azharul Islam Khan and Dhaka University Institute of Health Economics professor Syed Abdul Hamid signed the open letter.​

 

[Saif]

China keen to invest in health sector

Several hospital authorities of China at an event in Dhaka on Friday expressed their interest to establish multiple permanent hospitals in Bangladesh as part of a broader initiative to launch a new era of integrated, high-tech and sustainable healthcare...

www.newagebd.net

China keen to invest in health sector
Staff Correspondent 08 August, 2025, 23:57

New Age photo

Several hospital authorities of China at an event in Dhaka on Friday expressed their interest to establish multiple permanent hospitals in Bangladesh as part of a broader initiative to launch a new era of integrated, high-tech and sustainable healthcare collaboration between the two countries.

They announced the interest at the inauguration ceremony of the event titled Ni Hao! China-Bangladesh Health and Medical Development Expo 2025 at a hotel in Banani.

Chinese ambassador Yao Wen said that they wanted to help create a sustainable, humane and technology-driven healthcare system in Bangladesh.

‘Our experience during the Milestone plane crash support mission has deepened our bond, and we are eager to take the next step together,’ he added.

He also said that both the Chinese government and private hospitals were enthusiastic about participating in hospital construction in Bangladesh, dispatching Chinese medical professionals, facilitating patient referrals and conducting medical training for Bangladeshi doctors.

China, known globally for its advancements in modern medical technology and high-quality healthcare services, is ready to share its expertise to help Bangladesh transform its healthcare landscape, he added.

The Belt and Road Healthcare Centre in Bangladesh with assistance from the Chinese Bangladesh Alumnae Association of Bangladesh, the China-Bangladesh Postgraduate Doctors’ Alumnae Association and Amra Nari organised the exhibition.

The Belt and Road Healthcare Centre is a global initiative headquartered in China that connects patients with the country’s advanced healthcare system, while promoting Chinese medical technology.

According to them, more than 12 top-tier Chinese hospitals sent representatives to the expo, expressing strong interest in investing in Bangladesh’s healthcare sector.

The event offered facilities such as direct invitation for treatment from reputed Chinese hospitals, on-the-spot visa support and guidance for travel arrangements to China and complete assistance for patients, including airport transfers and interpreter services in China.

Chinese hospitals, including Boao Yiling Hospital, Fosun Health, Shenzhen Hengsheng Hospital, Foshan Fosun Chancheng Hospital, Guangzhou Fosun Chancheng Hospital, Guangzhou Shengmei Hospital, Guangzhou Fuda Cancer Hospital, Kunming Tongren Hospital, Modern Cancer Hospital and Xing Mei Hospital in Guangzhou, participated in the event.

The delegations from the various hospitals stated that they were preparing to send specialised doctors to Bangladesh, to offer advanced training programmes for Bangladeshi physicians in China and to introduce cutting-edge technologies, including robotic surgery and prosthetics.

These efforts aimed to bring transformative changes to the country’s healthcare standards, said the hospital delegates.

Health adviser Nurjahan Begum highlighted China’s humanitarian support.

She also said that during the Milestone plane crash, China extended tremendous assistance. ‘Moreover, during the July uprising, many people lost eyes, limbs and China provided robotic prosthetics that helped victims reclaim their lives.’

She also noted that a 1,000-bed hospital will be built in Rangpur with the fund from the Chinese government, along with training for doctors, nurses and technicians. ‘In addition, a memorandum of understanding has been signed to establish a rehabilitation centre for July victims.’

Korban Ali, chairman of Belt and Road Healthcare Centre, said, ‘This health bridge with China is not just about services; it’s about building capabilities and ushering Bangladesh into an era of medical innovation.’

Maruf Molla, CEO of the organisation, stated that they viewed this as the beginning of a long-term, strategic international healthcare collaboration and investment.

The organisers said that it would ease access to world-class treatment in China for Bangladeshi patients.

Officials from the health ministry, health directorates and various medical institutions were also present at the event.​

 

[Saif]

Why we need a referral system in healthcare

The healthcare system in Bangladesh is plagued with so many problems that some fundamental issues are often overlooked. The absence of a strong referral system in healthcare is one of such issues, which has created a series of problems affecting patients, doctors, and the overall efficiency of the

thefinancialexpress.com.bd

Why we need a referral system in healthcare

Shiabur Rahman
Published :
Aug 15, 2025 00:43
Updated :
Aug 15, 2025 00:43

The healthcare system in Bangladesh is plagued with so many problems that some fundamental issues are often overlooked. The absence of a strong referral system in healthcare is one of such issues, which has created a series of problems affecting patients, doctors, and the overall efficiency of the health sector.

In most countries, particularly those with well-organised healthcare systems, have a strong referral mechanism in which patients first consult general practitioners or GPs in their community - be it rural or urban areas. The GPs assess their conditions, offer primary treatment, and refer them to appropriate specialists, if necessary. This referral system ensures that patients receive the right treatment at the right time and reduces unnecessary expenses. Bangladesh should have such a system in place as a former colony of Britain, a good example of a well-organised GP-driven referral system that directs patients to start with primary care, because the foundation of Bangladesh's healthcare system was established during British rule. However, the present scenario in Bangladesh is far away from that system. Patients here usually bypass GPs, heading straight to specialist doctors of their choice due to the absence of the referral system. Most of the patients believe that specialists will solve their problems more effectively, no matter whether their condition actually requires consulting such specialists. This approach leads patients to misjudging their conditions and ending up visiting the wrong type of specialist. For example, someone with a common skin rash may rush to a highly reputed dermatologist without realising that a GP could have diagnosed and treated the issue in a fraction of the time.

This approach often causes an unnecessary burden of expenditure on patients, who have to meet a major portion of the medical expenses from their own pocket unlike the citizens of most countries. According to a World Bank report, Bangladesh's out-of-pocket expenditure on health per capita at purchasing power parity was the 8th highest among 45 least developed countries in 2021.

Specialist consultations, diagnostic tests, and treatments, which can sometimes be avoided with the guidance of GPs, generally involve higher fees compared to primary care services.

Choosing specialist doctors first also creates a huge burden of patients on "celebrity doctors", who are nationwide recognised for their expertise in particular fields. The excessive concentration of patients on a small group of doctors limits access for those who genuinely need their expertise. These doctors face overwhelming patient queues, making it difficult for them to spare adequate time for each case. Patients have to wait for hours, sometimes days, to secure an appointment, only to find that their issue does not require such specialised care. Such wastage of time sometimes heightens the risk for those encountering life-threatening conditions.

The absence of a referral system also leads to an inefficient use of medical resources. Without the system, specialist doctors spend a significant amount of time handling cases that could easily be managed at the primary care level. This inefficiency lowers the quality of care and delays in specialist treatment for serious conditions can have critical consequences.

The health scenario in Bangladesh would be changed drastically if the country is able to establish a well-designed referral system. Developing such a system would be hard, but not impossible. The existing network of community clinics and upazila health complexes could serve as the foundation for this system. But for that these facilities would have to be equipped with qualified doctors trained in general practice, along with sufficient medical supplies and diagnostic tools to handle common ailments. Besides, a campaign would also be necessary to make people understand that consulting a GP first is not a compromise in care but a smart, efficient step toward proper treatment.​