Healthcare

Key Challenges in Healthcare

High out-of-pocket (OOP) expenditure

Bangladesh allocates only 5% of its budget to health, far below the WHO's recommended 15%
Out-of-pocket (OOP) spending constitutes 73% of total health expenditures, with pharmaceutical costs making up 64% of this burden
Around 25% of Bangladeshi households face catastrophic health expenditures (CHE), i.e., healthcare expenses surpass 40% of non-food expenditure. CHE disproportionately affects rural households due to regional disparities in healthcare access and costs across regions.
Limited public healthcare utilization exacerbates high OOP costs, with only 11% of patients using public primary care and 29% seeking public outpatient care at the secondary level.
Public healthcare facilities lack resources - only 3% of Union Health and Family Welfare Centers and 1% of Community Clinics are equipped to provide antenatal care; only 50% of the district hospitals have the 6 basic amenities.

Gaps in mental health treatment

Less than 1% of the total health budget of Bangladesh is allocated to mental health.
Lack of community-based mental health guidelines and insufficient monitoring and supervision lead to poor mental health management.
Social stigma contributes to the high treatment gap of mental health problems in Bangladesh.

Ineffective management of non-communicable diseases

In 2019, 70% of the total deaths in Bangladesh was from non-communicable diseases.
Lack of awareness, unavailability of drugs, diagnostic challenges and lack of awareness contribute to poor management of non-communicable diseases.

Reform matrix

Policy Objectives

Recommended Activities for Policymakers

Outcomes

Potential Impact

Key Stakeholders

Recommended Activities for Policymakers

  1. Introduce affordable healthcare initiatives, such as:
    • Subsidized Social Health Insurance Programs targeted to the low-income groups
    • Voucher schemes for specific types of health services: maternal health, child health, NCD etc
    • Tailored Health Insurance Systems for university students, formal sector employees and informal sector employees
    • Pharmaceutical benefits system to reduce the financial burden due to drug purchases
  2. Regulate drug prices and usage by establishing a price control authority, enforcing price ceilings, conducting prescription audits, and strengthening laws on over-the-counter drug sales
  3. Implement need-based healthcare budget allocations and increase resources and equipment in public facilities to enhance capacity
  4. Extend opening hours in the PHC facilities and their pharmacies to increase accessibility of care
  5. Provide incentives to attract healthcare professionals to rural and remote areas

Outcomes

    1. Reduction in Catastrophic Health Expenditures (CHE) rates

    2. Decrease in OOP expenditures

    3. Reduced spending on drugs

    4. Higher utilization rate of public healthcare services

    5. Increased care capacity of public healthcare services

    6. Increased utilization of healthcare and treatment among low-income population

    7. Reduction in gap of service between urban and rural regions

    8. Reduction in budget-need gap in healthcare

Potential Impact

    1. Affordable access to healthcare

    2. Better health outcomes for the population

Key Stakeholders​

MOHFW, Directorate General of Drug Administration (DGDA), Public and Private Healthcare Facilities, Pharmacies, Public and Private Health Insurance Companies, NGOs

Recommended Activities for Policymakers

  1. Introduce trained lay mental health workers at the community level

  2. Introduce referral system for mental health services

  3. Launch mental health awareness programmes such as mental health literacy workshops

     

Outcomes

    1. Increased accessibility of mental health services in the community level

    2. Reduced Mental Health Treatment Gap

    3. Higher utilization of mental health services

    4. Increased mental health awareness

Potential Impact

  1. Improved mental wellbeing for the population

Key Stakeholders​

MOHFW, NIMH,NGOs and international agencies

Recommended Activities for Policymakers

  1. Undertake screening programs

  2. Strengthen capacity of health systems by training staff, providing equipment and medicines

  3. Raise public awareness of non-communicable diseases

  4. Introduce programs focused on promoting healthy lifestyles, preventing risk factors, and managing NCDs at PHC facilities

Outcomes

    1. Increased rates of early detection

    2. Reduced rate of non-communicable diseases

    3. Reduced premature mortality due to non-communicable diseases

    4. Increased treatment utilization rates for non-communicable diseases

    5. Increased awareness of non-communicable diseases

Potential Impact

  1. Robust management of non-communicable diseases
  2. Improved life expectancy

Key Stakeholders​

MOHFW, WHO, International Centre for Disease Control and Research in Bangladesh (icddr,b), Centre of Excellence for Non-Communicable Diseases and Nutrition
(CNCDN)

Policy Area scorecard

Priority Sector

Policy Objective

Activity

key Stakeholder

Baseline

End Target

Term (years)

Year 1 target

Year 2 target

Year 3 target

Score

Recommendation

Policy Area (e.g. Education, Environment, healthcare, Law and Governance, Economy, etc.)

The reform goal of the policy

Activities undertaken to achieve the reform goal

Stakeholders mainly responsible for implementation reform activities

Current status of the indicator

Desired status of the indicator

Time frame to achieve the goal (e.g. 3 years, 5 years, etc.)

Progress target in year 1 (FY2025/26)

Progress target in year 2 (FY2026/27)

Progress target in year 3 (FY2027/28)

Performance score in each year Year 1: Year 2: Year 3:

Recommendations for improvements or corrective actions Year 1: Year 2: Year 3:

Policy Area scorecard

Priority Sector

Policy Area (e.g. Education, Environment, healthcare, Law and Governance, Economy, etc.)

Policy Objective

The reform goal of the policy

Activity

Activities undertaken to achieve the reform goal

key Stakeholder

Stakeholders mainly responsible for implementation reform activities

Baseline

Current status of the indicator

End Target

Desired status of the indicator

Term (years)

Time frame to achieve the goal (e.g. 3 years, 5 years, etc.)

Year 1 target

Progress target in year 1 (FY2025/26)

Year 2 target

Progress target in year 2 (FY2026/27)

Year 3 target

Progress target in year 3 (FY2027/28)

Score

Performance score in each year Year 1: Year 2: Year 3:

Recommendation

Recommendations for improvements or corrective actions Year 1: Year 2: Year 3:

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