BANGLADESH, with significantly high life expectancy and infant mortality rates, is confronted with a growing prevalence of non-communicable diseases alongside growing mental health issues. It also faces dual challenges from chronic infectious diseases such as tuberculosis, which are intensified by inadequate funding, uneven distribution of resources, especially between urban and rural areas, and administrative shortcomings. From a geographical perspective, Bangladesh benefits from improved access and a skilled work force, which contributes to the substantial economic growth.
The primary health care initiative focused on boosting immunisation to reduce child mortality, notably in achieving a ‘polio-free’ status and implementing oral dehydration therapy for diarrhoea treatment, has seen a considerable success. However, the rapid and uneven growth of urbanisation poses long-term challenges for health management, alongside pollution and environmental pressure which are a major barrier to health infrastructure. Consequently, the current health landscape is confronted with numerous challenges and adversities.
Infectious diseases such as bacterial pathogens such as Mycobacterium tuberculosis, are responsible for tuberculosis. Over time, the focus has shifted from tuberculosis to non-communicable diseases, including stroke, heart diseases, chronic obstructive pulmonary disease, cancer and diabetes, which now account for the majority of fatalities. Simultaneously, the population bears a dual burden of inadequate public health and personal financial strain in addressing these diseases.
Mental health is another critical area of concern as Bangladesh handles a significant and escalating burden of mental health issues, with approximately 19 per cent of the adult experiencing mental disorders. The issues are exacerbated by rapid urbanisation, poverty, familial conflicts and certain genetic pre-dispositions. The acute shortage of mental health professionals, coupled with widespread medical shortage exceeding 90 per cent in this sector, is apparent. Women are particularly vulnerable to these conditions and while urban/rural discrimination is not excessively pronounced, there remains a substantial lack of mental health resources in rural areas, where conditions such as depression and anxiety are dominant.
The rise in stress, depression, neurological disorders, strokes and epilepsy is alarming. Anxiety disorders represent one of the fastest-growing categories of mental illness globally, impacting the mental development of at least 4.1 per cent of children and the adolescent. Among the most diagnosed anxiety symptoms in children and young adults aged 11 to 19 are separation anxiety or dissociative disorder; specific phobia, characterised by an irrational fear of certain stimuli; social anxiety disorder; generalised anxiety disorder; and panic disorder.
These mental anxiety disorders typically begin in early childhood or adolescence and over time, the symptoms often interact with other anxiety disorders. Bangladesh ranks among the lowest in public health expenditure globally, frequently fluctuating between about 0.7 per cent and 1.1v of its gross domestic product. As a result of insufficient funding, around 63 per cent to 73 per cent of the total health expenditure is directly incurred by patients.
This financial burden drives millions into poverty each year. Health insurance for the general populace is nearly non-existent, leaving individuals without financial protection during emergency medical situations. The scarcity of resources within the healthcare system, coupled with a lack of personnel and poor governance, perpetuates a vicious circle of underdevelopment, where the absence of resources and accountability results in significant adverse effects, including corruption, economic instability and inadequate public service delivery.
The unequal distribution of healthcare professionals, particularly specialists, between urban and rural regions is recognised as a contributing factor to the emergence of risks and illnesses. The systematic shortcomings in disease prevention and health awareness stem from various interconnected challenges within the healthcare system. A significant barrier is an inadequate emphasis on preventive measures and health promotion initiatives. The current overly centralised decision-making structure of the health ministry is deemed inappropriate, which is often the case. Top-down or top-down strategies result in a disconnect with the actual conditions in rural areas. These systemic issues are exacerbated by insufficient public health communication, particularly during emergencies such as the Covid outbreak, when misinformation proliferates because of ineffective information dissemination and subpar public health messaging.
Likewise, the recovery of the chronic infectious disease such as tuberculosis presents systemic obstacles, including inadequate patient support, exorbitant treatment costs and limited access to care, which contribute to incomplete treatment regimens and the emergence of resistant strains of Mycobacterium tuberculosis and its recovery. Despite ongoing efforts by government and non-governmental organisations through various initiatives, processes and local emergency care networks, there remains a significant deficiency in structural and institutional capacity to prioritise prevention and health education comprehensively, aiming for decentralisation and modernisation that benefits the most common and marginalised segments of the population.
The private health sector is often beyond control because of ineffective government systems, characterised by poor regulation, rampant commercialisation and high out-of-pocket expenses, leading to quality concerns and substantial financial strain for many. This unregulated landscape, marked by a focus on profit rather than quality, has driven many into debt. Conversely, key informal service providers in rural regions frequently lack adequate training, revealing significant administrative deficiencies. To transform Bangladesh into a healthy and developed nation, it is essential to establish a long-term strategic framework that addresses the issues, incorporating youth health and reproductive rights into the effective measures of the health planning structure.
At the core of this vision lies the commitment to ensuring an equitable access to health care, particularly for the adolescent and marginalised communities. It is advisable to execute the potential strategies that emphasise essential health systems, human capital, digital transformation and institutional reforms to establish a modern and stable Bangladesh, which can be viewed through the lens of current health practices, problem identification and actionable initiatives.
Universal health coverage can be broadened to encompass 75 per cent of the population by 2030, necessitating a service package that enhances health care, including lifestyle intervention and nutrition for women and children. The execution of a digital health strategy is crucial for the integration of telemedicine, electronic health records and data analysis among both public and private health service providers. The current primary health budget for the 2026 fiscal year stands at Tk 434.83 billion, reflecting a mere 5 per cent increase from the previous allocation of Tk 414.08 billion in the past financial year. This allocation constitutes 5.3 per cent of the national budget and 0.74 per cent of the gross domestic product, which is considerably lower than the 5 per cent of the gross domestic product recommended by the World Health Organisation.
Regrettably, public health allocations have consistently hovered around 5 per cent of the national budget for several years and even as the GDP share, it has marginally declined from 0.75 per cent in the 2024 financial year to 0.74 per cent in the 2025 financial year. This trend can be recognised as a clear contributor to administrative deficits and prudent management. To promote long-term health development, Bangladesh must enhance multilateral cooperation, which includes precise information sharing and investment strategies in health system infrastructure. Evidence-based decision-making, universal health coverage and community-based management will be crucial. Additionally, there will be sustainable coordination among government agencies, international donors and civic groups to align national health strategies with the Sustainable Development Goals, particularly in health.
By establishing social health protection systems and increasing government funding, while reducing out-of-pocket health expenditures for households, a blended financial system should integrates public and private capital, especially enhancing the capacity of the disease diagnostics sector, and extending medical care to health initiatives to ensure that they are more long-term, sustainable, and efficient. This can guarantee optimal resource use and social security levels.
Bangladesh has implemented several specialised training initiatives to strengthen its healthcare system, including the management sciences for health and good pharmacy practice training programme, supported by foreign funding and technology. This addresses fundamental topics including rational drug usage, patient consultation, antimicrobial resistance, pharmacovigilance and proper storage and labelling of medicines. Despite these advances, the challenges that remain include a significant shortage of healthcare workers, especially in rural areas, and a lack of investment in primary health care and community-based training. A recent survey reveals that 51 per cent of medical students are considering moving abroad, with 90 per cent expressing a preference for urban healthcare positions.
To tackle the challenges in the healthcare system, it is crucial to incorporate health workers into organised health frameworks, ensure ongoing training, and achieve a fair distribution of healthcare professionals. The progress of sustainable health systems relies on diversifying funding sources, boosting domestic investment and fortifying health systems through community-led initiatives, cross-border collaboration and integrated disease control. A modern, stable and resilient health system that promotes good health and well-being can be established through a combination of preventive services, health awareness and systemic approaches.
The concept of public-private partnership is increasingly acknowledged as a fundamental strategy for promoting long-term health development. With a population exceeding 180 million, Bangladesh faces challenges in accessing health care, particularly in rural and marginalized communities. Therefore, a measurable and sustainable model is crucial for reinforcing the health system. The governments, the private sector, non-governmental organisations and international donors are working collaboratively to address life-threatening diseases such as tuberculosis, HIV/AIDS and malaria while also establishing resilient infrastructure to achieve universal health coverage.
Sarker M Shaheen is a researcher of neurogenetics and precision medicine at the University of Calgary, Canada.
