Bangladesh’s healthcare at crossroads: Progress stalled by policy failures
Bangladesh’s healthcare sector is growing fast, but weak regulation, lack of coordination and financial barriers are undermining access and equity
Despite having remarkable economic strides, Bangladesh's healthcare sector remains locked in a cycle of underperformance, regulatory gaps and systemic inefficiencies.
Projections suggest that the healthcare sector could grow into a $23 billion market by 2030, up from $14 billion in January 2025; experts warn that without fundamental reforms, such potential may remain largely unrealised.
At first glance, the country seems to have a solid healthcare infrastructure. Bangladesh has over 645 public hospitals and a staggering 19,627 licensed private hospitals and clinics. The number of private diagnostic centres stands at 35,597.
Yet, a closer look reveals a troubling picture: out of all these private facilities, only 914 hospitals and 1,790 diagnostic centres renewed their licences by April 2025 — just 4.66% and 5%, respectively.
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There is a growing commercialisation of healthcare. Private providers are increasingly profit-driven, which is worsening disparities.
This indicates not only a lack of regulatory compliance but also the widespread operation of facilities that are likely outdated, unmonitored and potentially unsafe.
Much of Bangladesh's healthcare burden has shifted to the private sector, which now provides over 60% of urban services.
Dr Md Enamul Haque, Director General of the Health Economics Unit, points out that there is still no structured public-private partnership (PPP) model to ensure equitable and coordinated service delivery.
"Allocations for the health sector remain low, but even those are poorly utilised," he noted, adding that financial mismanagement continues to hamper progress.
The pharmaceutical industry, however, offers a contrasting narrative. Valued at over $3.5 billion in 2023, it meets 97% of domestic demand and exports to more than 100 countries, making Bangladesh a standout among the least developed countries.
Yet, this success does not mask the broader deficiencies in healthcare delivery, especially in urban settings.
Professor Rumana Huque, Executive Director of the ARK Foundation, highlighted the deep structural issues afflicting urban health governance. "Urban healthcare lacks clear mandates and suffers from fragmented responsibilities," she said.
Citing the 2022 STEP survey, she added that 21.5% of urban dwellers were diagnosed with diabetes, while 25.8% were hypertensive — figures that point to a worsening crisis in non-communicable diseases (NCDs). Urban environments exacerbate these problems through sedentary lifestyles, processed food consumption, and limited access to preventative care.
Out-of-pocket (OOP) expenditure remains alarmingly high at 68.5% (as of 2020), placing an unbearable financial burden on ordinary citizens.
"The cost of NCD care is a major driver of this burden," Professor Rumana said, indicating the chronic underfunding of primary healthcare and the over-reliance on external donors for key initiatives like the Urban Primary Health Care Services Delivery (UPHCSD) project.
Weak governance has further stalled progress. Dr Abu Hussain Md Moinul Ahsan, Director of Hospitals at the Directorate General of Health Services (DGHS), described urban health governance as suffering from "excessive coordination without clear direction".
He warned that multiple stakeholders, government bodies, NGOs, and private providers often work in silos, leading to duplication, inefficiency, and growing inequities.
This lack of coordination also affects data. Dr Shah Ali Akbar Ashrafi, Line Director of Health Information Systems (HIS), lamented the absence of an integrated urban HIS platform.
"We do not get patient data from private hospitals, and many urban programmes operate outside the purview of DGHS," he explained. This fragmented approach makes evidence-based planning and monitoring nearly impossible.
The absence of a structured referral system is another critical failure. As Dr Kamrul Islam, Director of Primary Health Care, noted, "Urban patients bypass primary care centres, flooding tertiary hospitals that are already overstretched."
At the same time, rural areas follow a tiered model of care; the lack of such a system in urban settings results in both underutilisation and overburden.
Moreover, healthcare access remains deeply inequitable. Wealthier populations can afford private care, while the urban poor rely on underfunded and poorly maintained facilities.
"There is a growing commercialisation of healthcare. Private providers are increasingly profit-driven, which is worsening disparities," Dr Ahsan said.
Government efforts to improve urban healthcare have also been hamstrung by contracting inefficiencies. Contracts tend to focus on inputs rather than outcomes, leading to poor quality monitoring.
As Professor Rumana observed, post-ADB programme capacity-building for Local Government Institutions (LGIs) has stalled due to a lack of funding and trained personnel.
What is perhaps most worrying is the absence of urgency in public discourse. Dr Rashid Zaman, Health Advisor at the British High Commission in Dhaka, said, "There is a lack of outcry because people do not recognise healthcare as a right. Reforming urban health is not just about policy shifts; it is about changing the public mindset."
Despite the daunting challenges, the pathway to reform is not unclear. Experts have consistently highlighted several priority areas: clearer governance structures, integrated health data systems, improved funding and financial planning, formalised PPPs, and a well-organised referral system.
Additionally, expanding the urban primary healthcare network, particularly through ward-level PHC centres, could significantly improve access and reduce pressure on tertiary care.
Importantly, these reforms must be underpinned by stronger political will and leadership. As the healthcare market grows — potentially hitting $23 billion in just five years — the urgency to ensure this growth is inclusive, accountable, and equitable becomes all the more pressing.
