Private sector missing link to achieving UHC in Bangladesh, say experts

 The role of the private sector in Bangladesh's pluralistic healthcare landscape is critical in attaining Universal Health Coverage (UHC) for the country, experts said at a health debate held today (6 February) at the Cirdap auditorium in the capital.

The event was organised by Power and Participation Research Centre (PPRC) and supported by Unicef as part of the UHC Forum's flagship multi-stakeholder debate series. 

Chaired and moderated by PPRC Chairman and UHC Forum Convener Hossain Zillur Rahman, the discussion brought together key stakeholders from government, private hospitals, NGOs and research institutions.

At the debate, the experts said while primary healthcare remains a government responsibility, private hospitals largely avoid providing primary care due to its lack of profitability. 

They came to a consensus that to achieve UHC, the government must find ways to engage the private sector in primary healthcare services.

Talking about private healthcare, the experts opined that the term is often a misnomer because non-government providers can include for-profit entities, entities with a social business model, NGO providers and also informal workers.

They also identified a key gap in the private healthcare sector in Bangladesh – the need for accreditation of hospitals, doctors and labs to ensure quality, data sharing, monitoring and pursuit of suitable public-private partnerships to advance the UHC agenda.

Regarding healthy regulation and engagement of the private sector, discussants raised the need for an overarching law and an umbrella body in the form of a health commission or a health security office. 

The participants also agreed that people's demand for healthcare was no longer limited to access only but also extended to affordability and quality.  

They further raised concerns about the excessive financial burden on citizens due to out-of-pocket healthcare expenses. They stressed the need to analyse how much of these expenses are necessary for healthcare and how much stem from unethical commercial motives.

They also pointed out a contradiction between high service expectations and low healthcare funding.

The private healthcare sector also lacks robust self-governance to improve quality of services and the standards of medical education, they added.

To enhance private-public partnerships, participants discussed models where public hospitals collaborate with private providers for service delivery and equipment procurement. 

They called for a universal regulatory body to standardise pricing, enforce quality accreditation and establish a grievance mechanism for patients. 

The discussion also stressed the need for innovative digital healthcare solutions, emphasising that healthcare is fundamentally about management, while leveraging data is essential for accountability, efficiency and service expansion.

In the concluding address, UHC Forum Convener Zillur Rahman stressed the importance of looking for areas of healthy and sound collaboration between the public and private sectors instead of getting stuck in a blame-game mindset. 

He said the question of how to incentivise private sector participation in primary health care should also be a priority as well as a measure toward promoting health. 

For the new aspirations unleashed by the popular uprising of July-August 2024, all stakeholders have to make concerted and collaborative efforts to elevate health into a compelling national agenda with sound actionable plans and policy approaches, he added.

Zillur Rahman also said the discussion's highlights will be shared with the Health Reform Commission. 

Participants in the debate included Prof Liaquat Ali of Health Reform Commission; Dr AM Shamim, doctor of medicine, Labaid; Dr Lutfor Rahman, chief medical planner, Grameen Telecom Trust; Prof Dr Emran Bin Yunus, neurologist and director, Centre for Specialized Care and Research (CSCR), Chittagong; Dr Md Moinul Ahsan, director (hospital), DGHS; Prof Dr Abul Kalam Azad, former DG-Health; Dr Md Aminul Hasan, UHC Forum; Dr Shaila Purvin, CEO, Surjer Hashi Network; Md Zainal Abedin Tito, line director (HSM), DGHS; Dr Manzur Kadir Ahmed, senior director, Gonoshasthaya Kendra; Shadab Mahmud, Sensiv Diagnostics Lab; Prof Khondaker A Mamun, CMED Health; Dr Iqbal Anwar, ICDDR,B; Mohan Raihan, Saaol Heart Centre, Dr Atiya Sharmeen, MSF; Dr Aftabuddin, chairperson, PHF; Nahid Akhter Jahan, IHE, DU; and Maya Vandecent, Unicef.  ***