Bangladesh is a densely populated and economically challenged nation in South Asia. In 2013, the population was 156.6 million, projected to rise to roughly 218 million by 2030. The country is experiencing significant social and economic transformations. A summary of its key demographic, economic, and health metrics can be found in Table 1. Urbanization is occurring at a rapid pace; for instance, the population of Dhaka surged from 5.8 million in 1990 to 10.2 million by 2000 and is anticipated to reach 16.8 million by 2015. The increasing urban population frequently lacks access to basic needs such as housing, security, and essential services like health, sanitation, and clean drinking water. Despite this swift urban growth, Bangladesh remains predominantly rural, with over 70 percent of its populace residing in rural areas. Almost half of the citizens live on less than US$1.25 daily. The population is relatively youthful, with only 4 percent aged 65 and older; however, this percentage is projected to rise to 6.6 percent by 2025.
There is a significant lack of public health services, and the facilities that do exist are often inadequately equipped and understaffed. The scarcity of skilled healthcare workers poses another challenge, as the country has a low doctor-to-patient ratio along with shortages of nurses and other healthcare professionals. Additionally, Bangladesh's healthcare system suffers from insufficient financial investment, with government spending on health constituting only 2.63% of the nation’s GDP, which falls short of the World Health Organization's recommended 5%. Furthermore, the healthcare budget allocation is not adequately prioritized, with a considerable share being directed toward curative care instead of preventive measures.
The healthcare system in Bangladesh largely depends on the public sector for financial resources, policy formulation, and service delivery frameworks. Despite facing numerous persistent challenges, the health sector appears to be overlooked in terms of national budgetary priorities. The World Health Organization reports that only about 3% of the Gross Domestic Product (GDP) is allocated to health services. Out of the total health expenditure (THE), government spending accounts for approximately 34%, while out-of-pocket (OOP) costs constitute the remaining 66%. Consequently, inequity remains a significant issue impacting the healthcare system. This paper evaluates the current challenges and opportunities within the Bangladeshi health system based on a review of secondary data. The results indicate that, despite various interconnected challenges such as insufficient public health facilities, a shortage of skilled personnel, limited financial resources, and political unrest, Bangladesh has made notable progress in fulfilling the health-related Millennium Development Goals (MDGs), particularly MDG 4 and MDG 5. While the private sector is expanding, mainly in providing tertiary healthcare services, Bangladesh has yet to develop a comprehensive health policy to strengthen its entire health system. It is clear that the key challenge lies in the lack of dynamic and proactive leadership capable of crafting and implementing policies that will further enhance and fortify the health system. Effective leadership could facilitate significant health system reforms, improving efficiency for the benefit of the health of Bangladesh’s population, grounded in the principles of equity and accountability.
Nonetheless, it poses a significant dilemma that, with the increasing national corruption, it remains uncertain how effective the packages would be (Al-Zaman, 2020). Conversely, the inefficiency has hampered the health system, and escalating corruption has further complicated the issues in this sector as well (Basu et al., 2023). Numerous studies have also highlighted the issue of corruption within Bangladesh's healthcare sector, such as the widespread corruption present in both private and public healthcare (Shah, 2020), rampant corruption in the pharmaceutical and health care area (Martinez et al., 2017), and bureaucratic corruption affecting various sectors in Bangladesh, including healthcare (Islam & Lee, 2016).
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Many studies indicate that outdated governance structures, a lack of digitalization, and deficient governance quality are closely linked to financial corruption in the healthcare sector during the COVID-19 crisis (Al-Zaman, 2020). The medical sector is one of the most severely impacted by the persistent corruption that Bangladeshi institutions have faced for an extended period, as suggested by anecdotal evidence, with the situation becoming more precarious during crises (Alam & Teicher, 2012; Asadullah & Chakravorty, 2019; Abdallah et al., 2022; Zafarullah & Siddiquee, 2001). On the flip side, this industry plays a vital role in efforts to manage the COVID-19 pandemic. Consequently, following the global COVID-19 outbreaks, this sector has received significantly enhanced budgetary allocations, including in Bangladesh (Mohiuddin, 2021).
- Health is a crucial factor for human development within a nation. In Bangladesh, government spending on healthcare has been decreasing for several years, leading to various pressing issues. Bangladesh has emerged as a “positive deviant” by advancing from being the second poorest nation globally to implementing exemplary initiatives in family planning, vaccinations, oral rehydration therapy for diarrhea management, and the detection and treatment of tuberculosis, among others.
- A recently released book, 50 Years of Bangladesh: Advances in Health, showcases these and several other accomplishments while outlining the significant challenges that must be addressed in the coming half-century for Bangladesh to achieve universal health coverage and the goal of “Health for All.”
- The most critical of these challenges include substantial increases in government health expenditure, the establishment of a robust primary health care system that relies on a professional cohort of community health workers visiting every home regularly, nationwide catastrophic health insurance for citizens, innovations in healthcare delivery grounded in a long-standing reliance on research and evidence, and strong independent civil society involvement from groups such as Bangladesh Health Watch.
In spite of these considerable challenges, the Government of Bangladesh has not undertaken comprehensive measures or formulated detailed future plans to integrate health insurance schemes into their healthcare financing strategy. While Bangladesh shares a similar sociodemographic backdrop with countries like Vietnam and Sri Lanka, which are currently expanding their social insurance frameworks, the financial burden of out-of-pocket payments has significantly decreased there since the advent of such systems. In contrast, Bangladesh lacks a national health insurance program, and its private insurance market remains underdeveloped. Only limited NGO-based insurance initiatives are present, and they have not alleviated the burden of out-of-pocket expenses. Therefore, the government ought to focus more on non-communicable disease (NCD) management programs and include health insurance within the health financing system.
The Convention on the Rights of the Child in 1989 highlights the significance of health quality, child health care, and rehabilitation for children. This convention stresses the need for protective measures that safeguard children's rights, which are essential for lowering child mortality rates, providing medical assistance, preventing diseases, and creating conditions that enhance children's education and nutrition. Additionally, the convention emphasizes the importance of family planning, parental education, and international cooperation to advance children's rights (Convention on the Rights of the Child, 1989, Article 24). Child health is closely linked to women's health, as women give birth to children and influence their development. Health issues are also addressed in CEDAW, adopted by the United Nations in 1979, aimed at eliminating discrimination against women. This agreement prioritizes key actions to ensure women’s rights, especially regarding health, such as initiatives to remove discrimination in health services between genders and provisions for free health care and nutritional support for pregnant women and during the postnatal period (CEDAW, 1979, Article 12).
FAQ Here:What are the main economic
problems in the health sector of Bangladesh?
ü The main
economic problems in the health sector of Bangladesh are the lack of adequate
financial allocation, the inadequacy of the necessary infrastructure for the
health care system, and the limitations of the people's ability to access
health care services. This is a major obstacle to the development of the health
sector.
Why is public participation
important in the health sector?
ü Active
public participation is very important for the improvement of the health
sector, as it not only increases the rate of healthcare utilization, but also
ensures the cooperation of society in health awareness and disease prevention,
which is necessary for long-term improvement.
What steps should be taken to
solve the economic problems in the health sector of Bangladesh?