Table of Contents

1. Introduction……………………………………………………………………………2
2. Background Literature………………………………………………………………...4
3. Theoretical Framework (major challenges in the health sector in Bangladesh)………5
4. Critical Analysis (Covid-19 pandemic is a wake-up call for further improvement and
development of the health sector in Bangladesh)……………………………………..8
5. Recommendations (five areas of the health sector where further development is essential)
……………………………………………………………………………...10
6. Conclusion……………………………………………………………………………12
7. References and Citation………………………………………………………………13

Figures

1. Figure 1: Percentage availability of different healthcare facilities in Bangladesh……9

Briefly identify major

challenges in the
health sector in
Bangladesh. Do you
think Covid-19
pandemic is a wake-
up call for further
emphasizing the
overall development of
the health sector in
Bangladesh? If so
then briefly
identify five such
areas with
justification where 1
further development is
essential.
1. Introduction

The medical care structure is the social action towards the factors of health. All communities rely
on a group of factors determining the well-being of people, which sometimes do not obey
science or reasoning. The basic principle of a healthcare system is the worth of human life. The
importance that a community places on human life mostly defines the human, substantial, and
monetary resources it allots for the medicare. The efficiency of a health system is contingent on
the attainability and accessibility of facilities in a way that the public is able to comprehend,
welcome and consume.

Health, Population and Nutrition (HPN) are closely connected and dependent on one another,
both as causes and as effects. HPN facilities are basic privileges of the public and hence HPN
degree is considered as a vital directory of human growth worldwide. Intrinsically, the
Bangladesh government is required to guarantee delivery of rudimentary needs of life, which
comprise healthcare to its people, increasing the amount of nutriment, and refining public health.

However, Bangladesh is subject to both a scarcity and regional misallocation of Human

Resource for Health (HRH). For every 10000 people, there are only around 3.05 doctors and
1.07 nurses, according to reports by Ministry of Health and Family Welfare Human Resource
Development (MoHFW HRD) in 2011. There is a huge disparity between assigned and occupied
health worker posts: out of the 36% jobs available for authorized health workers, only 32% of
the institutions have more than 75% of the assigned workers occupying the positions (World
Bank, 2009). 28% of remedy delivered in public health amenities is via complementary medicine
(herbal, unani, and naturopathy); nevertheless half of the posts for complementary medicine
providers were vacant as of June 2011 (MoHFW Alternate Medical Care (AMC), 2011).

Medical personnel are condensed in metropolitan ancillary and third-tier health centres, although
70% of the residents live in the country side (Country Case study, Global Health Workforce
Alliance (GHWA), 2008). Significant issues involve: a highly concentrated medical care; fragile
management framework and legislations; incompetent administration and organizational capacity
in the MoHFW; disintegrated delivery of civil service; ineffective distribution of government

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funds; absence of monitoring of the private enterprises – which hire 58% of all doctors; lack of
Human Resources for Health; big staff turnover ratio and non-attendance of healthcare
employees; and faulty upkeep of health centres and medical supplies.

In spite of these obstacles along with the detail that human resources were not regarded as
important in the current sector program, there have been new accomplishments that involve: a
surge in the quantity of qualified doctors and learning opportunities for medical staff, and a rise
in the amount of medical services in the villages. Recently, the MoHFW arranged the HPN
Sector Development Program (HPNSDP) and is reviewing its National Health Policy blueprint,
on the basis of experiences gained from past programs. Objectives comprise: forming an HRH
strategy; generating an efficient HRH Information System (HRIS); extending the output of
crucial medical personnel; presenting motivation packages to employ and maintain crucial
medical personnel in isolated and countryside regions; tackling the challenge of trained
midwifery by teaching local Skilled Birth Attendants (SBAs), nurses, and family planning staff;
and restructuring the enrolment and upgrade of nurses (PID, World Bank, 2011).

2. Background Literature

The Bangladesh healthcare system depends greatly on the government or state sector for funding
and establishing general guidelines and service providing schemes. Even though the medical care
system is met with numerous headstrong challenges, it appears to get insignificant importance
with regards to the government fund distribution. As stated by the World Health Organization
(WHO, 2010), a meagre 3% of the Gross Domestic Product (GDP) is expended on health
facilities. Yet, government spending on health is just around 34% of the whole spending on

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health, the remaining 66% being overhead expenses. Therefore, inequality is a severe issue
impacting the health care system.

According to an assessment of secondary information, the article evaluates the present

challenges and scopes of the medical structure in Bangladesh. The results imply that though the
healthcare structure confronts multidimensional challenges like the shortage of public health
services, lack of trained labor force, insufficient monetary fund distribution, and administrative
uncertainty; the country has displayed a lot of improvement in reaching the Millennium
Development Goals (MDGs) concerning health. Although Bangladesh has an evolving private
sector mainly delivering third-tier medical services, it still has not come up with a broad health
strategy to reinforce the whole health system. Evidently, the most important challenge is the lack
of a powerful and effective governance capable of structuring and implementing procedures to
additionally toughen and boost the total health system. A solid authority like that could cause
worthwhile and efficient modification of medical structure that will operate more proficiently for
the advancement of the fitness of Bangladeshi citizens, and would be established considering the
principles of justice and responsibility.

3. Theoretical Framework (major challenges in the health sector in

Bangladesh)

During its initial stages, the healthcare system in Bangladesh was mainly geared towards
delivering remedial services aimed at gynecological practices and child health. From the 1990s
onwards, the medical system slowly switched its focus on equally boosting health and
establishing precautionary services. The health sector also broadened its influence. However, a
great sum of the population of Bangladesh, especially in village areas, go on without adequate
reach to healthcare amenities. Even though there has been noteworthy development in various

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fitness pointers in the latest years, the government experiences big concerns regarding its ability
to design and establish a wide array of health and population facilities. A considerable quantity
of the people, specifically the underprivileged, face a broad range of health complications related
to socio-economic differences.

Some of the more dominant challenges faced by the Bangladesh health sector are:

 Inadequate Public Services – In Bangladesh, around 540 public hospitals consisting of about
37,400 beds offer inmate treatment facilities for a populace of 160 million. 413 Upazila (sub-
district) Health Complexes (UHCs) exist but have incompetent treatment facilities. Most
UHCs have only 20 seats mainly for attending to urgent requirements of expectant women.
Local hospitals are generally labeled as ancillary infirmaries as they have less specialized
care services contrary to medical college hospitals; these hospitals have inadequate
consultants, pathological and forensic services. Moreover, there are 9 central hospitals with
seat numbers ranging from 100-250 each. It is clear that the country does not own enough
hospital seats to cater to the huge population; Bangladesh only has approximately 0.4 seats
for every 1,000 people.

 Jeopardized Access – Although there are a great range of inmate treatment facilities
available in the public medical centres, they are often mishandled either due to restricted
access for the rural population or the cost of diagnosis and medications for supposedly free
primary medical services, which severely limit the rights of the underprivileged. Also, more
often than not, the ambulances reserved for the patients are either not working or being
exploited by the doctors for their personal use. In addition, nearly 66% of the treatment costs
have to be borne by the patients, which further limits the accessibility of the poor,
compromising the country’s constitution of parity.

 Unavailability of Necessary Supplies – Many medicines, medical equipment, and birth

control supplies are not available, which is a common issue in most public medical centres all
around the country. These arise from an inefficient management of the supply chain and the
shortage of finance to buy them. Besides, 65% of the ambulances owned by the public
hospitals are out of order for various reasons. Many of the healthcare centres have faulty

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 equipment ranging from x-ray machines to heart monitors. Occasionally, the medicines and
contraceptives intended for gratis distribution to poorer patients are sold to private businesses
for profit.

 Lack of Healthcare Workers – The treatment of medical inmates requires high levels of
education and skills. Bangladesh struggles with a persistent lack of properly qualified labor
force in the health sector. This restricts the delivery of service to the population as there is
44.2% vacancy in the allotted positions for doctors and 96% empty posts for nurses. It has
also been observed that the further away the medical centres are from Dhaka, the higher the
percentage of vacancy. These deficiencies are visibly lowering the standard of the health care
structure.

 Absence of Decentralization – The control and decision-making right remain exclusive to

the MoHFW in Dhaka, and the UHCs merely follow the decisions made by the Ministry.
Hence, the decisions do not represent the regional problems. Additionally, the absence of
authority at regional levels obstruct the professionals in those areas to respond to exceptional
cases of emergencies in the locality
.
 Lack of Morality and Ethics – In several circumstances, the doctors display nearly zero
ethics in their work. They breach the office hours suggested by the government, which causes
inconvenience to patients. The patients are frequently disregarded, unnoticed, or even
mistreated by the medical staff; they are also coerced to private medical centres to be charged
high fees for their treatments.

 Insufficient Monetary Reserves – Around 3.4% of the GDP of Bangladesh is allocated to the
health sector, from which only 1.1% is contributed by the government. Expressed in US
dollars, the total spending of Bangladesh on health is approximately $12 per capita annually,
only $4 of it being the government’s funding. Greater than 66.7% of the total health
expenditure is paid out of the pockets of individuals. 60% of the rest 33.3% is funded by the
government from the tax money paid by individuals and businesses and from construction
outlays; the other 40% is paid via development aid from overseas. More of the money from

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 the health care distribution of MoHFW goes to the richer population than the poorer ones,
leading to higher inequality and there is almost no health insurance in the country.

 Weak Health Information System – It is necessary to have the most dependable and the
latest healthcare information to form a competent health structure. Hence, WHO has stressed
on it being one of the key elements of any healthcare system (WHO, 2008). Simply gathering
unprocessed data is not sufficient; those data must be handled, evaluated and distributed
methodically to the relevant specialist to enable decision-making and prompt implementation
of required actions. Although several surveys and studies have been made country-wide
regarding the health sector, there is still an absence of a systematic method of accumulating
and taking care of health-based information from every medical centre at fixed intervals. If
the health information system of the country is standardized, all other parts of the healthcare
structure can be enhanced.

4. Critical Analysis (Covid-19 pandemic is a wake-up call for further

improvement and development of the health sector in Bangladesh)

Since the first Covid 19 patient was diagnosed in Wuhan, China towards the end of 2019, the
recent virus has circulated across 213 nations and zones. As of today, the sum of cases recorded
is 12,884,231 with 568,560 deaths and 7,510,761 recoveries. Bangladesh has been involved in
battling Covid-19 for the last four months. The number of confirmed cases in the country is
193,220, out of which 103,227 have recovered and 2,457 have died; the fatality rate is 1.3%. Due
to the unavailability of test kits resulting in a very small quantity of tests performed, these
numbers have been deduced from of a fairly small sample size.

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The Finance Ministry claims that 4.9% of the total budget has been allotted to the health sector
for the fiscal year 2019-20, which does not fulfil the World Health Organization (WHO)
standards of 15% of total budget for the health care system and belongs to the minimum range in
the entire South Asia. A swamped medical structure is almost on the verge of collapsing.

It has been brought to light that the reaction of the Bangladesh government to the challenge of
Covid 19 pandemic has been incompetent and it was too late to implement a countrywide
lockdown, more than three months after the Wuhan shockwave. Moreover, even though the
lockdown was announced, it was not strictly regulated and social distancing was not maintained
properly, which displayed the indecisiveness of the government. Bangladesh suffered from a lack
of integrated communication among sectors. Had the country followed Public Health Emergency
Preparedness (PHEP) premised on the most extreme cases, it could have handled the crisis
quicker and more efficiently.

Passenger screening at airports were also compromised and corrupted. Despite the Health
Services Division’s emphasis on the significance of emergency scanning and restricting the entry
of infected people into Bangladesh, the thermal scanning at airport entrances set up by the
government appeared loose and numerous press reports implied that almost all the thermal
scanners were faulty, and people coming from abroad were allowed fairly easy entrance to the
country without following proper inquiries about their health or solitary confinement rules. Many
people were diagnosed with the virus by the Institute of Epidemiology, Disease Control and
Research (IEDCR) long after they had entered the country and mixed freely with the crowd.

There is a miserable shortage of medical supplies in the healthcare institutions of Bangladesh.

This, coupled with a lack of health experts such as physicians and other medical personnel most
of whom are stationed at urban health centres in a country of 78% rural population, results in an
inefficient controlling of the Covid 19 pandemic. The situation exacerbates as more of the
already limited frontline medical staff are now getting contaminated by the virus. One-fourth of
the physicians and three-fifth of the nurses are yet to acquire Personal Protective Equipment
(PPE), and there are allegations of poor quality PPEs circulating the markets. Bangladesh
Doctors Foundation (BDF) reports that physicians now compose 6.5% of all cases.

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On the other hand, due to the conversion of numerous hospitals into exclusive Covid 19
treatment centres and many of the remaining ones shutting down in accordance to the lockdown
in effect, non-infected patients are being deprived of normal examination and treatment that is
worsening their illnesses. In a country with prevailing incompetent health sector, the attack of the
Covid 19 has marginalized facilities for the patients who aren’t infected by the virus. As a lot of
the health workers are refraining from attending the medical centres, regulating the healthcare
supplies such as oxygen cylinders and ventilators have become a great issue, stripping the
normal patients of access to these equipment. The non-affected patients are also avoiding visiting
the medical institutions for appointments in fear of getting infected.

Figure 1: Percentage availability of different healthcare facilities in Bangladesh.

5. Recommendations (five areas of the health sector where further

development is essential)

The Covid 19 crisis has set forth some evident priorities for the government of Bangladesh.
Some of the areas of health system need large-scale improvements to make healthcare more
accessible to citizens.

 The safety of healthcare members should be ensured at all times as they are more exposed to
contagious diseases. They must be provided with appropriate protective gears and sterilized

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 medical supplies. In the long run, the entire health sector needs to be remodeled to make it
more prepared in fending off crises in future. A complete relocation of medics is necessary to
distribute them equally in both urban and rural regions. The regulation of the health system
should also be strengthened and implementation of healthcare policies should be stricter. As
the government contemplates relaxing the lockdown, it has become more necessary than ever
to pay attention towards risk reduction. It is also required to improve the quality of services
provided by the medical facilities, and they need to be equipped with better supplies in order
to achieve that.

 A few policies need to be reconsidered regarding health. The forthcoming budget for the
fiscal year 2020-21 could be revised for a start. The money allotted to healthcare needs to be
raised considerably in amount both to mitigate the after-effects of the pandemic and to
prepare for future emergencies so that the safety of medical staff and patients are not
compromised anymore. The government should give a thought towards subsidizing private
medical centres to help them become capable of managing pandemics besides the public
sector. The establishment of special facilities for isolating infected patients and providing
bulk testing services should be funded.

 Although the World Health Organization (WHO) has set specific rules on International
Health Regulations (IHR) and Epidemic Control, people of Bangladesh are greatly unaware
of these measures or entirely ignorant about the consequences of not following them. Most
people are not maintaining social distancing or obeying the lockdown. Many of them go as
far as hiding their symptoms that endangers many other people including doctors. Hence, it
has become necessary for the government to educate the crowd and raise more health
awareness among the citizens. An elaborate strategy should be developed to make people
aware of the repercussions of their ignorant actions.

 Due to the high costs of funding health care for all the citizens of Bangladesh from the
government tax revenue, a mandatory health insurance policy offering punctual and thorough
coverage is the most logical solution for increasing the accessibility of healthcare for
everyone. An inclusive insurance bundle that covers health, life, and disability risks together

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 for the underprivileged civilians, where the health module would include all reliant blood
relatives is necessary for increasing the living standards of the poor.

 The government should make the medical college entrance exams easier and more accessible
for students so that the number of graduates and future doctors can be increased. Scholarship
programs for the students pursuing medical degrees must be introduced as incentives.
Moreover, more training facilities should be set up for nurses and other medical staff so that
the vacancies in those job positions can be fulfilled as much as possible. These measure are
required in order to increase doctor to patient ratio for the betterment of the health system.

6. Conclusion

Bangladesh MoHFW has been unsuccessful in implementing efficient steps towards identifying
the factors of inequalities in the health sector and taking subsequent actions in overcoming them.
Despite the issues faced by the healthcare sector being somewhat explicit, the decision-making at
the top level has been incompetent and uninterested in attempting to solve them. Every health
system is based on six interlinked components – proficient delivery of medical services;
adequately trained, educated, and well-distributed medical staff; an effective health information

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system; fair access to important medical supplies and equipment; sufficient funding; and proper
management and administration. The administrator of the country’s health structure should truly
understand and value these components and at the same time approach them so that the
shortcomings of the total health sector can be resolved. It is necessary to comprehend that a lack
of such a widespread approach will render investing more resources and establishing more health
institutions useless. The main concern is whether the policy makers and organizers are capable
and interested in addressing all these interrelated components of the health sector while making
attempts at implementing an integrated comprehensive approach.

7. References and Citation

Bangladesh COVID-19 Corona Tracker. Corona Tracker:

https://www.coronatracker.com/country/bangladesh/

Chowdhury, M.I. (2020) COVID-19 pandemic: Social awareness and our legal obligation as
citizens. The Business Standard: https://tbsnews.net/thoughts/covid-19-pandemic-social-
awareness-and-our-legal-obligation-citizens-61198

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Dr Rana, B.J. and Dr Sakka, H.E. (2020) WHO Bangladesh COVID-19 Situation Report #15.
World Health Organisation Bangladesh: https://www.who.int/docs/default-
source/searo/bangladesh/covid-19-who-bangladesh-situation-reports/who-ban-covid-19-sitrep-
15-20200608.pdf?sfvrsn=c2b0efc8_4

Hamid, S.A. (2014) Health Insurance for Government Employees in Bangladesh: A Concept
Paper. Pay and Services Commission, Government of Bangladesh:
https://www.researchgate.net/publication/273763025_Health_Insurance_for_Government_Empl
oyees_in_Bangladesh_A_Concept_Paper

Islam, A. and Biswas, T. (2014) Health System in Bangladesh: Challenges and Opportunities.
American Journal of Health Research, Vol. 2, No. 6, pp. 366-374:
https://www.researchgate.net/publication/276105127_Health_System_in_Bangladesh_Challenge
s_and_Opportunities

UNDP Bangladesh Research Facility team. (2020) Covid-19: A reality check for Bangladesh's
healthcare system. UNDP Bangladesh:
https://www.bd.undp.org/content/bangladesh/en/home/stories/a-reality-check-for-bangladesh-s-
healthcare-system.html

WHO. Global Health Workforce Alliance, Country responses:

https://www.who.int/workforcealliance/countries/bgd/en/#:~:text=Major%20challenges
%20include%3A%20an%20overly,lack%20of%20regulation%20of%20the

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