The State of Healthcare Industry in

Bangladesh [Part-I]
Since its independence in 1971, Bangladesh has been struggling with providing its
populace with a proper health care system. Recent statistics suggest that it has been
making progress throughout the years. Here, we are going to look into the nature and
mechanism of the industry, what problems it is facing and how those problems can be
faced with existing resources.

The Healthcare industry of Bangladesh

Bangladesh currently has a population of approximately 160.9 million with a density
of 1,034 people in every square kilometer. Average Bangladeshis have a lifespan of
71/73 years at birth (as of 2015) which is 46% higher from 1970. The birth rate
currently stands at 2.16% while the death rate is 46 children in every 1000.
The maternal mortality rate is 0.24%. Mothers in impoverished families often suffer
from malnutrition which results in their bearing undernourished babies. A 2008 report
by One World South Asia says that every 3 to 4 minutes a baby dies in Bangladesh
which shockingly amounts to 120,000 babies dying every year. However, the situation
has improved significantly in last few years with a sharp decline in children mortality
rate.
Several factors contribute to the detriment of health in Bangladesh: rapid growth of
population (2.7% annually), nutritional problem (lack of knowledge about health and
nutrition), and environmental sanitation (according to a survey, only 32% of latrines
in rural areas maintain the international sanitary latrine standards), general health
problems and communicable diseases.
Bangladesh has made a notable improvement in the area of immunizing children
under the age of five. A renowned British medical journal The Lancet noted that
Bangladesh’s under-5 mortality rate has fallen to 65 per 100 live births in 2006 from
202 in 1979. The Ministry of Health and Family Welfare (MOHFW) also published a
report stating the rate of fully immunized children to be at 52%.
The Nature of Health Services
Healthcare in Bangladesh is provided in three major categories. The type of service a
patient need is determined by the medical necessity. The service categories are
defined as follows. The primary care is given to people in need of general health care.
This type of care is commonly provided by family practice, pediatrics, internal
medicine, and sometimes gynecologist.
The secondary care is more intensive in nature than the previous one. It is provided by
certified physicians upon requests from the primary physicians. Hospitals like Dhaka
Medical College Hospitals, BIRDEM treat people needing secondary care. The type
of specialized consultative care, tertiary health care, is facilitated by specialists
working in a center that has personnel and facilities for investigation and treatment of
special health problems.
Medical Professionals and the Industry
There is a growing popularity of getting into the medical profession in Bangladesh.
Albeit that trend, the country still remains among the 57 countries recognized by
WHO in 2006 for having a severe scarcity of trained medical professionals.
According to reports of MOHFW published in 2012 and 2013, there are currently
64,434 registered doctors, 6,034 registered dentists, and 27,000 midwives. The figures
indicate a physician density of 0.036%.
Another recent report of WHO says that for every 1000 people in Bangladesh, there
are only 0.3 doctors and 0.3 nurses. Furthermore, cumulatively there are less than 23
doctors, nurses, and midwives per 10,000 populations.
Public Health Care Services
There is a total of 128 public medical intuitions that provide secondary and tertiary
level health care to both in and out-patients. Of these 128 institutions, 53 are district
hospitals, 11 general hospitals, a medical university in Dhaka (BSMMU), and 63
other types of hospitals.
The total number of seats for patients in these hospitals is 27,053 among which
district hospitals, medical/dental college hospitals, and BSMMU have respectively
7,850, 11,960, and 1,212 functional beds. Consequently, for every 5,657 people, there
is only one bed in the secondary and tertiary care hospitals and one bed per 12,696
population in the medical colleges. These statistics, needless to say, are disappointing.
Non-public Health Care Services
The private medical institutions are clustered mostly in the capital and large cities.
Other informal services (Kobiraji, homeopathy) can be found in other regions. An
important fact to note is that there is no organized body to oversee these informal
services. The authenticity of the services, thus, is dubious.
Asia-Pacific Observatory on Public Health Systems and Policies reports that there are
a total of 2,983 registered private hospitals around the country which provide 45,485
functional beds as of 2013. The bed-density in the private sectors then stands at
0.031%.
Another significant aspect of the health care industry is the new trend of startups. This
type of startups is initiated by a new breed of entrepreneurs who want to bring
affordability and speediness in the health care system by introducing technology.
Doctorola, the partner of this report, is such a startup that helps people get doctor’s
appointment through website and mobile phones.
Healthcare Expenditure
Government Funding: In spite of a stable GDP growth of 6-7% throughout the
previous decade, Bangladesh government has been reluctant to spend more in the
health sector. According to WHO, a mere 2.8% of the GDP of economy is being spent
as health expenditure whereas the percentage hovers around 8-12% in the developed
countries.
WHO also suggests that the ratio between public money to private money should be 3
to 1 while on the contrary, the government expenditure in health sector amounts to
only 37% of the total health expenditure.
Private (Out-of-Pocket) Expenditure
The rate of current government expenditure clearly indicates that private money is still
financing the major portion of the health care industry. The rate of out-of-pocket
spending is 61% in Bangladesh which is quite depressing compared to other countries
in the South Asia.
Foreign Investment and Donations
Bangladesh has been recieving investments and loans from countries and international
organizations in the healthcare sector. Notable bilateral investors are Australia, United
Kingdom, United States, Germany, and others.
The World Bank has been an avid helper in the health sector. Bdnews24.com reports
that WB has approved a loan of $150 million to the ‘Health Sector Development
Program.” With this additional financing, the loan granted by WB totals $508.9
million, as of June 2016. Besides World Bank, other multilateral donor organizations
are UNICEF, Asian Development Bank, and the European Union.
Problems and Possibilities
The health care sector in our country is beset with a number of hurdles. A survey done
in 2012 found out that out of 152.5 million population, only 10 million people (that is
less than 1%) is covered by some sort of formal health protection. Another survey by
the Household Income and Expenditure Survey points out that only 24.6% of
Bangladeshi families are covered by the social safety net program introduced in 2010.
The growth rate of GDP has remained stable at 6% in Bangladesh. Economists predict
an even higher rate in the near future. As GDP soars, the government must take steps
to increase its spending in the health sector and make plans to insure more families.
The health care industry is a diverse sector. As the famous medical journal, The
Lancet puts it, “health systems are complex and no simple recipe exists for success.”
Should the problems are addressed with due diligence, we can most certainly hope for
a booming industry and a healthy nation.