Health System Landscape

2.1 The Health Map

2.2 Enablers to Quality Health

The three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes:

1

Experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach.

2

Experimentation with informal and contractual partnership arrangements that capitalise on the ability of NGOs to generate community trust, reach the most deprived populations, and address service gaps.

3

Rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms.

2.3 Challenges of the Health System

Implementation Barriers

Poor human resource management, including shortages, deficient training, low motivation, retention issues, quality service provision
No protocol for treatment, referral, follow-up, and even general service management.
Identifying and reaching the hard-to-reach areas and population is another challenge.
Other policy level barriers like health budget, health financing, etc.

Lack of skilled healthcare providers

Low number of nurses
Increase in the number of unqualified allopathic providers during the past decade more than the qualified or semi-qualified allopathic providers
Geographic maldistribution of nurse to doctor ratio

Distribution of health services

Overwhelming urban bias of the distribution of the formally qualified HCPs
Concentration of CHWs from the NGO sector and the village doctors mainly in the rural areas
Pharmacies are evenly distributed between the rural and urban areas
Presence of a vast number of unlicensed drugstores in the country
Availability of prescription drugs over-the-counter

Demand-side barriers

Lack of awareness about health results in low overall health service consumption
Pervasive socio cultural barriers against insurance
People are not receptive to the idea of paying for government healthcare
Communities lack awareness and are not empowered enough to hold the decision-makers and services providers responsible for providing UHC

2.4 The Rural-Urban Divide

Even though health services, especially private ones are concentrated in urban Bangladesh, slums in these area remain underserved. The slums lack the organised systems of primary care provision that are available to the rural poor.
Informal private-for-profit providers have strategically filled this gap and cannot be ignored in efforts to increase effective coverage of services particularly for the urban poor.
In Dhaka City Corporation, the country’s capital, at least 1500 new migrants arrive daily making it one of the fastest growing megacities in the world (European Commission Humanitarian Aid Office 2010). Most of these incoming migrants settle in slums, contributing to an alarming growth rate of almost 7% per year (Streatfield and Karar 2008).
Nationwide, over 35% of the urban population reside in poor slum settlements that lack basic amenities such as safe water and sanitation (Streatfield and Karar 2008).
Another situational analysis on slums in Dhaka city estimated that two in every five cases of people experiencing illness sought treatment from pharmacies (Save the Children 2014).