Overview

The health system of Bangladesh has undergone a number of reforms and has established an extensive health service infrastructure in both the public and private sectors during the past four decades. Bangladesh has achieved impressive gains in population health, achieving the Millennium Development Goal 4 target of reducing under-five child mortality by two thirds between 1990 and 2015, and improving other key indicators such as maternal mortality, immunization coverage, and survival rates from malaria, tuberculosis, and diarrhoea diseases.

These outcomes have been achieved by increasing coverage of deliveries health facilities, childhood immunizations, management of diarrhoea with oral rehydration salts, and treatment success rates for tuberculosis.

Yet, Bangladesh is still a long way from achieving universal health coverage. Although the statutory health system, in principle, covers all citizens, many sick people are left untreated every year in practice. Private-sector services are too expensive for many and out of pocket expenditures for health care are high. The provision and coverage of services for the growing burden of noncommunicable diseases are only just beginning. Quality of care in both public and private services is poor, with assessments of the quality of provider care reporting low levels of professional knowledge and poor application of skills in practice.

There are several challenges to the health system. First, there is a lack of coordination between the two different ministries for the implementation of primary healthcare services in rural and urban areas. Second, there is a critical shortage of trained health providers with appropriate skill-mix in the public sector and a widespread increase in unregulated informal providers in the private sector. Third, there is a persistent low annual allocation to health in the government budget and high out-of-pocket payments by households. And fourth is the inequitable access to health services between urban and rural areas including variable health financing mechanisms. These factors hinder the achievement of universal health coverage in the country.

Mobilizing the private sector to increase the production of health workforce may facilitate reducing the gap in human resources. There is an urgent need for more investment of public funds and stronger local accountability to improve the quality of public services and regulating the quality of care provided by the private and informal sectors.