Since its independence, Bangladesh has made notable progress in the health sector. Infant and maternal mortality rates have declined significantly, while life expectancy has risen to more than 72 years. The immunization program has reached nearly full coverage. A large number of skilled personnel have been trained to provide health services at the community level. These achievements have been made with limited resources. Yet a large portion of the population still lacks access to basic healthcare. At the upazila level, infrastructure exists, but there are acute shortages of doctors, health workers, and medicines, along with mismanagement and inefficiency. Due to limited public investment, the private health sector has been expanding rapidly.
Overall, Bangladesh remains among the lowest-spending countries in Asia in terms of healthcare operations and investment. Just over 3 percent of the government’s total operating expenditure is allocated to the sector. Even there, inefficiency, inactivity, corruption, and mismanagement hinder the delivery of expected services.
In the revised budget for FY 2024-25, BDT 199.73 billion was allocated for operating expenses in the health sector. However, the actual spending stood at BDT 136.03 billion, only 3.4 percent of the government’s total operating expenditure. In the revised budget for FY 2023-24, BDT 184.46 billion was allocated for operating expenses in this sector. Of that, BDT 151.73 billion was spent, accounting for just 3.7 percent of total government operating expenditure.
Bangladesh is among the countries in Asia with the lowest share of government operating expenditure on health, and the lowest in South Asia. As a result, shortages of personnel, medical supplies, and quality services persist. In July 2023, the state-run Health Economics Unit (HEU) released an assessment report on the limitations of health sector financing. The report, titled “Review of Bangladesh Health Care Finance Strategy 2012-32,” was prepared with support from Sweden, the United Kingdom, and the World Health Organization (WHO).
The observation on the long-term economic picture of the health sector shows that Bangladesh has the lowest level of government financing in healthcare among South Asian countries. According to the report, in 2019, the government’s share of total health expenditure in Bangladesh was only 3 percent. The figure was so low that it fell below war-torn Afghanistan. In contrast, Maldives ranked first in South Asia, with government spending accounting for 19.15 percent of health expenditure. Bhutan ranked second at 10.41 percent, and Sri Lanka third at 9.25 percent.
The weak level of spending in healthcare was also highlighted in a recent World Bank report. It illustrated how much of total expenditure countries and regions worldwide allocated to the health sector until 2023. The report found Bangladesh at the bottom of the global list, with only 1.19 percent of total government spending going to healthcare. In comparison, South Asian countries on average spent 4.59 percent in 2022, while least developed countries spent an average of 5.55 percent in 2020. Even debt-burdened poor countries allocated 7 percent of their budgets to health care.
Public health experts say that although many people seek treatment at government hospitals and upazila health complexes, the services remain unsatisfactory. As a result, outside a few government facilities in Dhaka and Chattogram, people are increasingly turning to private hospitals and clinics. Yet the quality of service there is also in question. Frequent problems include misdiagnosis, incorrect medical reports, inadequate consultation time with patients, and deaths linked to negligence. An excessive commercial mindset in health care, along with a lack of transparency, accountability, and oversight, has further eroded public trust in the system. Consequently, wealthier patients are traveling abroad, to countries such as Singapore, Thailand, and Malaysia, for treatment.
To restore public trust in healthcare, experts say Bangladesh needs skilled professionals in the sector. They also stress the importance of government focus on research and technological development. All of this, they add, requires clear planning and adequate budget allocations.
The country’s most critical shortage in healthcare is human resources, particularly doctors, nurses, and technicians. A significant number of these posts remain vacant in government facilities, creating major obstacles to providing comprehensive care, according to experts.
Lenin Choudhury, a public health expert, told Bonik Barta, “No comprehensive plan has been formulated for healthcare delivery in Bangladesh. Because of the lack of planning, there is no proper budget allocation. Even the limited allocation we do have cannot be utilized effectively because the structure is not in place. For the past year, less than 1 percent of GDP is being allocated. These problems exist due to a lack of planning and coordination. What is needed is a plan, and the capacity to implement that plan. Bangladesh should prepare a comprehensive plan to ensure healthcare for all, and it should be organized step by step.”
According to the Directorate General of Health Services (DGHS) Health Bulletin, as of December 2023, there were 141,999 registered physicians in the country. Given Bangladesh’s population of 171 million, that comes to just 0.83 doctors per 1,000 people. The doctor-to-population ratio in Bangladesh lags far behind other Southeast Asian countries.
A report from the Health Reform Commission stated that the country requires 310,500 nurses for its population, but only 56,734 are available. In other words, just 28 percent of the required nurses are currently in service.
While the DGHS has no objection to the health budget allocations, government officials have acknowledged that the full amount is not being effectively utilized.
Professor Dr. Md Abu Zafar, the Director General of the DGHS, told Bonik Barta, “The increase in the budget for the healthcare sector for the following year depends on how much of the allocated funds we manage to spend. We are never able to use the full allocation. We prepare an annual plan. If it is ready by July, we can begin the procurement process quickly. But if there is a delay, the budget is not used as planned and funds are returned. The ability to spend the budget is a major issue.”
Addressing the shortage of essential healthcare personnel, a top DGHS official recently told Bonik Barta, “To reduce the staffing shortage, the recruitment process is underway through a special BCS examination to recruit 3,000 doctors, including 2,700 MBBS physicians and 300 dental surgeons. Once appointed, the shortage of doctors at the upazila level will ease. Recruitment of nurses is also in progress, with 3,512 nurses set to be appointed.”
Despite these measures, the health sector continues to face significant challenges, including inadequate patient care, shortage of equipment, and limited capacity for overall improvement. Health economists have stressed that meaningful reforms and expansion in the health sector require a substantial increase in budgetary allocation.
Dr. Syed Abdul Hamid, a Professor at the Institute of Health Economics at the University of Dhaka, told Bonik Barta, “The health sector receives only around one-third of the allocation it requires each year. Moreover, even that allocation is not fully spent. Simply increasing the budget will not solve this sector’s problems. Proper planning is essential. Without planning, budget allocations cannot be utilized effectively.”
The county’s healthcare sector has long suffered from severe staffing shortages. Nearly half of the staff in many hospitals remain absent. While the government has launched several initiatives to address absenteeism among doctors, nurses, and other public health officials at hospitals and health centers, regulatory bodies struggle to enforce accountability due to their own staffing limitations.
After the interim government assumed power, it launched major reforms in the health sector and established the Health Reform Commission. In its recommendations, the commission emphasized large-scale budgetary support for reforms and suggested that at least 15 percent of the national budget should be allocated to the healthcare sector.