A paper plan to curb health treatment abroad

Some promising healthcare reform plans taken a year ago by the interim government remain largely unmaterialised, with severe gaps in hospitals, equipment, and skilled personnel, leaving critical care patients in Bangladesh with no choice but to continue seeking treatment abroad.

Cancer, infertility, kidney and heart transplants are the four major conditions for which Bangladeshi patients most frequently seek treatment abroad – particularly in neighbouring India – according to a government assessment made last year. 

On 15 December 2024, the health ministry met with hospital representatives and experts to address gaps in treating these four conditions, planning short- and medium-term measures to boost capacity across public, non-profit, and private hospitals.

Infographics: TBS

The measures include making eight cancer hospitals and dialysis centres countrywide fully functional (initiated under the previous government), operationalising the BSMMU Super Specialized Hospital, and granting tax exemptions on cancer drugs and equipment, but progress on these fronts has been stalled.

The Gonoshasthaya Nagar Hospital applied for approval to provide cancer and dialysis services, which its authorities say has not yet been granted.

Meanwhile, patients continue seeking treatment abroad, with India as the top destination — around 482,000 Bangladeshis reportedly travelled there in 2024. Although recent visa complications caused a slight decline, India still accounts for roughly half of all Bangladeshi medical travellers, ahead of Thailand, Singapore, and Malaysia.

Sayed Abdul Hamid, a professor of Health Economics at the University of Dhaka, told TBS, "Bangladesh needs disease-specific plans backed by proper implementation to curb overseas treatment for cancer, kidney transplants and infertility. Without effective execution, patients will not benefit, and the large outflow of funds abroad will continue."

He added that the health sector's main weakness is the lack of a complete healthcare ecosystem, noting that buildings and equipment alone are insufficient without trained personnel, maintenance, research, support staff and policy coordination.

"Bangladesh needs disease-specific plans backed by proper implementation to curb overseas treatment for cancer, kidney transplants and infertility."  – Sayed Abdul Hamid, Professor, Health Economics, University of Dhaka.

Professor Syed Md Akram Hussain, a member of the Health Sector Reform Commission, said the commission had recommended several measures to boost local healthcare capacity and reduce patients' dependence on overseas treatment. These include tax exemptions on cancer treatment equipment, tax incentives for importing medical devices, and allowing the use of private hospital beds and equipment at government expense. 

He added that the commission also proposed forming a separate health-sector body to identify challenges and devise solutions, urging the government to prioritise implementation of the commission's recommendations.

With plans stalled, patients pay the price

Cancer treatment capacity in Bangladesh remains critically inadequate, making cancer patients among the most likely to seek treatment abroad. 

According to the GLOBOCAN 2020 report, around 156,000 people are diagnosed with cancer in Bangladesh each year. The World Health Organization (WHO) recommends at least one radiotherapy machine per 10 lakh people, which would require around 300 machines for the country. Currently, there are only 37 radiotherapy machines across both public and private hospitals, most of which are reportedly non-functional.

At the country's only government-run cancer hospital – the National Institute of Cancer Research and Hospital – just two out of eight radiotherapy machines are operational. Four machines have been officially declared completely non-functional, while the remaining two are also unusable but not yet formally declared defunct. 

A radiotherapist at the hospital, on condition of anonymity, told TBS, "With just two machines, 180 to 200 patients receive therapy every day, but another 300 to 400 patients come seeking treatment." He added that the shortage forces the tumour board to schedule treatment dates months later, and current patients may have to wait eight to ten months for radiotherapy.

A similar crisis exists at Bangladesh Medical University's oncology department, which operates a single radiotherapy machine capable of treating around 70 patients per day, while demand stands at 200–300 patients. 

Professor Dr Sayed Md Akram Hussain, chairman of Clinical Oncology at BMU, told TBS, "Managing patient pressure with just one radiotherapy machine is extremely difficult. Since there is no backup, treatment will come to a halt if the machine breaks down. We already have bunkers ready to install two more machines. If we get the machines, we could provide radiotherapy to more than 300 patients a day." He added, "If patients have to wait three to four months for radiotherapy, the severity of cancer can increase."

Dr Akram also highlighted a shortage of essential equipment for chemotherapy. The department currently has eight infusion pumps obtained through donations. "Infusion pumps are essential for properly controlling chemotherapy and saline administration. We need another 20 to 30 infusion pumps," he said.

The government had planned to support cancer treatment through tax exemptions on medicines and equipment. In March this year, the National Board of Revenue (NBR) reduced the advance income tax on imported raw materials used in cancer drug manufacturing from 5% to 2%. That was the only change made so far. 

Last year, the health ministry also announced plans to make eight cancer hospitals and dialysis centres across the country's eight divisions operational within a medium-term timeframe of six to 12 months, each with 100 beds.

However, Health Services Division Secretary Saidur Rahman told TBS that construction of these hospitals has not yet been completed, and equipment procurement is still pending. 

"We hope to make the cancer hospitals operational in all eight divisions in the next fiscal year. Once they are launched, cancer treatment capacity will increase and dependence on overseas treatment may decline," he said.

Infertility treatment services have also been expanded, but inquiries reveal that at the government level, care is virtually unavailable outside Dhaka Medical College Hospital, where services remain very limited. 

Infertility treatment in Bangladesh is largely private, with high costs and mixed success rates, prompting many patients to seek comparatively cheaper care in India.

Since August 2024, Indian visa complications have further restricted patients' ability to travel for treatment. While critically ill patients could still travel on medical visas, anti-India political unrest and the closure of the Indian visa centre in Chattogram have worsened access. 

The government has encouraged patients to seek care in China, and some are also going to Thailand, Malaysia, and Singapore. However, high costs and language barriers limit access in these countries.

Ismat Ara, 34, has been trying for three months to obtain an Indian visa after failing to conceive despite IU and IVF procedures at two private hospitals in Bangladesh. "We have tried all available treatments in the country. Over the past three years, we have spent nearly Tk10 lakh. Now we are planning to go to India, but we are unable to get a visa. IVF treatment in Thailand is far too expensive, so we cannot even consider going there," she told TBS. 

$5b lost annually to overseas treatment

"Bangladesh loses around $5 billion annually as patients seek medical care abroad, mainly due to lack of trust in domestic healthcare, inaccurate diagnoses, and weak service management," said Malik Talha Ismail Bari, MD and CEO of United Hospital Limited and former senior vice president of Dhaka Chamber of Commerce and Industry (DCCI), at a seminar in Dhaka on 13 December. 

Talha said that patients and their families distrust domestic care due to doubts about diagnosis accuracy, sudden hospital bill hikes, hidden charges, counterfeit medicines, and substandard equipment. These factors contribute to the perception that seeking treatment abroad is safer.

Super Specialized Hospital yet to be fully operational

The Tk1,500 crore Super Specialized Hospital of Bangladesh Medical University (BMU), launched in September 2022 to reduce overseas treatment for patients with complex diseases, is still operating at only about 10% of its capacity, three years after inauguration.

On 12 December 2024, at a discussion organised by the Alliance for Health Reforms Bangladesh, Dr Sayedur Rahman, special assistant professor at the Ministry of Health, said, "To reduce patients' reliance on foreign treatment, the interim government is working to make the BMU Super Specialized Hospital fully operational. The state must ensure optimal use of this hospital, which has the most advanced technology and infrastructure under the Bangladesh government. Running the hospital has been given top priority. As of today, there are 60 patients admitted. This 700-bed hospital should soon lead efforts to reduce patients going abroad for treatment."

However, full operationalisation is yet to be achieved. Last week (20 December), Health Secretary Saidur Rahman told TBS that a meeting was held with hospital authorities, requesting a specific plan since the project is scheduled to be completed by June. Once finished, the syndicate will clarify how the exit will be managed and who will take over.

Dr Shahidul Hasan, additional director of the Super Specialized Hospital, said that the hospital will come under the administration of Bangladesh Medical University, with a syndicate meeting scheduled for the first week of January next year.

Amendment to the Organ Transplant Act

The government amended and gazetted the Organ Transplant Act last month to raise kidney transplant rates, expanding the definition of close relatives and allowing emotional donors – a move experts say could increase donor availability. However, kidney transplants at government facilities remain limited.

Dr Md Abdus Shukur, registrar at the National Institute of Kidney Disease & Urology (NIKDU), said transplant numbers have improved from earlier levels. "Previously, we conducted only one transplant a month. Since August this year, we have been performing one transplant per week, with two transplants carried out in one week. We are now working toward a target of two kidney transplants per week," he said, adding that donor scarcity remains the biggest obstacle.