Why Bangladesh’s healthcare system must earn back public trust

The healthcare sector in Bangladesh stands at a critical crossroads. While the nation has seen significant economic progress, the healthcare system continues to grapple with systemic inefficiencies, ineffective and inefficient public funding, a poor infrastructure for capacity building and a profound crisis of confidence among its citizens. The path to a resilient healthcare system requires a multi-faceted approach addressing everything from budget allocation to the digital transformation of patient care.

A paradox of growth and inadequacy 

Statistically, the healthcare system in Bangladesh presents a stark reality. The country currently has the lowest government health spending in South Asia, with a per capita public expenditure of only Tk1,070 . In the revised budget for 2024-25, the Health Services Division received only 2.84% of the total budget, a decline from previous years . This lack of investment is reflected in global rankings, where Bangladesh sits at 95th worldwide on the Global Health Security Index.

Access to care remains a significant hurdle, as 49% of the population does not receive quality healthcare services. The infrastructure is similarly strained, providing only 0.88 beds per 1,000 people, which is far below the World Health Organization (WHO) benchmark of three beds. 

The financial burden on citizens is heavy; out-of-pocket expenditure (OOPE) rose to 73% in 2021, meaning the vast majority of medical costs are borne directly by patients.

Despite these challenges, the healthcare market is expanding rapidly. The sector is currently valued at approximately $14 billion (2025 estimate) and is growing at a Compound Annual Growth Rate (CAGR) of 10.3%. Projections suggest the market could nearly double to $23 billion by 2030–2033. 

This growth is fueled by a rising middle class, rapid urbanization, and a shift in disease patterns toward non-communicable diseases (NCDs) like diabetes and cancer, which require long-term, specialized care.

Systemic barriers and the urban-rural divide

One of the most pressing issues identified is the extreme disparity in service distribution. Healthcare in Bangladesh is heavily centralized; 75% of doctors are located in Dhaka, even though 70% of the population resides in rural areas. Specialized care is similarly concentrated, with 19 of the country's 36 specialized hospitals located within the Dhaka Division. 

This leaves rural and regional facilities with significant gaps in tertiary care, equipment, and trained personnel.Beyond geography, the system faces a shortage of skilled health professionals. The WHO benchmark suggests a need for 17 doctors and 70 nurses per 10,000 people; however, Bangladesh currently has only 6.73 doctors and fewer than 6 nurses per 10,000 people. 

The laws and authorities that govern the establishment and operation of educational institutions for the training of such professionals are often severely outdated, and provide no incentivising framework for private investors to divert funds to this sector. Overall, this contributes to a workforce shortage, and, combined with outdated equipment and infection-prone environments,  this has created a significant "quality and trust deficit".

The $5 billion drain: The flight for medical tourism

Perhaps the most visible symptom of this trust deficit is the massive exodus of patients seeking treatment abroad. It is estimated that Bangladeshis account for nearly 52% of India's medical tourists, amounting to approximately 482,000 visas annually . Other top destinations include Thailand, Singapore, and Malaysia . This trend results in a staggering annual economic drain of $5 billion in capital flight.

The "push" factors driving this exodus are not always related to a lack of local medical expertise. Instead, patients cite diagnostic doubt, "bill shock" from hidden charges, and concerns over counterfeit drugs as primary reasons for leaving. Overseas hospitals in regions like Kolkata are perceived to offer better value through cleaner facilities, transparent billing, and more attentive nursing care. For many families, the perceived efficiency of an accurate foreign diagnosis outweighs the risk of "trial-and-error" visits at home. 

This presents serious challenges that need to be addressed through proper marketing communication, and a government communicating strongly that it is pro-health, coordinating with the private sector to do so most effectively. 

Benchmarking against regional peers

When compared to its neighbors and advanced Asian systems, the gaps in Bangladesh's healthcare system become even more apparent. For instance, while Bangladesh's OOPE is at 74%, Japan maintains a rate of only 11–13% through a Social Health Insurance model where the government sets prices. 

Singapore utilises a mandatory savings system (the "3M" system) to prevent catastrophic financial loss, keeping its OOPE at 30%. Even regional peers like Sri Lanka and India outperform Bangladesh in terms of per capita health spending and the Universal Health Coverage (UHC) Index.

The way forward: Strategic reforms

To reverse these trends and strengthen public confidence, the sources outline a comprehensive "Way Forward" involving financial, regulatory, and technological reforms:

Financial and regulatory reforms: There is an urgent need to progressively increase the health budget to 5% of GDP. The government should also establish an independent Accreditation Board to monitor medical service quality and introduce standardized pricing frameworks to ensure transparency and fairness.

Infrastructure and digital transformation: The presentation advocates for the National Digital Health Architecture, which includes unique patient IDs, e-prescriptions, and a shared health record (SHR) system . Upgrading community clinics with modern diagnostic facilities and fostering public-private partnerships (PPP) to expand infrastructure outside of Dhaka are also vital .

Human resource development: To address the personnel shortage, the sources suggest incentivizing recruitment in remote areas through hardship allowances, tax incentives and better housing . Furthermore, the system could benefit from hiring foreign medical staff to train local professionals and streamlining the licensing process for international experts to work in domestic hospitals.

The revitalisation of healthcare in Bangladesh is not merely a matter of building more hospitals; it is about restoring the bond of trust between the patient and the provider. By addressing the high out-of-pocket costs, digitalizing patient data, and decentralizing specialized care, the nation can transform its healthcare sector from a source of capital flight into a pillar of national stability and pride.

In essence, a healthcare system is like a bridge: it requires strong financial pillars and a deck of technological innovation, but without the suspension cables of public trust and regulatory oversight, it cannot safely carry the wei ght of a nation's health.

Malik Talha Ismail Bari is the Managing Director of United Hospital Ltd.