Bangladesh's healthcare at a critical juncture, moving forward thwarted by policy missteps
In the bustling cityscapes of Bangladesh, urban healthcare governance faces significant challenges that have resulted in growing inequities among its citizens.
Primary Challenges
Urban healthcare suffers from excessive coordination without effective leadership, leading to inefficiencies and duplication among government bodies, NGOs, and private providers working in silos. This lack of clear direction has resulted in a fragmented service delivery and data system, with no integrated urban health information system (HIS) that includes data from private hospitals.
High out-of-pocket (OOP) expenditures pose a severe financial burden on citizens, particularly for non-communicable diseases (NCDs), reflecting chronic underfunding of primary healthcare. The absence of a structured referral system has led to patients bypassing primary care facilities, overwhelming tertiary hospitals already under pressure.
Rapid urbanisation without matching healthcare infrastructure expansion has further strained existing health services, particularly affecting underserved slum communities. Inadequate focus on health governance in national policies means that policies do not sufficiently emphasize governance improvements critical for better coordination and service equity.
Proposed Solutions
Strengthening primary healthcare networks by expanding ward-level primary health centers in urban areas can improve access and ease tertiary hospital load. Establishing an integrated, common-standard Electronic Medical Records (EMR) system linked to national ID numbers can ensure standardized, accessible medical data across all facilities, improving continuity of care and monitoring.
Improving urban health governance through clear leadership and coordination mechanisms can reduce duplication and foster collaboration among all stakeholders—government, NGOs, and private sectors. Implementing a structured referral system can redirect patients appropriately from primary to secondary and tertiary care, optimising healthcare resource use.
Increasing public funding for primary healthcare and reducing OOP expenditures can alleviate financial barriers, especially for chronic disease management. Leveraging scalable urban health interventions targeting underserved populations, such as slum communities, can ensure equitable access amidst rapid urbanisation.
These reforms require strengthened political will, leadership, and inclusive accountability to ensure the growing urban healthcare market benefits all citizens equitably.
Despite the presence of over 645 public hospitals and 19,627 licensed private hospitals and clinics, only 914 hospitals and 1,790 diagnostic centres renewed their licences by April 2025, representing 4.66% and 5%, respectively. Healthcare access remains deeply inequitable, with wealthier populations affording private care while the urban poor rely on underfunded and poorly maintained facilities.
The 2022 STEP survey revealed that 21.5% of urban dwellers were diagnosed with diabetes, while 25.8% were hypertensive, indicating a worsening crisis in NCDs. The cost of NCD care is a significant burden, due to chronic underfunding of primary healthcare and reliance on external donors for key initiatives like the Urban Primary Health Care Services Delivery (UPHCSD) project.
In conclusion, improving urban healthcare governance in Bangladesh hinges on enhancing coordination, data integration, primary care infrastructure, financial protections, and referral systems under a unified governance framework supported by strong political commitment. A change in public mindset, recognising healthcare as a right, is also crucial for driving urgency in public discourse around reforming urban health.
- Science can play a crucial role in devising effective leadership strategies for urban healthcare governance, leading to more efficient coordination and reduced duplication.
- Embracing technology such as Electronic Medical Records (EMR) in the workplace-wellness sector can ensure standardized, accessible medical data across all facilities, improving continuity of care and monitoring.
- Incorporating medical-conditions management, including nutrition and fitness-and-exercise therapies and treatments, into personal-finance planning can help citizens manage their health expenses better.
- The finance sector, particularly medicare, needs to invest more in primary healthcare to reduce out-of-pocket expenditures and alleviate financial barriers, especially for non-communicable diseases (NCDs) management.
- By attracting investment in career-development programs for healthcare professionals, the business sector can contribute to improving urban health service equity.
- The integration of education-and-self-development resources into health-and-wellness platforms can empower individuals to make informed decisions about their lifestyle, food-and-drink choices, and home-and-garden habits.
- In collaboration with relationships experts, developing support networks for patients with medical-conditions can help improve their overall well-being and adherence to treatment plans.
- Achieving better governance requires fierce advocacy from advocacy groups and policymakers to prioritize urban health under travel and tourism policies.
- Businesses focusing on shopping, particularly those that offer health-related products, can take a more proactive role in promoting preventive healthcare measures to the public.
- Sports organizations can contribute to health equity by providing structured fitness and exercise programs tailored to underserved communities in urban areas.
- Considering weather patterns and their impact on health, especially during extreme weather events, should be a part of urban health governance strategies in order to ensure the wellbeing of citizens.
