The health system of Bangladesh relies heavily on the government or the public sector for financing and setting overall policies and service delivery mechanisms. Although the health system is faced with many intractable challenges, it seems to receive little priority in terms of national resource allocation. According to the World Health Organization (WHO 2010) only about 3% of the Gross Domestic Product (GDP) is spent on health services. However, government expenditure on health is only about 34% of the total health expenditure (THE), the rest (66%) being out-of-pocket (OOP) expenses. Inequity, therefore, is a serious problem affecting the health care system. Based on a review of secondary data, the paper assesses the current challenges and opportunities of the health system in Bangladesh. The findings suggest that although the health system faces multifaceted challenges such as lack of public health facilities, scarcity of skilled workforce, inadequate financial resource allocation and political instability; Bangladesh has demonstrated much progress in achieving the health-related Millennium Development Goals (MDGs) especially MDG 4 and MDG 5. Although the country has a growing private sector primarily providing tertiary level health care services, Bangladesh still does not have a comprehensive health policy to strengthen the entire health system. Clearly, the most crucial challenge is the absence of a dynamic and proactive stewardship able to design and enforce policies to further strengthen and enhance the overall health system. Such strong leadership could bring about meaningful and effective health system reform, which will work more efficiently for the betterment of the health of the people of Bangladesh, and would be built upon the values of equity and accountability.

Coronary artery disease (CAD) is an increasingly important medical and public health problem, and is the leading cause of mortality in Bangladesh. Like other South Asians, Bangladeshis are unduly prone to develop CAD, which is often premature in onset, follows a rapidly progressive course and angiographically more severe. The underlying pathophysiology is poorly understood. Genetic predisposition, high prevalence of metabolic syndrome and conventional risk factors play important role. Lifestyle related factors, including poor dietary habits, excess saturated and trans fat, high salt intake, and low-level physical activity may be important as well. Some novel risk factors, including hypovitaminosis D, arsenic contamination in water and food-stuff, particulate matter air pollution may play unique role. At the advent of the new millennium, we know little about our real situation. Large scale epidemiological, genetic and clinical researches are needed to explore the different aspects of CAD in Bangladesh.

A B S T R A C THypertension (HTN) is an increasingly important medical and public health problem. In Bangladesh, approximately 20% of adult and 40-65% of elderly people suffer from HTN. High incidence of metabolic syndrome, and lifestyle-related factors like obesity, high salt intake, and less physical activity may play important role in the pathophysiology of HTN. The association of angiotensin-converting enzyme (ACE) gene polymorphism and low birth weight with blood pressure has been studied inadequately. Studies have found relationship between mass arsenic poisoning and HTN. Hypovitaminosis D presumably plays role in the aetiopathogenesis of HTN in Bangladeshi population. South Asians appear to respond to antihypertensive therapy in a similar manner to the Whites. The latest National Institute for Health and Clinical Excellence guideline advocates a calcium-channel blocker as step 1 antihypertensive treatment to people aged ≥ 55 years and an ACE inhibitor or a low-cost angiotensin-II receptor blocker for the younger people. Calcium-channel blockers and beta-blockers have been found to be the most commonly prescribed antihypertensive drugs in Bangladesh. Non-adherence to the standard guidelines and irrational drug prescribing are likely to be important. On the other hand, non-adherence to antihypertensive treatment is quite high. At the advent of the new millennium, we are really unaware of our real situation. Large-scale, preferably, nation-wide survey and clinical research are needed to explore the different aspects of HTN in Bangladesh.

BackgroundThis paper is aimed at critically assessing the extent to which Non-Communicable Disease NCD-related policies introduced in Bangladesh align with the World Health Organization’s (WHO) 2013–2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs.MethodsThe authors reviewed all relevant policy documents introduced by the Government of Bangladesh since its independence in 1971. The literature review targeted scientific and grey literature documents involving internet-based search, and expert consultation and snowballing to identify relevant policy documents. Information was extracted from the documents using a specific matrix, mapping each document against the six objectives of the WHO 2013–2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs.ResultsA total of 51 documents were identified. Seven (14%) were research and/or surveys, nine were on established policies (17%), while seventeen (33%) were on action programmes. Five (10%) were related to guidelines and thirteen (25%) were strategic planning documents from government and non-government agencies/institutes. The study covered documents produced by the Government of Bangladesh as well as those by quasi-government and non-government organizations irrespective of the extent to which the intended policies were implemented.ConclusionsThe policy analysis findings suggest that although the government has initiated many NCD-related policies or programs, they lacked proper planning, implementation and monitoring. Consequently, Bangladesh over the years had little success in effectively addressing the growing burden of non-communicable diseases. It is imperative that future research critically assess the effectiveness of national NCD policies by monitoring their implementation and level of population coverage.