Our healthcare system needs urgent reforms

Despite some successes in Bangladesh’s healthcare sector, millions of people, particularly the poor, marginalized communities, and lower income families, continue to face serious barriers in obtaining affordable, safe, and quality healthcare. Ensuring good governance, accountability, transparency, and equitable access to healthcare has become one of the country's most urgent development priorities.

One of the greatest challenges facing Bangladesh's healthcare sector is weak governance accompanied by corruption and inadequate oversight. Reports of informal payments, irregular procurement, unnecessary diagnostic tests, excessive prescription of medicines, absenteeism of healthcare professionals, and weak regulatory enforcement continue to undermine public confidence. These practices increase healthcare costs, reduce access to quality services, and disproportionately affect poor households that can least afford additional financial burdens. Public trust cannot be restored without strong accountability mechanisms and effective monitoring throughout the healthcare system.

According to the World Health Organization and the World Bank, Bangladesh spends only about 2.3 percent of its Gross Domestic Product on healthcare, considerably lower than many countries with similar levels of development. Even more concerning, nearly 70 percent of total health expenditure comes directly from patients through out of pocket payments, one of the highest rates in South Asia. Families frequently pay for consultations, medicines, laboratory tests, surgeries, and hospital admissions from their own savings. A single serious illness often forces vulnerable families into debt, asset sales, or long term poverty.

Public healthcare facilities remain under considerable pressure. Government hospitals are overcrowded and frequently suffer from shortages of doctors, nurses, medicines, diagnostic equipment, beds, and other essential resources. Rural communities continue to experience shortages of qualified healthcare professionals, while urban hospitals struggle with overwhelming patient numbers. Although the private healthcare sector has expanded rapidly, significant variations remain in service quality, pricing, ethical standards, and accountability. Many patients continue to report excessive medical bills, unnecessary investigations, and limited transparency regarding treatment costs.

Bangladesh therefore needs comprehensive healthcare reforms that strengthen governance at every level. Every hospital, clinic, diagnostic centre, pharmacy, and healthcare institution should operate under clearly defined standards for patient safety, quality of care, pricing transparency, professional ethics, and financial accountability. Regular inspections, independent performance audits, digital monitoring systems, accreditation mechanisms, and meaningful penalties for malpractice should become standard practice. Patients should also have accessible complaint and grievance mechanisms that enable them to report negligence, corruption, unethical behaviour, and poor quality services without fear.

Increasing public investment in healthcare is equally important. Healthcare should be viewed as a long term investment in national development rather than merely a public expenditure. A healthier population contributes to higher productivity, stronger educational outcomes, increased economic growth, and greater national resilience. Bangladesh should gradually increase its healthcare budget while prioritizing primary healthcare, disease prevention, maternal health, child nutrition, emergency services, mental healthcare, and the availability of essential medicines. Investment should not be limited to constructing new buildings but should also strengthen laboratories, medical equipment, supply chains, healthcare management, and human resources.

According to the World Health Organization and the World Bank, Bangladesh spends only about 2.3 percent of its Gross Domestic Product on healthcare, considerably lower than many countries with similar levels of development.

Affordable medicines remain another major concern. Although Bangladesh possesses a well developed pharmaceutical industry that produces many high quality generic medicines, many poor families still struggle to purchase essential drugs for chronic illnesses. The government should strengthen price regulation, expand subsidies for essential medicines, and establish a comprehensive national essential medicines programme targeting low-income households, older persons, pregnant women, children, and patients suffering from diabetes, hypertension, asthma, cardiovascular diseases, and other long-term illnesses. Such measures would substantially reduce catastrophic healthcare expenditure among vulnerable populations.

Bangladesh also faces a shortage of skilled healthcare professionals. The country continues to have relatively low doctor, nurse, and midwife ratios compared with international recommendations. Greater investment is required in medical colleges, nursing institutes, midwifery schools, public health education, and technical training institutions. Continuous professional development should become mandatory for doctors, nurses, pharmacists, laboratory technologists, and community healthcare workers. Better remuneration, improved working conditions, career development opportunities, and incentives for serving rural communities would help retain qualified professionals within the country.

Digital transformation also offers important opportunities to improve governance and reduce corruption. Electronic health records, online appointment systems, digital procurement, telemedicine services, electronic licensing, and integrated health information systems can improve efficiency, transparency, and accountability. Digital platforms enable authorities to monitor medicine distribution, track hospital performance, detect financial irregularities, and improve planning and resource allocation. Expanding digital healthcare services can also improve access for remote and underserved communities.

Bangladesh should undertake a comprehensive review of its healthcare system to ensure that every citizen receives affordable, safe, and quality healthcare regardless of income, gender, age, disability, or place of residence. Universal access to healthcare should become a national commitment supported by effective governance, adequate financing, professional integrity, and transparent institutions.

Healthcare reform is not simply a policy option but a strategic investment in the nation's future. A healthier population strengthens families, enhances productivity, reduces poverty, and supports sustainable economic growth. By eliminating corruption, improving governance, increasing public investment, strengthening primary healthcare, ensuring affordable medicines, expanding healthcare workforce capacity, embracing digital innovation, and protecting poor and marginalized communities, Bangladesh can build a healthcare system that truly serves every citizen with dignity, fairness, and accountability.