Contradictions in health sector must be resolved to achieve universal health coverage: Experts

Despite having an extensive healthcare infrastructure, Bangladesh’s health system continues to face several structural contradictions that limit its overall performance, experts have said, stressing the need for urgent reforms to achieve universal health coverage (UHC).

The observations came during a policy dialogue titled “Actionable Priority Agendas for Achieving Universal Health Coverage” held at the CIRDAP Auditorium in Dhaka today (7 March) as part of the Bangladesh Road to Universal Health Coverage – New Dialogue Series 2026.

The event was jointly organised by the Power and Participation Research Centre (PPRC) and the UHC Forum with support from Unicef.

Policymakers, public health experts, researchers and civil society representatives participated in the dialogue to discuss key reform priorities and policy actions needed to accelerate Bangladesh’s progress toward UHC.

Presenting a paper titled “Actionable Priority Agendas for Achieving UHC,” Dr Hossain Zillur Rahman, executive chairman of PPRC and convener of the UHC Forum, said the country’s health sector is constrained by five major contradictions.

These include extensive health infrastructure but low productivity, underfunding alongside inefficient expenditure, jurisdictional ambiguity between the health and local government ministries, excessive centralisation in decision-making, and a strong focus on infrastructure development without adequate human resources.

He noted that the Service Coverage Index (SCI) remains stuck at around 54%, highlighting the need to address these systemic gaps.

Former Director General of the Directorate General of Health Services (DGHS) Dr Abul Kalam Azad also presented a proposal for introducing an e-health card, which would allow doctors to instantly access a patient’s treatment history, test results and medication records at any hospital or clinic.

He said such a system could help physicians make more accurate decisions, reduce medical errors, avoid duplication of medicines and tests, and lower unnecessary healthcare costs.

However, several issues need to be resolved before implementing the system, including whether the card will be separate or integrated with the national ID or birth registration, whether it will be citizen-based or family-based, and whether it will be a physical card, digital card or app-based system.

Authorities will also need to determine where patient data will be stored, how synchronisation will work, and how privacy and data security will be ensured.

Dr Azad noted that Bangladesh already has significant digital health infrastructure under the health ministry, including a data centre managed by the DGHS Management Information System (MIS) division. By connecting existing systems through an interoperability layer, backend requirements could be met, while a mobile app could serve as the front-end interface for patients, healthcare providers and authorities.

He also stressed the importance of strong data protection measures, including encryption, blockchain-based security and an appropriate legal framework.

State Minister for Health Dr MA Muhit said the government has formed a specialised cell to design and implement key reforms in the health sector. “Work will begin on developing the framework for an e-health card, which will initially be piloted in one to three districts before wider implementation. The government also plans to introduce a referral system and recruit 100,000 health workers in phases.”

Muhit added that the government aims to train health workers so that children with severe disabilities can be identified at the primary healthcare level.

Acknowledging persistent challenges in the sector, the state minister said corruption remains a serious concern. He noted that while the government plans to expand public–private partnerships (PPP) in healthcare, such initiatives could become sources of corruption without proper policy frameworks and monitoring.

He also highlighted several problems faced by patients in hospitals, including poor cleanliness, the presence of brokers and staff absenteeism. According to a random data check by the ministry, about 45% of staff were absent from their workplaces on a given day.

Muhit added that the government is working to establish an ambulance pool system at the upazila level to improve emergency services. He also said medical waste management, a long-neglected issue, will be addressed as part of broader reform efforts.

Emphasising the importance of ensuring the presence and safety of healthcare providers at service delivery points, particularly at the local level, he said stronger collaboration among policymakers, researchers and stakeholders is essential to improve healthcare outcomes in Bangladesh.