Bangladesh’s healthcare landscape is standing on the precipice of a historic transformation. Welcoming the nation’s unprecedented Tk 69,401 crore health budget, Professor Syed Abdul Hamid of the Institute of Health Economics at the University of Dhaka declared the allocation a monumental opportunity to overhaul public healthcare and radically expand citizen services.
In an exclusive conversation with Md Al Amin Sadman of TIMES of Bangladesh, Professor Hamid hailed the budget as a watershed milestone, highlighting a historic first: national health spending has finally breached the 1% GDP threshold, climbing to 1.01% from the current fiscal year’s bleak 0.58%.
However, Prof Hamid he stressed that the true significance of the allocation will be determined by its implementation rather than the announced figure. According to Hamid, the government’s foremost challenge is ensuring funds are fully utilized and translated into better healthcare access and outcomes.
He warned that long-standing structural weaknesses within the health sector could undermine the budget’s impact if left unaddressed, arguing that increasing allocations alone is insufficient. Meaningful reform, he noted, requires overcoming persistent barriers to spending and service delivery. To maximise the benefits of this record allocation, Professor Hamid proposed a series of measures aimed at improving healthcare delivery, strengthening accountability, and ensuring public spending produces visible results for patients.
Without immediate action, he warned, future promises of raising health spending to 5% or 10% of GDP will carry no weight.
Pointing to the previous fiscal year, he noted that the initial Tk42,000 crore allocation was ultimately slashed to Tk34,000 crore in the revised budget due to the ministry’s inability to spend it.
To avoid a repeat of this mid-year reduction, Professor Hamid urged the government to ensure the health ministry receives and fully utilizes the entire proposed allocation to deliver tangible, welfare-driven services directly to the public.
To understand the utilisation challenge, Professor Hamid categorized the proposed budget into three parts: the operating budget for regular hospital management, the existing development budget for ongoing projects, and a massive development reserve of approximately Tk 27,000 crore set aside for electoral pledges.
Regarding the operating budget, he identified several critical systemic bottlenecks that routinely stall expenditures. These include the Essential Drugs Company Limited (EDCL) frequently failing to supply medicines on time or issue No Objection Certificates (NOCs) for local purchases, as well as a widespread lack of managerial capability.
Furthermore, hospital managers, often intimidated by local political actors demanding tenders, frequently hesitate to make procurement decisions.
Weaknesses in auditing and accounting systems, along with slow coordination from supporting agencies like the Health Engineering Department (HED), Public Works Department (PWD), Central Medical Stores Depot (CMSD), and the National Electro-Medical Equipment Maintenance Workshop and Training Centre (NIMEW), continue to paralyse hospital operations.
To streamline operating expenditures, Professor Hamid proposed two immediate structural solutions.
First, the Directorate General of Health Services (DGHS) should establish a dedicated procurement helpdesk staffed by three to five procurement specialists to guide district and upazila hospitals through complex purchasing guidelines.
Second, a powerful coordination cell, led by an additional secretary at the Ministry of Health, must be created to streamline operations with external supporting organizations like the EDCL, PWD, and CMSD.
Additionally, Prof Hamid urged the government to hold hospital managers accountable. While emphasising that they should be properly trained and empowered to make decisions, he argued they must also face administrative consequences if they fail to spend their allocations and leave patients without care.
“If you cannot spend the allocated funds to serve the patients, you have no right to hold your position,” he said.
For the development reserve budget, Prof Hamid recommended implementing well-considered projects that yield immediate public benefits.
His first recommendation is to address the 25 to 30 per cent vacancy rate in government hospitals by immediately hiring support staff, nurses, and technologists. This approach, he noted, could bypass the lengthy Bangladesh Civil Service (BCS) recruitment process and be fully accomplished within a single year.
He also proposed a phased universal maternal care programme, noting that Bangladesh records around 3,000 to 4,000 maternal deaths each year out of roughly 30 lakh deliveries, with home births posing high risks of oxygen deprivation and long-term developmental impacts for newborns.
To ensure institutional delivery, he suggested allocating Tk 50,000 per pregnant mother. Funded by the reserve budget, this programme could be rolled out over three years at an annual cost of about Tk 5,000 crore, aiming to expand access to full prenatal, delivery, and postnatal care. “The mothers will not receive cash; they will receive comprehensive services covering ANC [antenatal care], PNC [postnatal care], and safe delivery at public or designated private hospitals,” he clarified.
Furthermore, Prof Hamid advocated for strategic purchasing to protect citizens from catastrophic health expenses during emergencies.
He suggested identifying families suffering from cancer and kidney diseases and offering them a Tk 3 to 5 lakh treatment ceiling, with the government directly reimbursing the healthcare providers.
To prevent road accident victims from dying en route to distant government facilities, he proposed that the government partner with designated private hospitals.
By funding installation charges to equip emergency departments and officially guaranteeing the reimbursement of treatment costs, the state can incentivise private hospitals to admit emergency accident patients without fearing unpaid bills or police harassment.
Finally, addressing the government’s plan to launch an “E-Health Card,” Prof Hamid agreed that digital records are highly beneficial.
However, to achieve true reform, he proposed linking the health card to a Tk 50,000 annual financial ceiling per family for services and medicine at public hospitals.
Armed with a card that explicitly guarantees a Tk 50,000 health entitlement, citizens will gain the legal leverage to question hospital staff if they are denied medicine or asked to perform diagnostic tests at outside commercial facilities.
“This will help citizens understand their legal rights and give them a stronger voice to demand services,” Hamid explained. “They will be able to say, ‘My Tk 50,000 entitlement is not exhausted. Why are you not providing this service?’ This will make the system more accountable.”
While the digital card creates the technical environment, he emphasised that it is this entitlement system that delivers the actual benefits directly to the people.
According to Hamid, this bottom-up pressure will force hospitals to utilise their budgets, curb corruption, and build public trust in the healthcare system, whilst allowing the state to calculate the massive multiplier value of its health investments.
He noted that a major shift would occur if health financing were calculated within a broader framework where the government’s contribution and total system value are properly reflected, rather than just looking at the initial allocation.
He argued this approach would significantly change how out-of-pocket payments and overall health spending are accounted for, leading to a drastic, positive revision of the system’s financial picture.
“Three benefits emerge: citizens become empowered because they receive the services they are entitled to and understand what they should receive; hospitals gain clarity on service delivery and value, which improves accountability; and the government will be able to gain public trust and connect with the people more deeply,” Hamid concluded.
