IN THE crowded wards of Dhaka鈥檚 hospitals, where young doctors juggle endless shifts for little pay, the cracks in Bangladesh鈥檚 healthcare system are becoming impossible to ignore. The problem is not merely about overburdened infrastructure or inadequate facilities; it is about the human resource crisis brewing at the very heart of the system. Doctors and nurses, the backbone of healthcare delivery, are leaving 鈥� sometimes to foreign hospitals, sometimes to more lucrative private practice, and too often, to disillusionment.
A recent study on salary policy in the public and private health sectors paints a sobering picture. The average annual salary of a doctor in Bangladesh hovers around Tk 3 lakh. For nurses, it is even lower, barely Tk 1.9 lakh. These figures may appear respectable in isolation, but when placed against the regional and global context, they reveal a crisis in the making. In India, the average annual salary of a doctor is over Tk 16 lakh 鈥� more than five times higher. In Nepal, it is over Tk 10 lakh, in Sri Lanka nearly Tk 5 lakh, and in Pakistan more than Tk 4 lakh. Nurses too earn substantially more in neighbouring countries, with salaries that are three to four times higher than their Bangladeshi counterparts. When compared with developed economies, the difference is staggering. A doctor in the United Kingdom earns 33 times more, while a nurse鈥檚 income is 25 times higher than what Bangladesh offers.
Such disparities are not mere statistics. They are direct signals to young professionals about where their future lies. If a country鈥檚 most skilled health workers can earn multiples of their current income simply by crossing borders, the incentive to leave becomes not just tempting, but rational. This is precisely why the trend of outmigration among Bangladeshi doctors and nurses is rising, eroding the national healthcare system from within.
The crisis deepens when one considers the distribution of the health workforce. While the public sector employs a little over 150,000 workers, the private sector now accounts for more than 190,000. Yet, the private sector remains largely unregulated in terms of salary structure, benefits and working conditions. Entry-level MBBS graduates in private hospitals often receive monthly salaries between Tk 18,000 and Tk 25,000 鈥� barely enough to survive in an expensive city like Dhaka, let alone support a family or pursue higher education. For many, these wages amount to little more than a subsistence allowance after years of costly medical training.
The issue is not simply low salaries but structural neglect. The pay scale in Bangladesh鈥檚 public sector is cadre-based, designed more for bureaucratic uniformity than for recognising specialised skills or market realities. Doctors are slotted into the same framework as administrative officers, their compensation tied to rank rather than the life-saving expertise they bring. This rigid system allows little room for performance-based incentives, skill recognition, or differential pay for high-demand specialties. Promotions are slow, dependent on additional degrees rather than experience or quality of service. Opportunities for career advancement remain restricted, particularly for those outside the major cities.
Meanwhile, the private sector takes advantage of this vacuum. By offering low wages but allowing private practice, it has created an informal system of compensation that shifts the burden of income generation onto doctors themselves. In effect, doctors are left to supplement meagre salaries through long hours of private consultations or part-time work in multiple clinics. The toll on their mental health, work-life balance and commitment to quality care is immense. In this way, what looks like flexibility on paper has translated into burnout, disillusionment, and in many cases, moral compromises in patient care.
Nurses face an even bleaker reality. Despite being indispensable to patient management, their pay is disproportionately low compared to their training, responsibilities and international standards. The annual salary of a Bangladeshi nurse is not even a third of what nurses in India or Nepal earn. This wage suppression reflects a broader undervaluation of caregiving roles in the country, where gender dynamics also play a role, since most nurses are women. The result is predictable: high attrition rates, migration of skilled nurses abroad and a perpetual shortage of qualified personnel at home.
The broader implication is alarming. When doctors and nurses leave or disengage, patients suffer. Lower morale and reduced efficiency among healthcare professionals directly affect the quality of service. Already, Bangladesh struggles with inadequate doctor-to-patient ratios, particularly in rural areas. If young professionals continue to opt out of the system, either by migrating or by retreating into private practice for survival, the national goal of equitable healthcare access becomes increasingly unattainable.
The irony is that healthcare delivery in Bangladesh depends on this very workforce. Yet the state has failed to design policies that reflect their importance. Salary structures remain inconsistent, fragmented between public and private sectors, and disconnected from the realities of regional and global competition. At a recent policy dialogue, experts emphasised that healthcare workers are among the foundational elements of the country鈥檚 health delivery system, yet they remain neglected in compensation and incentives.
Comparisons with South Asia make Bangladesh鈥檚 position look dire, but the real contrast is with the developed world, where doctors and nurses are treated not just as employees but as critical assets. In many countries, salaries are tied to performance, quality of service and patient satisfaction. Special allowances are provided for those serving in remote or high-risk areas. Healthcare professionals receive structured career pathways, with opportunities for both financial and professional growth. By contrast, Bangladesh continues to treat them within a bureaucratic hierarchy designed decades ago, one that no longer matches either the demand of the healthcare system or the aspirations of its workforce.
The consequences of this neglect are already visible. Outmigration is not just a future possibility 鈥� it is happening now. Each year, hundreds of young doctors and nurses apply for overseas placements, creating a silent exodus that drains the system of its most energetic and capable professionals. Those who remain behind often do so reluctantly, caught between a passion for service and the harsh realities of survival.
What makes the situation particularly concerning is the lack of urgency in policy response. For years, successive governments have acknowledged the problem but done little beyond incremental adjustments. The excuse is often that raising salaries for doctors alone would disrupt parity with other cadres. But this argument ignores the unique role of health care in national well-being. Unlike administrative tasks, healthcare delivery is directly tied to life and death. Treating doctors and nurses as interchangeable with bureaucrats is not only unfair but dangerously shortsighted.
Reform is not only necessary but overdue. A separate salary structure for the health sector is the most obvious step. Such a framework should recognise the distinct skills of healthcare workers and align their compensation with regional benchmarks. Performance-based incentives must be introduced, rewarding quality of care rather than mere seniority. Special allowances should be extended to those working in underserved or remote areas, ensuring that rural populations are not abandoned. Minimum wage standards must be enforced in the private sector, preventing exploitative practices and ensuring a baseline of dignity for new entrants.
The cost of inaction is far greater than the financial burden of reform. Every doctor or nurse who leaves Bangladesh represents an investment lost. Years of education, subsidised training and public resources vanish the moment a skilled professional boards a flight abroad. Worse still, every vacancy left behind multiplies the suffering of patients who must endure longer waits, overworked doctors and declining standards of care.
Bangladesh has made progress in expanding healthcare access in recent decades, reducing child mortality and improving maternal health. But these gains are fragile. Without a motivated, adequately compensated workforce, the system risks sliding backward. Global comparisons show clearly that healthcare workers are not a cost to be minimised but an asset to be protected. Until Bangladesh embraces this reality, the exodus will continue, quietly but steadily draining the lifeblood of its healthcare system.
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HM Nazmul Alam is an academic, journalist, and political analyst based in Dhaka, Bangladesh. Currently he is teaching at IUBAT.
