Health System in Bangladesh: Challenges and Opportunities

Abstract

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.

Healthcare Financing in Bangladesh: Challenges and Recommendations

“…Due to the high OPP, thousands of poor households are being pushed into poverty every year which is called catastrophic expenditure. Studies have shown that 6.4 million (4%) people in Bangladesh get poorer every year due to excessive health cost 21,22 . People have to borrow money or sell assets to pay for health care.…”

Majmawalas and sexual health promotion in Bangladesh: An ethnography of street healers in Dhaka City

“…The World Bank's World Development Indicators: Health System (2013) shows a similar status in Bangladesh. According to this report and other studies (such as Islam and Biswas, 2014), from 2006 to 2011, there were only 0.4 physicians and 0.2 nurses per 1,000 population in Bangladesh, whereas in Australia, there were 3.9 physicians and 9.6 nurses, and the World averages were 1.4 physicians and 2.9 nurses per 1,000 population. Furthermore, the World Bank found a significant gap between sanctioned and filled health worker positions in Bangladesh.…”

“…The Bangladesh Health Watch Report (BHWR, 2008) notes that qualified modern practitioners account for a small proportion of the entire workforce, making up just 5% of all health care providers with just 7.7 physicians, dentists and nurses together per 10,000 population (BHWR, 2008: ii). The recent reviews of the Bangladesh health system (Islam and Biswas, 2014;Khan et al 2015;Darkwa et al 2015;Khatun et al 2015) echo the similar critical shortage of professional health workforces. All of these recent studies confirm that there is no significant change in the number of the professional health workforce in recent time in Bangladesh.…”

“…The ministry is responsible for policy formulation and implementation of health care regulations. The estimated number of health workers in this sector (see Table 2.1) is just 20,234 doctors, (Islam and Biswas, 2014), 15000 nurses, 10,000 paramedics and 54,595 community health workers for a national population of 153 million people (Chowdhury et al, 2013). The clinical facilities are also poor.…”

“…Ahmed et al (2013), BHWR (2012), Islam and Biswas (2014) Table 2.1 clearly shows a high level of health workforce shortage if we only consider the formal sector health workforce in Bangladesh. Adams et al (2013) state such deficits have resulted in a 'crippled' health system.…”