TDS Desk

Bangladesh used to depend heavily on Indian cattle for its meat supply. However, in 2014, when India imposed a ban on cow exports, it caused a sharp rise in beef prices and created economic challenges for Bangladesh.

Despite this setback, the country quickly took action by expanding its livestock sector. Over the next few years, Bangladesh not only achieved self-sufficiency in meat production but also began exploring opportunities to export meat to other markets.

Similarly, the Drug Control Ordinance 1982, introduced during Ershad’s regime, restricted the import of non-essential drugs and encouraged local manufacturing. Although this policy initially led to a shortage of medicines in the local market, it eventually fuelled the growth of Bangladesh’s pharmaceutical industry, which has now become a global leader in generic drug production.

Today, a similar opportunity arises with India’s ongoing visa restrictions, which have caused significant difficulties for many Bangladeshi patients who were seeking treatment in India. Previously, around 2.5 million Bangladeshi patients travelled to India annually, spending approximately $500 million on healthcare, according to India’s tourism ministry.

Dr Ahmed Mushtaque Raza Chowdhury, convener of Bangladesh Health Watch and professor of the School of Public Health at Columbia University, sees this as a pivotal moment for healthcare reform in Bangladesh. He noted that while the visa restrictions pose challenges, they come at a time when the interim government is already working to reform various sectors.

“So, this is a unique opportunity for Bangladesh to strengthen its healthcare system and restore the confidence of citizens who previously relied on treatment abroad,” said Dr Mushtaque, also the former Vice Chair of BRAC.

Public health activist Sumit Banik also highlighted the significant challenges in Bangladesh’s healthcare system, including a shortage of trained professionals, inadequate facilities and limited access to quality care, particularly in rural and marginalised areas. According to him, the concentration of tertiary care in urban centres and the lack of specialised services and modern diagnostics often compel patients to seek treatment abroad.

“Amid these challenges, the [Indian] visa restrictions offer a chance to redirect focus and resources towards strengthening the local healthcare sector,” he shared his opinion.

Experts assert that meaningful healthcare reform in Bangladesh to restore people’s faith requires a two-pronged approach: immediate short-term reforms by the interim government and foundational long-term reforms for the next elected government to continue. These reforms must address both public and private healthcare systems, starting with primary healthcare in rural areas.

Dr Chowdhury highlighted that primary healthcare services in upazilas, unions and community clinics face challenges due to inadequate technology, equipment and workforce, resulting in a lack of public trust. With healthcare expenditure accounting for only 0.7% of the national GDP, rural areas remain underserved, causing an influx of patients into urban facilities.

Despite these challenges, the Finance Ministry allocates limited funds to healthcare due to the Health Ministry’s failure to present clear and detailed budget proposals, especially highlighting areas where funding is most needed.

Dr Chowdhury stressed the importance of greater accountability within the Ministry of Health and the need for separate departments for spending and procurement.

He also noted that while Dr Zafrullah Chowdhury attempted to decentralise the healthcare system in the 1990s, those efforts were not fully realised.

“However, with the advancement of high-end technology and the possibility of online treatment, the healthcare system should no longer be confined to major cities,” said the public health expert.

Dr Shafiun Nahin Shimul, a professor at Dhaka University’s Institute of Health Economics, highlighted communication gaps within the healthcare system.

He noted that Bangladeshi doctors are not as bad as some people might assume. Still, many patients bypass primary healthcare facilities, opting instead for tertiary care and specialized doctors—even for minor ailments. This overburdens specialized doctors, reducing both the quality of care and the time available for consultations.

It’s worth mentioning that according to a 2017 British Medical Journal (BMJ) publication, the average duration of physician consultations in Bangladesh in 2015 was a mere two minutes, while in countries like Sweden and the United States, it is as high as 21 minutes. Interestingly, the same journal reported that the average length of physician consultations in India was also just two minutes.

Nevertheless, the prevailing perception among Bangladeshi patients seeking treatment in India is that Indian doctors are more engaged and eager to attentively listen to all of their concerns, be they relevant or irrelevant.

Dr Shimul proposed implementing a robust referral system to address this issue.

“A well-organised referral system would require patients to first consult primary doctors, who could then refer them to secondary or tertiary care if necessary. Without proper referrals, some people seek tertiary care even for minor issues,” Dr Shimul said.

He further explained that this would help create a more organised healthcare network and ease the pressure on urban tertiary healthcare facilities. That in turn will restore public trust in local healthcare services and reduce the need for people to travel abroad for treatment.

“Insurance companies could play a significant role in this regard by imposing restrictions on allocating funds to patients who do not consult specialised doctors without a proper referral,” said Dr Shimul.

Another recommendation proposed by him is to not only strengthen the healthcare system at the surface level but also ensure better education for everyone in relation to healthcare.

“There are many nursing and medical assistant colleges in the country, but they mainly issue certificates without providing adequate training. These certified people often fail to win patients’ trust through their work. The same issue once plagued India, but they have managed to turn the situation around by focusing on providing quality education for nurses and other healthcare professionals,” Dr Shimul said.

Over time, Bangladesh needs to develop its own specialities within the healthcare system. “No matter how advanced the US is, many people still travel from the US to Mexico because Mexico has built a strong reputation for its fertility treatments. Similarly, Bangladesh could focus on creating its niches in the healthcare sector.”

Apart from public healthcare, private healthcare also needs some major reform, opined Dr Chowdhury. He recalled the time of the coronavirus pandemic when the blood-sipping habit of private healthcare was laid bare.

He believes one of the main reasons private hospitals operate with little accountability is that the Medical Practice of Private Clinics and Laboratories (Regulation) Ordinance 1982 is outdated.

“The interim government should take steps to update it,” he stated.

He also advised that the government initiate efforts to allow foreign hospitals, such as Apollo, Mount Elizabeth, Fortis, and Bangkok Hospital, to establish their facilities in Bangladesh.

“While it’s true that such a move will face numerous objections, the government could set a condition for these foreign hospitals to work towards strengthening Bangladesh’s local healthcare capacity. In the long run, this approach would ultimately benefit the country,” he said.

Dr Shimul also observed that collaboration with hospitals from countries like Thailand and Malaysia will be beneficial in sending the message to those who go to these countries that a similar level of treatment is very much possible in our own country as well.

Meanwhile, Sumit Banik emphasised the importance of public-private partnerships (PPPs). “They can play a transformative role by fostering innovation and investment in healthcare infrastructure.”

Through this, private companies can contribute advanced technologies, expertise and capital to build or upgrade infrastructure, introduce new services, and enhance patient care.

PPPs can also help efficiently allocate resources, expand services in underserved areas and reduce financial risks for the government, ensuring long-term sustainability.