The government alone cannot fix Bangladesh’s healthcare system
A partnership between the state and the citizens is needed to ensure that healthcare is accessible, affordable, and of high quality
The healthcare system in Bangladesh, much like in many developing nations, is confronted with significant challenges that hinder its ability to provide equitable and quality healthcare services to its population.
These challenges are multifaceted, ranging from inadequate infrastructure and insufficient funding to inefficiencies in service delivery and a shortage of trained medical professionals.
Despite various attempts at reform, these issues continue to affect the accessibility and quality of healthcare, particularly for marginalised and rural populations who remain underserved. However, genuine and lasting reform in the healthcare sector cannot be achieved by the state alone, no matter how well-intentioned its efforts may be.
While the government plays a pivotal role in shaping healthcare policy, providing funding, and ensuring that medical facilities are established and equipped, it is not enough for the state to shoulder this responsibility alone. The complexities of improving healthcare in a country like Bangladesh require a more holistic approach, where both the state and the citizens actively participate in the process of reform.
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The state has a responsibility to ensure that healthcare is accessible, affordable, and of high quality, but citizens too have a fundamental responsibility towards the healthcare system. These responsibilities are not only limited to following medical guidelines or paying taxes that fund healthcare services, but also encompass how citizens engage with and navigate the system.
For instance, the state is responsible for creating laws, providing resources, and establishing infrastructure. This includes providing healthcare coverage, ensuring health workers are trained and distributed equitably, and ensuring that essential services are available to all citizens.
However, these efforts are often undermined by a range of factors that stem from the citizens' behaviours, such as a tendency to bypass regulations, a lack of trust in the system, or a culture of using personal influence to gain preferential treatment. These behaviours not only distort the fairness of the system but also contribute to inefficiencies that make it harder for marginalised populations to access the care they need.
In this context, it is essential to recognise that the success of any healthcare reform efforts depends on a partnership between the state and its citizens. This partnership requires that citizens take ownership of their role in supporting the system. They must engage responsibly with healthcare services, adhere to established protocols, and contribute to creating a respectful and efficient environment.
When citizens actively participate, either by following rules, holding service providers accountable, or making informed health choices, they help to strengthen the healthcare system, making it more accessible, inclusive, and equitable for all.
The need for this two-way dynamic is clear: while the government must continue to create and implement policies that promote transparency, fairness, and quality in healthcare services, citizens must also take responsibility for their behaviour, showing respect for the system and for fellow citizens. This collaborative approach is crucial for bringing about systemic change, ensuring that healthcare services are not only more widely available but also more effectively utilised.
Both the state and the citizens must be seen as active participants in the process of reform, with each fulfilling its respective roles to create a more efficient, equitable, and sustainable healthcare system.
True reform in Bangladesh's healthcare system cannot be achieved through the efforts of the state alone. It requires a shared commitment, where both the government and its citizens work together to build a system that is fair, transparent, and truly centred on the needs of the people.
Only through such a partnership can Bangladesh hope to overcome the current challenges and create a healthcare system that serves all its citizens equitably, regardless of their socio-economic background or geographical location.
The government of Bangladesh has taken significant steps to reform its healthcare system, with improvements in infrastructure, the establishment of health centres, and the expansion of healthcare access to rural areas.
However, the pace of reform has been slow, and many challenges remain. The state's role in ensuring healthcare for all is undeniably crucial—through providing funding, formulating policies, and ensuring the availability of essential medicines and services. But for these reforms to have a lasting impact, they must go beyond just government intervention.
One critical challenge that persists in Bangladesh is the weak enforcement of regulations. While health facilities are intended to provide standardised services, in practice, there are significant gaps in quality, accessibility, and availability, particularly in rural or underserved areas. Corruption, resource mismanagement, and inadequate monitoring mechanisms have hindered progress.
To address these issues, the government needs to focus on institutional transparency, accountability, and a comprehensive overhaul of health policies that consider the needs of marginalised populations. Only then can a truly equitable healthcare system emerge.
While the state must invest in structural reform, citizens also have a critical role to play. In Bangladesh, a common cultural tendency to bypass rules and assert personal power often complicates the efficient delivery of healthcare services.
This culture, where personal influence is sometimes used to gain preferential treatment, can often obstruct the pathway to equitable service delivery. Though this may provide short-term advantages to individuals, it undermines the system and creates inequities, especially for the marginalised.
Moreover, this behaviour also exacerbates the systemic issues in healthcare. Power dynamics between service providers and recipients often lead to discriminatory practices, with patients from lower socioeconomic backgrounds or rural areas facing obstacles in accessing essential services. The lack of mutual respect and understanding between providers and recipients further exacerbates this divide.
For the healthcare system to function effectively, both healthcare providers and recipients must adopt a more responsible and respectful approach. Citizens must recognise that their actions directly affect the quality of services they receive and that a cooperative, responsible attitude is crucial for smooth healthcare delivery. A shift towards a more accountable and respectful approach will help foster a cordial relationship between citizens and healthcare providers, ensuring better service delivery for all.
The state's role in instituting reforms must be accompanied by a focus on institutional transparency. Transparent processes within healthcare institutions ensure that resources are used efficiently, services are delivered fairly, and corruption is minimised. Institutional transparency also builds trust between the government, healthcare providers, and citizens, which is essential for the long-term sustainability of healthcare systems.
A transparent healthcare system makes it easier for citizens to hold providers accountable and demand quality services. It also promotes better management of resources, ensuring that underserved communities, particularly in rural and hard-to-reach areas, receive the care they deserve.
Efforts should be made to establish clear guidelines, accessible complaint systems, and performance evaluations that ensure healthcare institutions are meeting the standards set by the government.
Ultimately, for Bangladesh's healthcare system to achieve its full potential, there needs to be a collaborative approach between the state, healthcare providers, and citizens. The government must continue to strengthen regulations, promote transparency, and address systemic issues such as corruption and resource mismanagement.
However, citizens must also take responsibility for their actions and contribute to creating a respectful and accountable healthcare environment. Only through mutual effort and shared responsibility can Bangladesh hope to build a healthcare system that truly serves all its people equitably.
The healthcare system must evolve from a transactional one, where service providers merely deliver care, to a more holistic, people-centred approach where both recipients and providers work collaboratively towards the common goal of better health outcomes.
By fostering a culture of responsibility, respect, and transparency, Bangladesh can pave the way for a healthcare system that is not only efficient and sustainable but also equitable and inclusive for all its citizens.
Sumit Banik is a public health activist and trainer.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.
