THE overall state of healthcare in Bangladesh remains a matter of grave concern. With nearly 180 million people living within a landmass of just 147,570 square kilometres, Bangladesh is among the most densely populated nations in the world. Yet, more than two-thirds of its population, around 120 million people, have little or no access to standard health services.
Bangladesh has made impressive economic progress since independence. Once dubbed a 鈥榖ottomless basket鈥�, the nation鈥檚 economy is now growing faster than many others globally. In 1971, the country鈥檚 per capita income was less than $91; today, it stands at around $2,854. Yet, nearly 28 per cent of the population still lives below the poverty line. For this large section, the only available healthcare option is the public system, a network of hospitals and clinics that are chronically under-resourced, poorly managed and woefully inadequate in number.
The country鈥檚 healthcare infrastructure consists of hospitals, clinics, diagnostic centres, community clinics and Maternal and Child Welfare Centres spread from union levels to upazila, district and divisional headquarters. A handful of specialised hospitals, mostly located in Dhaka, provide treatment for infectious diseases such as diarrhoea, tuberculosis and leprosy. At independence, these facilities were extremely limited. Since then, the number of hospitals, clinics, diagnostic centres, hospital beds and healthcare professionals has increased substantially; yet the demand continues to far outstrip supply.
The shortage of doctors, nurses, and hospital beds remains acute. There is reportedly only one hospital bed for every 250 patients in public hospitals. Healthcare expenditure is barely 3 per cent of the gross domestic product, far below the 5 per cent benchmark recommended by the World Health Organisation.
For the poorer half of the population, private healthcare is prohibitively expensive. Getting a bed in a public hospital is often compared to asking for the moon, and even those who manage to enter the system frequently face harassment from hospital staff. Consequently, many poor patients forgo treatment altogether, enduring prolonged suffering; and, in some cases, preventable death.
The country鈥檚 rapid urbanisation has led to a massive influx of people into cities and towns. Still, around 65 per cent of the population continues to live in rural areas, where medical services are extremely limited. The available facilities include community clinics and union health centres for basic consultation and Upazila Health Complexes for treatment. Yet these complexes are constrained by limited beds, typically between 20 and 50 depending on the upazila, poor infrastructure, outdated or malfunctioning equipment, and a chronic shortage of medical staff.
While the private healthcare sector caters largely to the affluent, it too suffers from widespread irregularities, mismanagement, and disproportionately high costs. Thus, neither public nor private healthcare offers a satisfactory model of service delivery.
Corruption within the public healthcare system compounds the crisis. It is widely known that essential medicines and family planning commodities, intended for free distribution, are frequently pilfered and sold to private vendors. As a result, poor patients are forced to purchase medicines externally and undergo diagnostic tests in private centres, expenses they can ill afford. Studies indicate that out-of-pocket payments constitute nearly 67 per cent of total healthcare expenditure, even in public hospitals where treatment should be free or heavily subsidised.
Despite the severity of these problems 鈥� including a shortage of medical personnel, overburdened tertiary hospitals, unregulated pharmacies and diagnostic centres and inequitable resource distribution 鈥� the health sector continues to receive minimal budgetary attention. According to WHO (2010), only about 3 per cent of Bangladesh鈥檚 GDP was allocated to health expenditure at the time. A decade later, in 2020, the figure remained largely unchanged at around 2.63 per cent.
Bangladesh鈥檚 per capita health expenditure is among the lowest in South Asia, and the percentage of GDP spent on health remains equally dismal. The shortage of trained professionals 鈥� doctors, nurses and technicians 鈥� is chronic and undermines service quality across the system. These realities make it abundantly clear that Bangladesh鈥檚 healthcare system requires a complete overhaul, in every sense. The oft-quoted question, 鈥榳ho will bell the cat?鈥�, has never been more pertinent. Words and policy pronouncements abound, but it is now time for concrete action.
The government must treat health as a national priority. Budgetary allocations for health have been among the lowest in the region and must be increased substantially. The nation urgently needs more hospitals, more qualified and trained medical professionals and greater financial resources to strengthen infrastructure and service delivery.
Healthcare professionals in Bangladesh are among the lowest-paid in South Asia. A recent policy dialogue revealed that the average annual income for a doctor is around Tk 3lakh, and for a nurse Tk1.9 lakh. In contrast, doctors in India earn around Tk10 lakh annually, while nurses earn three to four times more than their Bangladeshi counterparts. Such disparities have inevitable consequences, discouraging talented individuals from entering or remaining in the public health service.
The government therefore has no alternative but to increase budgetary allocations substantially, enabling the state to pay competitive wages commensurate with qualification and experience. Simultaneously, infrastructure development must align with regional benchmarks and systemic corruption and mismanagement must be decisively addressed.
The Bangladesh Public Procurement Authority recently uncovered shocking irregularities in the procurement of medical supplies, including life-saving equipment. Their investigation revealed instances of misappropriation of public funds and waste of state resources. The BPPA has made several recommendations aimed at rectifying these systemic issues and the government must act upon them without delay.
The interim government, in particular, should take three immediate steps: (a) root out corrupt elements from the sector; (b) significantly increase budgetary allocations; and (c) establish a robust accountability mechanism across every level of healthcare management.
Bangladesh鈥檚 journey towards universal and equitable healthcare will remain incomplete unless these measures are implemented with urgency and integrity. The time for rhetoric has long passed. What the nation now needs is decisive, transparent, and sustained action to heal its ailing health system.
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Captain Hussain Imam is a retired merchant mariner.
