Healthcare in Bangladesh: A journey towards universal access

Health, in fact, is a fundamental human right, and it is the responsibility of the state to ensure this right of all its citizens. However, a critical examination reveals that not all South Asian governments are effectively ensuring this right of every member of their respective populations. South Asian countries share common demographic challenges that significantly impact healthcare. Foremost among these challenges are issues related to the accessibility and affordability of medical services. Additionally, a substantial deficit in the availability of qualified medical practitioners is a prevalent concern. These shared issues are pervasive across many South Asian nations.

Over the past few decades, Bangladesh has undergone significant healthcare reforms and has built extensive healthcare infrastructure encompassing both public and private sectors. While the healthcare system may not match the sophistication of more developed countries, the nation is earnestly committed to enhancing and bolstering its healthcare services through increased funding. Bangladesh has made remarkable strides in expanding healthcare accessibility, yet the journey towards comprehensive healthcare remains an ongoing endeavour. Government-led initiatives have played a pivotal role in advancing this sector. Over the last fifty years, healthcare conditions in Bangladesh have witnessed substantial improvement, resulting in an increase in the average life expectancy from 52 years in the 1970s to the current 72 years. This progress has also been instrumental in reducing infant and maternal mortality rates, facilitating greater access to healthcare and education, and driving positive changes in various social indicators.

Bangladesh, situated in South Asia and characterised by its high population density, has made significant strides in improving its healthcare system over the years. The country's healthcare infrastructure comprises both public and private healthcare facilities. However, it's worth noting that there exists an uneven distribution of doctors and healthcare resources across the nation. Notwithstanding Bangladesh's commendable progress in expanding the accessibility of healthcare services, the standards of these services occasionally fall short of desired levels, leading to adverse effects on health outcomes. A top-notch healthcare system is one that promptly caters to the requirements of patients and the populace, leveraging data-driven, ongoing procedural enhancements to consistently deliver reliable, effective, reliable, and fair healthcare. This approach aims to enhance and sustain health outcomes for all individuals.

Bangladesh receives backing from various international partners to advance its healthcare domain. For instance, with assistance from USAID, there has been a significant reduction in maternal and child mortality, with the average fertility rate plummeting from over six children to two. Notwithstanding noticeable enhancements in nutritional well-being, nearly a third of children still face stunted growth. While half of all births now occur in healthcare facilities, in contrast to 17 per cent a decade ago, maternal mortality rates have plateaued. Although approximately 62 per cent of married couples employ contraceptives for birth control, 12 per cent of married women below 50 express a desire for contraception but lack access to it. Moreover, Bangladesh stands as one of the eight nations responsible for over two-thirds of the global tuberculosis burden, with this treatable disease claiming 115 lives daily across the country.

Bangladesh's healthcare system faces notable challenges, characterized by its lack of dependability, responsiveness, and compassion. Repeated instances have highlighted the system's inadequacy in consistently providing quality healthcare to the public. One of the glaring issues is the concentration of medical facilities in urban regions, creating a stark healthcare divide that disproportionately affects rural areas. This geographical disparity exacerbates the difficulties faced by those living in remote or underserved areas, who often encounter limited access to healthcare services.

This divide underscores the urgent need for more equitable and accessible healthcare infrastructure, especially in rural and less-privileged regions. The healthcare system's shortcomings in terms of reliability, responsiveness, and empathy underscore the imperative for comprehensive reforms that prioritise patient well-being and foster a more inclusive and efficient healthcare ecosystem. Addressing these issues is crucial in ensuring that all citizens, regardless of their geographic location, have equal access to quality healthcare and receive the attention and care they deserve.

The sixth Bangladesh National Health Accounts, released in early 2023, reveals that the majority of Bangladeshis are shouldering more than two-thirds of their healthcare expenses from their own pockets. This represents a concerning trend, as the data from the Bangladesh National Health Accounts spanning 1997 to 2020 indicates a steady increase in out-of-pocket expenditure, rising from 62 per cent in 2012 to a staggering 68.5 per cent in 2020. Despite government assurances to reduce out-of-pocket healthcare costs to 32 per cent by 2032, achieving this goal appears increasingly unlikely, given the current healthcare expenditure landscape.

In recent times, an increasing number of Bangladeshi patients are turning to neighbouring countries such as India, Thailand, Singapore, and Malaysia in pursuit of what they perceive to be "better treatment," which, in turn, has led to a considerable drain on foreign exchange reserves. According to data from India's tourism ministry, the influx of Bangladeshi patients seeking medical care in India has surged by a substantial 83 per cent in the past three years. Several factors contribute to this phenomenon, including unprofessional conduct among healthcare professionals, issues related to misdiagnosis and unnecessary diagnoses, a lack of clear communication regarding health conditions, and the propensity of doctors to recommend unwarranted tests and medications.

This growing trend of medical tourism not only has financial implications but also adversely impacts the local healthcare sector in Bangladesh. The outflow of patients seeking treatment abroad results in a significant loss of foreign currency, putting pressure on the country's foreign exchange reserves. Moreover, this exodus of patients abroad highlights a lack of trust in the domestic healthcare system, which is underscored by the dissatisfaction with local medical services. The consequences of this trend extend to the weakening of the local healthcare sector's reputation, raising questions about the quality and efficiency of medical care provided within Bangladesh. Addressing these issues and improving the local healthcare infrastructure is imperative to retain patients within the country and safeguard the nation's foreign reserves.

The pharmaceutical industry has emerged as a vital pillar in the healthcare sector, with Bangladeshi manufacturers playing a commendable role. They currently satisfy an impressive 98 per cent of the domestic demand for pharmaceutical products. Furthermore, Bangladesh has been progressively establishing itself as a global centre for the production of high-quality, cost-effective generic medications, addressing the needs of countries lacking the requisite facilities for manufacturing such drugs.

Also, Bangladesh has emerged as a significant player in the global pharmaceutical market, with local companies successfully exporting their products to more than 151 countries worldwide. This achievement serves as an exemplary benchmark for many other nations aspiring to enter the international pharmaceutical trade arena. According to data from the Export Promotion Bureau (EPB), pharmaceutical exports from Bangladesh amounted to $175.42 million in the last fiscal year (FY), a slight decrease from the $188.78 million recorded in FY2021-22. This showcases the country's continuous commitment to contributing to the global pharmaceutical landscape.

The nation has set ambitious targets and envisions achieving Universal Health Coverage (UHC) by the year 2030. This goal aims to ensure that every citizen in the country has access to high-quality healthcare services and financial protection. The pursuit of UHC is not only integral to the achievement of the Sustainable Development Goals but also aligns with the government's constitutional obligation to provide healthcare services to all its citizens.

Interestingly, despite recommendations from the World Health Organization (WHO suggesting that there should be 3.5 hospital beds in public healthcare facilities for every 1,000 people, Bangladesh currently falls far short of this standard. It only offers 0.32 hospital beds per 1,000 citizens in government healthcare institutions.

Furthermore, access to modern and advanced healthcare services remains largely concentrated in the capital city and a few major urban centres, presenting a significant challenge in ensuring equitable healthcare access for all. To overcome these disparities, it is imperative to allocate resources and efforts towards the development of a skilled healthcare workforce and enhance their capacity to provide quality care across the nation.

To address the challenge of delivering efficient healthcare services to Bangladesh's substantial population of 160 million, relying solely on government investment is not immediately feasible due to the substantial financial commitment required. Consequently, the imperative of the moment is to engage private sector partners and investors.

The government has initiated a plan to implement Shared Health Records (SHR) in public hospitals nationwide. SHR is a digital repository of a patient's medical data, accessible to healthcare providers. This modern system is expected to streamline healthcare services, reducing inconvenience for both patients and medical professionals. Furthermore, it promises to enhance transparency, contributing to the delivery of high-quality healthcare services throughout the country.

The Bangladesh government can enhance its healthcare services by focusing on several key strategies. First, increasing public funding for healthcare infrastructure and services can improve accessibility and affordability. Second, investing in medical education and training programs to address the shortage of healthcare professionals is crucial. Third, implementing technology-driven solutions for telemedicine and health information systems can expand reach and efficiency.

In this context, there are several avenues through which we can foster increased collaboration forging public-private partnerships (PPPs) in the healthcare sector. When shaping PPP projects, it is essential for governments to take into account the broader socio-economic advantages they bring to the targeted constituents as a key success criterion, rather than solely focusing on financial returns. PPPs present a promising solution to healthcare issues in Bangladesh, fostering joint efforts to provide comprehensive healthcare services.

Mohammad Ashraful Islam Khan, President of the Supply Chain Street, and previously Head of Supply Chain Advisory Services at KPMG Bangladesh, now resides in Winnipeg, Canada. He is a dedicated management consultant with expertise in growth strategy, operational optimisation, fintech, and supply chain management.

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