Health sector crisis deepens in Bangladesh: Who will step in?

For many in Bangladesh, the country’s strained health system is not an abstract policy issue but a daily reality measured in long waits, rising bills, and difficult choices between treatment and survival. The COVID-19 pandemic exposed these weaknesses sharply, yet little has changed since. Shortages of doctors and nurses, low budget allocation, mismanagement, and soaring treatment and medicine costs continue to weigh heavily on patients and families.

Experts say the system lacks a comprehensive master plan and remains overly centralized, leaving rural and district-level facilities under-resourced and overcrowded. Decentralization, they argue, is key to making healthcare accessible to ordinary people.

In Bangladesh, health sector allocation remains below 1% of GDP, with most of it spent on salaries and allowances. Although the World Health Organization recommends at least 5%, that benchmark has not been achieved. During the interim government period, the sector saw little visible progress. The BNP’s election manifesto included a pledge to allocate 5% of GDP to health, though experts say implementation will be difficult.

Health Secretary Kamruzzaman Chowdhury said the government plans to spend 5% of GDP on the sector, focusing on infrastructure development and modernization to improve services and build a healthier nation. The Health Sector Reform Commission has recommended allocating at least 15% of the national budget to health. However, only 5.3% has been allocated in the 2025–26 fiscal year.

Public health expert Dr. Lelin Chowdhury said that although the allocation is low, even the existing resources are not being effectively utilized. He said the health ministry and its directorates lack the capacity to manage funds efficiently and need restructuring, though no initiative is visible.

For patients, the imbalance between demand and available healthcare providers is most visible at hospitals and clinics. Bangladesh has only 0.83 doctors per 1,000 people, with around 90,000 practicing physicians. Nursing shortages are even more severe: against a need of 310,500 nurses, only 56,734 are currently employed—just 28% of the requirement.

This shortage means longer waiting times, hurried consultations, and overworked medical staff. In many rural and upazila-level facilities, patients often find no choice but to travel to private hospitals or delay treatment altogether.

Each doctor ends up seeing far more patients than recommended, while limited nursing support affects patient care and recovery. The situation contributes to declining service quality and growing frustration among patients. The government has announced plans to recruit doctors, nurses, and technicians in phases. Health Minister Sardar Md. Sakhawat Hossain said the shortages will be addressed gradually through large-scale hiring.

Dr Lelin Chowdhury noted that the country has about 172,000 hospital beds, with roughly 100,000 in the private sector and 72,000 in the public sector. He said oversight capacity is limited, particularly in monitoring private facilities, and there is no dedicated system to ensure quality standards. He added that serving a population of 180 million requires a comprehensive plan and better distribution of services.

For many families, the biggest burden is not just access to care but the cost of it. A study by the Health Economics Unit shows that individuals bear the majority of healthcare expenses. In 2018, 2019, and 2020, out-of-pocket spending accounted for 64%, 66%, and 69% of total health expenditure, respectively, while government spending remained much lower.

More than 8.6 million people fall below the poverty line each year due to medical expenses, with medicines alone accounting for 64.6% of total spending.

A 2020 study found that individuals bear 68.5% of total healthcare costs themselves. A Bangladesh Institute of Development Studies (BIDS) report published in July 2024 showed that out of every Tk100 spent on healthcare, patients pay Tk73—54.40% on medicines, 27.52% on diagnostics, 10.31% on doctors, and 7.77% on transportation.

Latest estimates from the World Health Organization and the World Bank indicate that 44% of households face financial hardship due to healthcare costs. Public health expert Professor Dr Be-Nazir Ahmed said many people are forced to forgo treatment, deplete savings, take on debt, or sell assets to afford care. “The burden falls most heavily on the poor,” he noted.

Lelin Chowdhury said tertiary care services remain concentrated in Dhaka and major cities, leaving district-level populations underserved. He stressed that decentralization is necessary to reduce pressure on urban hospitals and improve access to advanced care closer to home.

The Health Sector Reform Commission, formed by the 2024-2026 interim government, submitted 32 recommendations aimed at short- and medium-term improvements, including structural reforms, digital health systems, increased funding, universal health coverage, protection of healthcare workers, and better medicine management.

Commission chief Dr. A.K. Azad Khan said the responsibility of the commission was to recommend reforms, while implementation lies with the government. Public health expert Dr. Mushtaq Hossain said the recommendations have largely not been acted upon. He added that even a monitoring committee was not formed to oversee reforms, and little attention has been given by the current government as well.

For patients and families navigating this system, the gap between policy discussions and everyday realities remains stark—reflected in overcrowded wards, rising bills, and the ongoing question of who will truly take responsibility for a health sector under strain.