Apr92025

Bangladesh’s health system is at a pivotal juncture. What happens when donor money dries up, but the health challenges keep growing?

That’s the question Bangladesh is facing right now—and the answers lie in bold reforms, smarter funding, and a reimagining of what it means to truly “own” our health system.

 

Context of Bangladesh’s Health System

Over the past two decades, Bangladesh has achieved remarkable progress in public health indicators. Maternal mortality dropped from 351 per 100,000 live births in 2007 to 136, and under-five mortality decreased from 60 to 33 per 1,000 live births (Prothom Alo, 2024). Life expectancy has also improved, reaching 72.3 years (Prothom Alo, 2024). These gains stem from expanded immunization, stronger primary healthcare, and improved workforce distribution.

 

Chronic and Emerging Health System Challenges

Despite progress, the system is strained by:

  • Rising NCDs: Hypertension and diabetes are increasing rapidly. Bangladesh aims to place three million patients under protocol-based care by 2025 (WHO, 2023).
  • Urban-Rural Divide: Health infrastructure and staffing remain concentrated in urban centers, limiting rural access.
  • Out-of-Pocket Expenses: Households still bear around 63% of total health expenditures, leading to financial hardship and care avoidance (World Bank, 2021).

 

Potential of Domestic Resource Mobilization

As external aid declines, Bangladesh must develop robust domestic financing strategies:

  • Tax Reform: A progressive taxation system can boost government revenue for health spending.
  • Public-Private Partnerships (PPPs): Strategic collaboration with the private sector can unlock additional funding and innovation.
  • Efficiency Improvements: Streamlining procurement, reducing corruption, and investing in digital infrastructure can improve the return on public investment.

 

Government Reform Initiatives

Several recent efforts signal a move toward self-reliance:

  • Health Sector Reform Commission: In November 2024, the government formed a commission led by Professor A.K. Azad Khan to recommend comprehensive reforms to make health services more accessible and affordable (Dhaka Tribune, 2024).
  • Increased Budget Allocation: The national health budget for FY 2024-25 rose to Tk 41,407 crore from Tk 38,051 crore the previous year (Prothom Alo, 2024), reflecting a growing focus on strengthening the sector.
  • Commitment to UHC: In May 2023, the government reaffirmed its goal to achieve Universal Health Coverage (UHC) by 2030, with support from international development partners (UNICEF, 2023).

 

Global Best Practices and Recommendations

Bangladesh can draw on lessons from other countries to shape its path forward:

  • Community Health Workers (CHWs): Ethiopia and Brazil have effectively used CHW programs to expand reach and improve primary care outcomes.
  • National Health Insurance Models: Thailand’s Universal Coverage Scheme demonstrates how government-financed insurance can reduce out-of-pocket costs and increase equity.
  • Performance-Based Financing (PBF): Rwanda’s adoption of PBF, where funds are tied to service outcomes, has improved accountability and efficiency in healthcare delivery.

The Bottom Line

Bangladesh is standing at a crossroads. The donor era is fading. But that’s not a crisis; it’s a chance.

A chance to take control of our health priorities.
A chance to make our systems more equitable.
A chance to finally decolonize how we think about health funding.

Through tax reforms, efficiency gains, public-private collaboration, and strategic policymaking, the country can build a resilient, inclusive, and equitable health system rooted in national ownership. Let’s make sure we don’t waste this moment.

 

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