Healthcare and education: What Brazil got right and why Bangladesh keeps falling short

There is a quiet but revealing way to measure how much a government values its people: look at what it spends on health and education.

By that measure, Brazil and Bangladesh tell two very different stories. One country has built institutions, invested boldly, and proved that bold public policy can reshape a nation's trajectory. The other has spent decades doing just enough to claim progress, while leaving its people to fend for themselves.

The contrast is not simply about money. It is about will, vision, and the political courage to treat human beings as the primary asset of a nation.

Brazil's universal bet

Brazil's transformation began not with a single policy, but with a constitutional commitment. The 1988 Brazilian constitution declared healthcare a universal right of every citizen and a duty of the state. 

From that foundation grew the Sistema Único de Saúde — the SUS, or Unified Health System. Since the end of the 1980s, Brazil has provided its citizens with a universal healthcare scheme known as the SUS, financed by the federal government along with local municipalities, designed to strip away bureaucratic and budgetary barriers to care. 

This was not a pilot programme or a safety net for the very poor. It was a declaration that healthcare was for everyone.

The scale of SUS services ranges from primary care and vaccinations to highly complex procedures, including organ transplants. It covers approximately 90% of healthcare interventions across the country, according to a study published in the Frontiers in Public Health journal.

The study mentions the National Immunization Program, established in the 1970s, as one of the most recognised and widely known initiatives under SUS. Under this scheme, coupled with broader public health initiatives, infant mortality (for children under five) declined from 212 deaths per thousand live births in 1940 to just 14 per thousand in 2019. That is a reduction of over 93% across eight decades of sustained public investment.

Brazil also put real money behind the rhetoric. The Brazilian government spent 161.22 billion Brazilian reals on health in 2023 alone, according to Statista, citing data from Brazil's official federal spending database. It was estimated to be about 10% of the country's GDP, making it one of the highest health spenders in Latin America relative to its economy.

Even when political winds shifted — as they did under Jair Bolsonaro's administration, when a constitutional spending cap froze social investments — the institutional foundations of SUS held, and the Lula government has since moved to restore those resources.

In education, Brazil's approach was similarly structural. Rather than leaving school funding to the whims of wealthier municipalities, the government built redistribution into the financing system itself. 

The FUNDEB mechanism, first introduced in 1996 and made permanent by constitutional amendment in 2020, ensures that every child receives a minimum level of per-student spending regardless of where they were born. 

As per 2020, FUNDEB benefits over 38 million students enrolled in public schools at all levels and is specifically designed to broaden access in rural areas, underserved regions, and among indigenous populations. 

In 2020, the federal government increased its contribution to FUNDEB from 10% to 23%, and resources are now transferred directly to the poorest municipalities instead of to states, making educational investments more equitable.

Brazil also tackled the demand side of education with equal ambition. The Bolsa Família programme, launched under President Lula in 2003 by consolidating four separate welfare schemes, became one of the most studied and imitated social policies in the world. 

Bolsa Família reached almost a quarter of the Brazilian population and became the most progressive cash transfer made by the state, producing significant impacts in poverty and inequality reduction and the improvement of educational and health indicators. The programme made cash conditional on school attendance and vaccination, linking economic relief to behavioural outcomes. The poverty reduction attributed to it fell 27% during Lula's first administration, and about 12 million Brazilian families were receiving funds from the programme.

The results at the state level show what is possible when ambition meets execution. In the state of Ceará, a results-based financing model tied to educational outcomes allowed the state to improve learning quality faster than any other part of Brazil within just over a decade. 

Today, Ceará has the lowest rates of learning poverty in Brazil, and its students perform well above what would be expected given the socioeconomic context in which they live. The Ceará model has since been cited by the World Bank as a replicable blueprint for the rest of Latin America.

However, Brazil is not without its contradictions. Inequalities between wealthy and poorer states persist. The Bolsonaro years saw the gutting of social budgets, and the Amendment to the Constitution EC 95 froze social investments for 20 years, leaving SUS severely underfunded during that period. Quality gaps between private and public schools remain wide. 

But what distinguishes Brazil is that despite these setbacks, the architecture remains standing. The institutions, the constitutional commitments, and the redistribution mechanisms survive political change — and that is the hallmark of a system built to last.

Bangladesh: Spending least when it matters most

Bangladesh's gains in child mortality, female education, and garment-led economic growth have made it a favourite case study in development literature. But beneath those headline numbers lie a quiet crisis in public investment — one that is becoming harder to ignore.

The numbers are bleak. In 2023, government expenditure on education was only 1.64% of GDP, whereas most upper-middle-income countries spend around 5 to 6% of their GDP on education. 

The Eighth Five-Year Plan had set a target to increase education spending to 3.5% of GDP by FY2025. The actual figure stands at just 1.69% of GDP. This places Bangladesh among the very lowest education spenders, not just in South Asia but globally. Its average education expenditure as a share of GDP from 2016 to 2023 was the third lowest among 38 Least Developed Countries.

Budget allocation for health has been less than 1% of GDP for the past two decades, indicating that healthcare has been one of the least prioritised sectors by the government. 

A World Bank report found Bangladesh at the bottom of the global list, with only 1.19% of total government spending going to healthcare. South Asian countries on average spent 4.59%, while least-developed countries spent an average of 5.55%. By this measure, Bangladesh spends less on the health of its people than almost every comparable nation on earth.

The consequences fall hardest on the poor. In 2021, out-of-pocket expenditure accounted for 73% of total healthcare costs in Bangladesh — far higher than in India, Bhutan, Nepal, or Sri Lanka. 

The problem is not only how little is allocated, but how poorly the allocation is spent. 

As of December 2023, Bangladesh had just 0.83 doctors per 1,000 people — far below the WHO-recommended threshold of 1 per 1,000, let alone the standards of a country aspiring to middle-income status.

What Bangladesh lacks is not the knowledge of what to do. Every five-year plan, every budget analysis, every expert recommendation says the same thing: spend more and spend better. What it lacks is the political will to make human development the actual priority of the state — not just the rhetorical one.

Brazil's SUS and FUNDEB did not emerge from a perfect country. They emerged from a country that decided, after years of inequality and exclusion, that such systems were worth building. Bangladesh still seems to be in the process of setting its priorities.