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[🇧🇩] Healthcare Industry in Bangladesh
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A year of disruptions for health sector

Scrapping of programme, medicine shortage deprived thousands of much-needed care
Health services faced disruptions throughout the year, as shortages of medicines, equipment and contraceptives left thousands of people without much-needed care following the scrapping of a decades-long operational arrangement.

Troubles began with the sudden halt of USAID funding in January, which affected the health sector -- both directly and indirectly. One immediate setback was the suspension of icddr,b's Alliance for Combating Tuberculosis, which was aimed at improving the tuberculosis case detection mechanism.

In the latter part of the year, public medical facilities witnessed protests by health workers pressing for a wide range of demands. Amid mounting pressure, the government promoted over 6,000 doctors, mostly to supernumerary posts.

Meanwhile, dengue continued to take a heavy toll on human lives, stretching the public health facilities to their limits. Influenza infection rate hit 59.2 percent in July -- the highest since surveillance of the disease began in 2007.

Adding to the concerns, the Multiple Indicator Cluster Survey 2025, released last month, revealed that the Total Fertility Rate (TFR) rose to 2.4 from 2.3 in the previous survey. This marks the first increase in TFR in five decades.

Despite extensive discussions on the urgent need for health sector reforms, progress remained elusive. A high-powered commission submitted a report recommending sweeping changes, but efforts to implement those were hardly visible.

Prof Be-nazir Ahmed, a health expert and former director of disease control at DGHS, said that though the sectoral programmes had some shortcomings, Bangladesh performed reasonably well in preventive healthcare through them over the last few decades.

"But the sudden halt to the programmes has put many of our hard-earned achievements -- such as the country's success in eliminating Kala-azar [a life-threatening parasitic disease] -- at risk of reversal," he told The Daily Star.

The interim health administration could have set an example by simultaneously taking two measures -- preventing corruption and sustaining or improving public health services.

But it could not to do so, creating a serious gap in service delivery, which will be difficult for the next administration to overcome, he added.

Prof Rashid E Mahbub, a medical expert and former president of the Bangladesh Medical Association (BMA), said the administration failed to provide an alternative plan following the suspension of the sectoral programmes, which resulted in service disruptions.

SERVICE DISRUPTIONS

Since 1998, the health ministry has implemented four Health, Population, and Nutrition Sector Programmes (HPNSPs) to provide a range of health, nutrition and family planning services, with the last one ending in June 2024.

The interim government scrapped the proposed fifth HPNSP and decided to integrate the sectoral programmes into regular ones to improve coordination and strengthen infrastructure.

The ministry took up several projects to complete the unfinished tasks of the Fourth HPNSP and to continue the supply of medicines and other emergency items. Though some projects were approved last month, many health services were disrupted for months, depriving thousands of essential care.

For example, there were disruptions in the supply of five types of medicines for diabetes and hypertension to 430 hospitals, mostly at the upazila level. The supply has yet to return to normal, even though the government recently allocated Tk 100 crore for the service, according to a health official.

Moreover, around 14,500 community clinics, which provide care to 490,000 people a day, saw disruptions in medicine supply throughout the year. No drugs were procured between July 2024 and May 2025 due to a fund crunch after the expiry of the HPNSP, severely affecting the supply of 22 types of medicines.

Though drug supply from the centre was fully restored in August this year with block allocations, procurement was halted in November due to various complications, said an official.

Regarding the disruption, Health Secretary Saidur Rahman said it took time to approve several projects to continue the supply. The situation will gradually become normal.

Health services and vaccination programmes also faced disruptions in November, as several sections of medical professionals demonstrated to press home their demands.

DOCTORS' PROMOTIONS

The interim health administration received praise for its decision to promote more than 6,000 doctors. But around 5,000 of them were placed in supernumerary posts, which are temporary positions created outside the regular structure.

Allegations were raised that many doctors were deprived of promotions this time as well due to political reasons.

Prof Rashid said it was commendable that the administration promoted many doctors who had been waiting for a long time. However, the existing health infrastructure is not adequate to absorb services from the promoted doctors, and the government does not have the necessary plan in this regard.

Asked, Saidur Rahman admitted that they would not be able to post all assistant and associate professors to medical colleges due to a lack of available posts. In such cases, they would have to work in hospitals.

Asked about the allegation that doctors affiliated with the pro-Awami League doctors' association were not promoted, he said, "Not everyone will get a promotion, and there are various reasons for that."

LITTLE PROGRESS IN REFORMS

In May, the Health Sector Reform Commission, led by National Professor AK Azad Khan, recommended a sweeping overhaul of healthcare management, but the government did not initiate any major reform.

In its report, the commission suggested that the government make primary healthcare a constitutional obligation and provide it free of cost to ensure universal access.

When asked, Saidur Rahman said the ministry implemented some minor reforms, but made little progress on major ones. "We have tried our best but it's a big sector with a lot of challenges."

Prof Be-nazir Ahmed said that had the interim administration initiated the process of implementing the recommendations properly, the next government could have carried it forward.

"But given the current situation, the next government will have to review them and start the process afresh, which will take a long time, he added.​
 
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Rural health clinics: promises, performances, and despair

Abdullah A Dewan and Dulary A Maher
Published :
Jan 08, 2026 00:58
Updated :
Jan 08, 2026 00:58
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A heath worker providing health tips to a group of young mothers at a community clinic in Bangladesh — WHO Photo

Across Bangladesh’s countryside, a remarkable health-policy transformation has unfolded over the past two decades. Tens of thousands of low-level health posts—community clinics and union-level health and family welfare centres—now bring medical care within reach of rural populations. The ambition is noble: to make healthcare a right at the doorstep of every village. Yet behind the success of expanded access lie persistent deficiencies in staffing, medicine supply, and service quality. The question is no longer whether these clinics exist, but whether they effectively and consistently deliver the care rural Bangladeshis need.

Structure of Rural Health Care: Bangladesh’s rural health system rests on two foundational tiers. The first and most localised is the community clinic, each designed to serve roughly 6,000 people in a cluster of villages. These clinics provide basic preventive and promotive care—immunisations, family planning, nutrition counselling, and treatment of minor ailments. Above them are the union health and family welfare centres, which cover about 25,000 people per union and offer maternal and child healthcare, deliveries, and limited curative services. Together, they form the lowest rungs of the national healthcare ladder, linking upward to upazila health complexes and district hospitals.

The Promise of Accessibility: The World Health Organization (WHO) and the World Bank have hailed Bangladesh’s community clinic model as a milestone in reaching rural and marginalised populations. Each clinic typically has one full-time Community Health Care Provider (CHCP), assisted by two part-time workers who visit households, maintain vaccination coverage, and promote hygiene. Built on the principle of local ownership—where villagers donate land and manage operations—the system was revolutionary in its simplicity. By placing care within walking distance, the government reduced physical and psychological barriers that once kept villagers away from formal healthcare.

For millions, especially women and children, the community clinic became the first point of contact with the state’s health system. Proximity increased the likelihood that mothers would seek antenatal care and children would receive timely immunisations. Maternal and child health indicators improved steadily, and the clinics became the backbone of Covid-19 outreach and vaccination campaigns. Accessibility, once a dream, became reality.

Where the System Falters: The story of progress, however, must be balanced against performance. Efficiency—delivering the right care with the right resources—remains the system’s weak link.

Staffing shortages are the first constraint. Each community clinic employs a CHCP and shares a health assistant and a family welfare assistant. Yet these are paraprofessionals, not degree-holding physicians or registered nurses. Union-level centres, meant to have at least one doctor, midwife, and several paramedics, often operate with half their sanctioned staff. In many unions, one worker shoulders the duties of ten. Without qualified personnel, many clinics are limited to dispensing paracetamol, saline, and advice.

Medicine availability and treatment capacity present the second bottleneck. Community clinics were designed primarily for prevention, not full-scale curative care. Consequently, many lack a reliable supply of antibiotics or diagnostic tools. Drug shortages are common, forcing patients to buy medicines from private pharmacies or travel to distant upazila hospitals. A 2025 reform commission even recommended authorising these clinics to sell essential over-the-counter medicines at subsidised prices—an implicit acknowledgment that rural demand for basic treatment remains unmet.

Workload pressure and weak supervision form the third constraint. Multiple staffing studies using the World Health Organization’s Workload Indicators of Staffing Need (WISN) method reveal that staffing norms are out dated and fail to reflect actual patient volumes. Community health workers face overwhelming workloads, leading to rushed consultations that often last less than four minutes. Weak referral systems, poor transportation, and inadequate communication with higher-tier facilities further erode efficiency.

Dual Practice and Referral Malpractice: Beyond shortages and inefficiencies lies an ethical fault line that quietly corrodes rural healthcare. Many government-employed doctors, officially posted at union or upazila health complexes, also maintain part-time private practices in nearby towns. This dual practice often turns into dual morality. In the government clinic, patients complain of being hurried, dismissed, or even scolded. Yet when the same doctor is visited in a private chamber—after paying consultation fees—the tone changes to courtesy, patience, and care.

Even more troubling is the referral-for-profit network that has emerged, as documented repeatedly in media reports and health-sector studies. Some doctors routinely direct patients to city-based diagnostic centres or specialists with whom they have personal or financial ties. In many cases, the referrals are unnecessary, driven not by medical need but by commission-based incentives. Such practices impose crushing financial burdens on poor families and erode faith in local health facilities.

This behaviour transforms what should be a public service into a marketplace of manipulation. The poor, who turn to government clinics precisely because they cannot afford private care, end up neglected or deceived into unnecessary expenditures. Without strict enforcement, dual practice has become the unspoken rule of the rural health economy—where duty ends at the clinic gate and profit begins at dusk.

Measuring Efficiency: Judged by four criteria—human resources, medicine availability, quality of care, and accessibility, the results are mixed. On access, Bangladesh has succeeded impressively; nearly every rural citizen now lives within a few kilometres of a health post. But the absence of qualified physicians and nurses leaves many facilities operating on the margins of competence. Quality and monitoring vary widely across districts: some clinics thrive under motivated leadership, while others stagnate due to absenteeism or neglect. The problem is not intent but implementation design that favours coverage over capability.

What Must Change: To fulfil the promise of universal health coverage, Bangladesh must move from access to efficiency. This requires recruiting more doctors, nurses, and midwives for rural postings, supported by financial incentives and credible pathways for career advancement. The current two-tier paraprofessional model is insufficient for a country facing a rising burden of chronic and non-communicable diseases.

Equally urgent is guaranteeing consistent stocks of essential drugs, including antibiotics, and equipping clinics with basic diagnostic tools for blood pressure, glucose, and common infections. Without medicines and diagnostics, proximity offers little more than false reassurance.

The system must also pilot enhanced community clinics staffed by at least one trained nurse or physician’s assistant capable of managing uncomplicated infections and chronic conditions. Such intermediate capacity would relieve pressure on hospitals while restoring confidence in local care.

Digital registers and connectivity should be leveraged to monitor attendance, medicine stocks, and referral patterns in real time, allowing district authorities to identify underperforming clinics and intervene early. Finally, citizen participation must be institutionalised through active management committees and regular public hearings, empowering villagers to demand transparency and quality from local providers.

The Road Ahead: Bangladesh’s network of rural clinics remains one of the boldest health outreach initiatives in the developing world. It has achieved what many nations still struggle with—universal access to a health facility within walking distance. Yet access alone is not enough. Without qualified staff, adequate drugs, reliable diagnostics, and effective supervision, accessibility risks becoming a hollow victory. The measure of success should not be how many clinics exist, but how many lives they improve.

These concerns are widely shared among observers of Bangladesh’s health system. Yet the deeper problem lies in the quiet despair gripping rural patients—mistreated by medical professionals, denied basic services, and driven toward private clinics run by the very doctors entrusted with public duty. Such hopelessness reflects a broader culture of dishonesty and corruption that has trickled down from the top to every tier of society. It exposes how numerical policy achievements can conceal lived disillusion when care is indifferent, supervision weak, and accountability absent.

Part of the remedy must begin with raising the salaries of medical professionals to restore dignity to their service, while making private practice for government-employed doctors strictly illegal—punishable by permanent removal from public employment and ineligibility for future government fellowships, including FCPS and foreign training programs. The call is for a renewal of purpose, so that access is matched by care, performance by compassion, and promise by integrity.

Dr Abdullah A. Dewan, Professor Emeritus of Economics at Eastern Michigan University, USA, formerly a Physicist and Nuclear Engineer, BAEC.

Dr Dulary A Maher, MBBS (DU), PGT, CCU, Urban Primary Care Delivery Project Suja Nagar, Comilla.

 
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Effective strategies for health care

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BANGLADESH, with significantly high life expectancy and infant mortality rates, is confronted with a growing prevalence of non-communicable diseases alongside growing mental health issues. It also faces dual challenges from chronic infectious diseases such as tuberculosis, which are intensified by inadequate funding, uneven distribution of resources, especially between urban and rural areas, and administrative shortcomings. From a geographical perspective, Bangladesh benefits from improved access and a skilled work force, which contributes to the substantial economic growth.

The primary health care initiative focused on boosting immunisation to reduce child mortality, notably in achieving a ‘polio-free’ status and implementing oral dehydration therapy for diarrhoea treatment, has seen a considerable success. However, the rapid and uneven growth of urbanisation poses long-term challenges for health management, alongside pollution and environmental pressure which are a major barrier to health infrastructure. Consequently, the current health landscape is confronted with numerous challenges and adversities.


Infectious diseases such as bacterial pathogens such as Mycobacterium tuberculosis, are responsible for tuberculosis. Over time, the focus has shifted from tuberculosis to non-communicable diseases, including stroke, heart diseases, chronic obstructive pulmonary disease, cancer and diabetes, which now account for the majority of fatalities. Simultaneously, the population bears a dual burden of inadequate public health and personal financial strain in addressing these diseases.

Mental health is another critical area of concern as Bangladesh handles a significant and escalating burden of mental health issues, with approximately 19 per cent of the adult experiencing mental disorders. The issues are exacerbated by rapid urbanisation, poverty, familial conflicts and certain genetic pre-dispositions. The acute shortage of mental health professionals, coupled with widespread medical shortage exceeding 90 per cent in this sector, is apparent. Women are particularly vulnerable to these conditions and while urban/rural discrimination is not excessively pronounced, there remains a substantial lack of mental health resources in rural areas, where conditions such as depression and anxiety are dominant.

The rise in stress, depression, neurological disorders, strokes and epilepsy is alarming. Anxiety disorders represent one of the fastest-growing categories of mental illness globally, impacting the mental development of at least 4.1 per cent of children and the adolescent. Among the most diagnosed anxiety symptoms in children and young adults aged 11 to 19 are separation anxiety or dissociative disorder; specific phobia, characterised by an irrational fear of certain stimuli; social anxiety disorder; generalised anxiety disorder; and panic disorder.


These mental anxiety disorders typically begin in early childhood or adolescence and over time, the symptoms often interact with other anxiety disorders. Bangladesh ranks among the lowest in public health expenditure globally, frequently fluctuating between about 0.7 per cent and 1.1v of its gross domestic product. As a result of insufficient funding, around 63 per cent to 73 per cent of the total health expenditure is directly incurred by patients.

This financial burden drives millions into poverty each year. Health insurance for the general populace is nearly non-existent, leaving individuals without financial protection during emergency medical situations. The scarcity of resources within the healthcare system, coupled with a lack of personnel and poor governance, perpetuates a vicious circle of underdevelopment, where the absence of resources and accountability results in significant adverse effects, including corruption, economic instability and inadequate public service delivery.

The unequal distribution of healthcare professionals, particularly specialists, between urban and rural regions is recognised as a contributing factor to the emergence of risks and illnesses. The systematic shortcomings in disease prevention and health awareness stem from various interconnected challenges within the healthcare system. A significant barrier is an inadequate emphasis on preventive measures and health promotion initiatives. The current overly centralised decision-making structure of the health ministry is deemed inappropriate, which is often the case. Top-down or top-down strategies result in a disconnect with the actual conditions in rural areas. These systemic issues are exacerbated by insufficient public health communication, particularly during emergencies such as the Covid outbreak, when misinformation proliferates because of ineffective information dissemination and subpar public health messaging.


Likewise, the recovery of the chronic infectious disease such as tuberculosis presents systemic obstacles, including inadequate patient support, exorbitant treatment costs and limited access to care, which contribute to incomplete treatment regimens and the emergence of resistant strains of Mycobacterium tuberculosis and its recovery. Despite ongoing efforts by government and non-governmental organisations through various initiatives, processes and local emergency care networks, there remains a significant deficiency in structural and institutional capacity to prioritise prevention and health education comprehensively, aiming for decentralisation and modernisation that benefits the most common and marginalised segments of the population.

The private health sector is often beyond control because of ineffective government systems, characterised by poor regulation, rampant commercialisation and high out-of-pocket expenses, leading to quality concerns and substantial financial strain for many. This unregulated landscape, marked by a focus on profit rather than quality, has driven many into debt. Conversely, key informal service providers in rural regions frequently lack adequate training, revealing significant administrative deficiencies. To transform Bangladesh into a healthy and developed nation, it is essential to establish a long-term strategic framework that addresses the issues, incorporating youth health and reproductive rights into the effective measures of the health planning structure.

At the core of this vision lies the commitment to ensuring an equitable access to health care, particularly for the adolescent and marginalised communities. It is advisable to execute the potential strategies that emphasise essential health systems, human capital, digital transformation and institutional reforms to establish a modern and stable Bangladesh, which can be viewed through the lens of current health practices, problem identification and actionable initiatives.

Universal health coverage can be broadened to encompass 75 per cent of the population by 2030, necessitating a service package that enhances health care, including lifestyle intervention and nutrition for women and children. The execution of a digital health strategy is crucial for the integration of telemedicine, electronic health records and data analysis among both public and private health service providers. The current primary health budget for the 2026 fiscal year stands at Tk 434.83 billion, reflecting a mere 5 per cent increase from the previous allocation of Tk 414.08 billion in the past financial year. This allocation constitutes 5.3 per cent of the national budget and 0.74 per cent of the gross domestic product, which is considerably lower than the 5 per cent of the gross domestic product recommended by the World Health Organisation.


Regrettably, public health allocations have consistently hovered around 5 per cent of the national budget for several years and even as the GDP share, it has marginally declined from 0.75 per cent in the 2024 financial year to 0.74 per cent in the 2025 financial year. This trend can be recognised as a clear contributor to administrative deficits and prudent management. To promote long-term health development, Bangladesh must enhance multilateral cooperation, which includes precise information sharing and investment strategies in health system infrastructure. Evidence-based decision-making, universal health coverage and community-based management will be crucial. Additionally, there will be sustainable coordination among government agencies, international donors and civic groups to align national health strategies with the Sustainable Development Goals, particularly in health.

By establishing social health protection systems and increasing government funding, while reducing out-of-pocket health expenditures for households, a blended financial system should integrates public and private capital, especially enhancing the capacity of the disease diagnostics sector, and extending medical care to health initiatives to ensure that they are more long-term, sustainable, and efficient. This can guarantee optimal resource use and social security levels.

Bangladesh has implemented several specialised training initiatives to strengthen its healthcare system, including the management sciences for health and good pharmacy practice training programme, supported by foreign funding and technology. This addresses fundamental topics including rational drug usage, patient consultation, antimicrobial resistance, pharmacovigilance and proper storage and labelling of medicines. Despite these advances, the challenges that remain include a significant shortage of healthcare workers, especially in rural areas, and a lack of investment in primary health care and community-based training. A recent survey reveals that 51 per cent of medical students are considering moving abroad, with 90 per cent expressing a preference for urban healthcare positions.

To tackle the challenges in the healthcare system, it is crucial to incorporate health workers into organised health frameworks, ensure ongoing training, and achieve a fair distribution of healthcare professionals. The progress of sustainable health systems relies on diversifying funding sources, boosting domestic investment and fortifying health systems through community-led initiatives, cross-border collaboration and integrated disease control. A modern, stable and resilient health system that promotes good health and well-being can be established through a combination of preventive services, health awareness and systemic approaches.

The concept of public-private partnership is increasingly acknowledged as a fundamental strategy for promoting long-term health development. With a population exceeding 180 million, Bangladesh faces challenges in accessing health care, particularly in rural and marginalized communities. Therefore, a measurable and sustainable model is crucial for reinforcing the health system. The governments, the private sector, non-governmental organisations and international donors are working collaboratively to address life-threatening diseases such as tuberculosis, HIV/AIDS and malaria while also establishing resilient infrastructure to achieve universal health coverage.

Sarker M Shaheen is a researcher of neurogenetics and precision medicine at the University of Calgary, Canada.​
 
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Affordable care must be next govt’s focus: Say health experts

By Tuhin Shubhra Adhikary

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With the national election less than a month away, political parties are finalising their manifestos. The Daily Star spoke to experts to identify the pressing issues that should top the agenda for parties.

As major political parties prepare to roll out their election manifestos, health experts say that ensuring quality primary healthcare for all and reducing high out-of-pocket expenditure should be their top priority.

They note that primary healthcare remains weak and underfunded, particularly in urban areas, despite its critical role in preventing diseases and protecting people from falling into poverty due to high medical costs.

Health should not be treated as the sole responsibility of a single ministry; rather, it should be integrated into all government policies and activities, they observe.

To achieve these goals, the experts have called for an overhaul of health management, including restructuring the system under three separate directorates -- clinical, academic, and public and primary healthcare -- along with higher budgetary allocations to improve coordination, efficiency, and accountability.

The country goes to the polls at a time when the health sector faces major challenges, including inadequate funding, shortages of health workers, high out-of-pocket expenses, unequal access to services and weak governance.

As thousands of people continue to be deprived of quality treatment, the rise in the total fertility rate for the first time in 50 years has fuelled fresh concerns.

Public health expert Prof MA Faiz said that primary healthcare has not received due importance, particularly in urban areas, where services remain very poor. It should be given priority regardless of whether the area is rural or urban.

He suggested that a doctor-led team should provide services to a defined population size, ensuring that no one is left behind.

In Bangladesh, the universal service package exists only in name. It should be gradually expanded -- both in terms of the number of services and the population covered -- to ensure universal health coverage. Individuals should bear costs according to their financial capacity, said Prof Faiz, also former director general of Directorate General of Health Services (DGHS).

“This needs to be done to reduce people’s out-of-pocket expenditure that remains very high in the country. Excessive healthcare costs are pushing many people into poverty while depriving many others of services.”

He also stressed the need for skill-driven medical education to produce the required manpower capable of providing quality primary healthcare.

“The health budget must be increased to achieve these goals,” he added.

Outlining the major tasks for the next government, Prof Liaquat Ali, a member of the Health Sector Reform Commission, said it will need to review the commission’s report and set priorities for implementing the recommendations.

The first priority should be to enact a law declaring primary healthcare a constitutional obligation and provide these services free of cost, said Prof Liaquat, also a former vice chancellor of Bangladesh University of Health Sciences.

At least 15 percent of the national budget, or five percent of the country’s gross annual income, should be allocated to the health sector in phases, he said, adding that the allocated budget must be fully utilised.

He also recommended reorganising the healthcare system under three directorates -- clinical, academic, and public and primary healthcare -- to ensure better coordination and service delivery, with adequate manpower assigned accordingly.

Stressing the need to reduce out-of-pocket healthcare expenditure, Mohib Ullah Khondoker, a member of the executive management committee at Gonoshasthaya Kendra, said the next government must properly regulate the medicine market.

It must ensure that all stakeholders adhere to the updated National Essential Drug List once the prices of the 295 medicines on the list are fixed, he noted.

“Priority should be given to ensuring quality education for health professionals and strengthening primary healthcare services, particularly in view of the growing burden of non-communicable diseases, which involve high treatment costs,” he added.

Emphasising the importance of preventive and promotive healthcare, Prof Syed Abdul Hamid from the Institute of Health Economics at Dhaka University said these areas should be prioritised so that fewer people fall sick.

All ministries must play a role by giving priority to health issues, which means health should be integrated into all government policies and activities, he said.

The country has a large network of government hospitals to provide curative care, but these facilities are not functioning properly mainly due to poor governance and shortages of funds and manpower, he said, calling for effective measures to make them functional.

Private facilities, which charge higher fees but often fall short of quality service, must be brought under an accreditation council to ensure standards, said Prof Hamid, also convener of Alliance for Health Reforms Bangladesh.

Steps must be taken to improve the quality of medical education and promote professional development for doctors so that they stay aligned with global advancements in healthcare, he added.​
 
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