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
- 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
- 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
- Implement need-based healthcare budget allocations and increase resources and equipment in public facilities to enhance capacity
- Extend opening hours in the PHC facilities and their pharmacies to increase accessibility of care
- Provide incentives to attract healthcare professionals to rural and remote areas
Outcomes
Reduction in Catastrophic Health Expenditures (CHE) rates
Decrease in OOP expenditures
Reduced spending on drugs
Higher utilization rate of public healthcare services
Increased care capacity of public healthcare services
Increased utilization of healthcare and treatment among low-income population
Reduction in gap of service between urban and rural regions
Reduction in budget-need gap in healthcare
Potential Impact
Affordable access to healthcare
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
Introduce trained lay mental health workers at the community level
Introduce referral system for mental health services
Launch mental health awareness programmes such as mental health literacy workshops
Outcomes
Increased accessibility of mental health services in the community level
Reduced Mental Health Treatment Gap
Higher utilization of mental health services
Increased mental health awareness
Potential Impact
Improved mental wellbeing for the population
Key Stakeholders
MOHFW, NIMH,NGOs and international agencies
Recommended Activities for Policymakers
Undertake screening programs
Strengthen capacity of health systems by training staff, providing equipment and medicines
Raise public awareness of non-communicable diseases
Introduce programs focused on promoting healthy lifestyles, preventing risk factors, and managing NCDs at PHC facilities
Outcomes
Increased rates of early detection
Reduced rate of non-communicable diseases
Reduced premature mortality due to non-communicable diseases
Increased treatment utilization rates for non-communicable diseases
Increased awareness of non-communicable diseases
Potential Impact
- Robust management of non-communicable diseases
- 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
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: