Why Bangladesh must strengthen digital public infrastructure to achieve universal health coverage

Bangladesh has made notable progress in the health sector over the past decade. Immunisation rates have improved, while maternal and infant mortality have declined.

Yet beneath these achievements lies a more complex reality. The Covid-19 pandemic exposed significant fragilities within the health system, highlighting longstanding challenges – including limited capacity to deliver quality services, shortages of qualified health professionals and medical equipment, and weak governance and planning.

One of the most pressing concerns is the high level of out-of-pocket expenditure. According to the World Bank, out-of-pocket spending in Bangladesh reached around 79.31% in 2023 – significantly higher than the South Asian average of 46.65% and the average for least developed countries at 50.30%. Such high costs often push families into poverty and restrict access to essential healthcare.

At the same time, public spending on health remains critically low. In FY26, only 5.30% of the national budget was allocated to the health sector, equivalent to just 0.67% of GDP. This level of investment is insufficient given the scale of existing needs and structural challenges.

Against this backdrop, the newly elected government has pledged a series of initiatives to achieve universal health coverage (UHC). These include increasing health sector allocation to at least 5% of GDP, recruiting an additional 100,000 health workers, expanding primary healthcare in metropolitan and district towns, and strengthening governance and accountability.

The government has also committed to introducing an electronic health card to improve service delivery. In this context, digital public infrastructure in health (DPI-H) will be critical. While these commitments are promising, their success will depend on how effectively digital technologies are used to build a system that is affordable, equitable and people-centred.

Countries with strong digital public infrastructure have demonstrated greater resilience during external shocks, including crises such as the Covid-19 pandemic.

The pandemic also created an opportunity for Bangladesh to accelerate its digital health transformation. The country already has several foundational components of DPI that can support UHC expansion. These include the National Identity system, the Digital Health Information System (DHIS2), Surokkha, MyGov, mobile financial services such as bKash and Nagad, and the national payment gateway EkPay.

The Digital Health Strategy 2023–2027 further outlines a roadmap for digital patient records, improved data flow and more efficient service delivery.

Connectivity has improved significantly in recent years, creating favourable conditions for digital health expansion. Internet penetration has increased from just 0.07% in 2000 to 44.5% in 2023, while mobile subscriptions exceeded 114%. The widespread availability of digital national identity cards has also made data collection and service integration easier.

Despite this progress, Bangladesh's digital public infrastructure in health faces several challenges. These include rural–urban digital divides, low levels of digital literacy, unreliable telecommunications and limited trust in digital systems.

In rural areas, unreliable internet connectivity and frequent power disruptions constrain the expansion of digital health services. Many people remain sceptical of remote healthcare providers, while concerns about data privacy and security persist.

Low digital literacy among both patients and healthcare providers further limits the effective use of e-health and m-health solutions, despite high mobile phone penetration. At the same time, the absence of unified, standardised and interoperable systems makes data sharing across institutions difficult, resulting in fragmented information flows.

There is also a shortage of trained personnel to manage digital health systems, particularly electronic health records (EHRs). Weak regulatory frameworks, insufficient policy support and poor inter-ministerial coordination further slow the integration of digital health technologies.

Addressing these challenges will require a comprehensive policy response.

First, the government must increase budget allocations for health and strengthen oversight to improve service quality. Introducing a national health insurance system is essential to reduce out-of-pocket expenditure. Regulatory frameworks should also be strengthened to ensure fair pricing and better oversight of private healthcare providers.

Second, greater emphasis must be placed on human capital. Bangladesh's demographic dividend presents an opportunity to harness its large youth population for digital health transformation. Training programmes, internships and innovation platforms can equip young people with the skills needed to support digital health systems.

As early adopters of technology, young people can play an important role in strengthening data systems, raising community awareness and improving service delivery through feedback and innovation.

Third, Bangladesh can benefit from stronger South–South cooperation. Countries such as India have successfully integrated digital identity, payment systems and health services within their UHC frameworks. India's digital public infrastructure, anchored by the Aadhaar system, supports initiatives such as the Ayushman Bharat Digital Mission.

Engaging in knowledge exchange, joint research and interoperability initiatives can help Bangladesh adapt and scale similar models.

Fourth, civil society organisations (CSOs) have a critical role to play. By generating evidence, analysing policy gaps and facilitating dialogue among stakeholders, they can support the development of a coordinated national strategy. Strengthening collaboration between government agencies, development partners and technical experts will be essential.

Finally, the private sector and digital health startups can drive innovation in areas such as telemedicine, data analytics and digital service delivery. Public–private partnerships can accelerate progress while ensuring affordability and accessibility.

Lessons can also be drawn from international systems such as NHS England, where integrated digital platforms, interconnected data systems and user-facing applications have improved efficiency, coordination and quality of care.

Bangladesh now stands at a critical juncture where UHC and digital public infrastructure must advance together. Achieving universal healthcare requires systems that are efficient, inclusive and financially protective.

Digital public infrastructure offers powerful tools to support these goals. However, success will ultimately depend on governance, sustained investment and meaningful participation from citizens.

With strategic planning and stronger collaboration across sectors, Bangladesh can build a resilient and inclusive health system capable of delivering universal health coverage for all.

Foqoruddin Al Kabir is a senior research associate at the Centre for Policy Dialogue (CPD). He can be reached at kabir@cpd.org.bd. Ayesha Suhaima Rab is a programme associate at the Centre for Policy Dialogue (CPD). She can be reached at ayesha@cpd.org.bd.

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.