Due to the high out-of-pocket expenses, the poor struggle to receive even basic services in public hospitals. Photo: Saqlain Rizve

Over the past decades, Bangladesh has made significant progress in improving public health indicators, such as reducing child mortality, controlling infectious diseases, and increasing life expectancy. Yet, these achievements conceal deeper structural weaknesses within the healthcare system, which continues to struggle in providing equitable, quality care for all citizens.

Ranked 88th globally in healthcare quality, the country contends with issues such as a shortage of doctors and nurses, negative attitudes within the healthcare workforce, limited access to advanced medications, and high costs in private hospitals.

These challenges are exacerbated by long travel and waiting times, making public healthcare facilities particularly inaccessible to those in rural and underserved areas. Reforming the healthcare sector to ensure everyone in Bangladesh has access to quality care, regardless of socio-economic status, is not only necessary but a moral obligation.

A critical shortage of healthcare professionals: One of the most urgent challenges facing Bangladesh's healthcare system is the shortage of trained professionals. The World Health Organization (WHO) recommends a doctor-to-patient ratio of 1: 1,000, but Bangladesh falls significantly short, with approximately 1 doctor for every 1,581 people as of 2023. 

This gap is even more pronounced in rural areas, where healthcare workers are scarce, forcing communities to rely on untrained or semi-trained personnel for medical care.

The shortage of nurses is even more severe, with a nurse-to-patient ratio of 1: 5,000, far below the global average. This imbalance not only overburdens the existing workforce but also undermines the quality of care patients receive.

Negative attitudes and professionalism: Negative attitudes and a lack of professionalism among healthcare workers are significant barriers to accessing quality care in Bangladesh. Patients frequently report experiences of rudeness, negligence, and even malpractice, which discourages them from seeking treatment, especially in public hospitals. 

The absence of a strong regulatory framework to enforce professional standards worsens these problems, creating a culture where poor patient care is often tolerated.

Inadequate access to advanced medications: Although the country has a robust pharmaceutical industry producing many essential drugs, access to newer, advanced medications remains limited. 

This is due to high costs, restrictive patent laws, and an inefficient drug approval process that delays the introduction of new therapies. As a result, patients with chronic or life-threatening conditions often cannot access the treatments they need.

Financial barriers and healthcare costs: With over 64% of healthcare spending being out-of-pocket, many families face the difficult choice of forgoing necessary medical care or incurring debt. This financial burden weighs most heavily on rural and low-income populations, who are also hindered by the long distances and waiting times at public healthcare facilities. 

The result is a healthcare system marked by stark disparities, where the affluent access high-quality private care, while the poor struggle to receive even basic services.

Urban vs. rural healthcare disparities: Geographical disparities in healthcare access are a significant issue in Bangladesh. Urban areas, particularly Dhaka and Chittagong, are home to the majority of the country's healthcare facilities, including specialised hospitals and clinics. In contrast, rural areas, where over 60% of the population resides, are severely underserved. 

Pathways to Reform

Addressing these systemic issues requires a comprehensive and multi-faceted approach. Reforms are needed in some critical areas to ensure that all Bangladeshis have access to quality healthcare, regardless of their location or socio-economic status.

Expanding and strengthening the healthcare workforce: A key aspect of healthcare reform in Bangladesh is expanding and strengthening the healthcare workforce. The government must invest in medical and nursing schools to train a larger, more diverse workforce. 

Policies that incentivize healthcare professionals to work in rural areas are essential. Financial incentives, such as higher salaries and housing allowances, alongside opportunities for career advancement through continuous professional development, could address this. 

Also, implementing community health worker programs, modelled after successful initiatives in Ethiopia and India, would help bridge the rural-urban healthcare gap. These workers could offer basic healthcare services, conduct health education campaigns, and refer patients to higher-level facilities, easing the burden on the current workforce.

Enhancing professionalism and patient-centred care: To improve professionalism in healthcare, mandatory training focused on patient-centred care, communication skills, and ethics should be introduced for all healthcare workers. 

Regular assessments and certification processes would ensure adherence to high standards of professionalism. Establishing independent regulatory bodies to monitor and enforce professional conduct is also crucial. Public awareness campaigns should educate patients about their rights, empowering them to demand dignified care.

Improving access to advanced medications: Access to advanced medications remains limited in Bangladesh. So, the government should also encourage local production of advanced medications to reduce dependency on imports. Public-private partnerships, supported by subsidies and tax incentives, could spur investment in research and development. 

Expanding the national drug policy to include a wider range of essential drugs would ensure availability and affordability across healthcare settings. 

Additionally, establishing a national drug price control mechanism would prevent price gouging and guarantee that essential medications are accessible to all.

Addressing financial barriers to healthcare: To reduce financial barriers, Bangladesh should work towards a universal healthcare system, providing basic services free of charge. This system could be funded through a mix of taxation, social health insurance, and donor contributions. 

A phased approach could start by expanding existing social safety net programs to cover healthcare costs for the poorest. Regulating private healthcare fees by setting price caps on consultations and treatments, alongside subsidies for low-income patients, would help make healthcare more affordable. 

Expanding public and private health insurance schemes would further reduce out-of-pocket expenses and protect families from catastrophic costs.

Bridging the urban-rural divide: Building new hospitals and clinics and upgrading existing facilities will expand the range of services available in underserved areas. Improved transportation networks would ease access to these facilities for rural residents. 

Additionally, telemedicine and mobile health clinics could provide essential healthcare services in remote areas. Telemedicine platforms would allow patients to consult with specialists in urban centres, while mobile clinics could deliver diagnostic tools and trained healthcare workers directly to rural communities.

Reforming Bangladesh's healthcare system requires a collective effort from the government, private sector, and civil society. Expanding the healthcare workforce, enhancing professionalism, improving access to medications, reducing financial barriers, and addressing geographical disparities are all essential steps. With the right policies and commitment, Bangladesh has the potential to create an inclusive healthcare system that provides quality care to all its citizens, fostering social equity and national development.

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.