In a welcome departure from years of low public funding for healthcare, the government has proposed a significant increase in the health sector budget. It is a heartening move. One can only hope the proposal receives final vetting as parliament prepares to approve the FY 2026-27 national budget later this week.
For too long, citizens in Bangladesh have faced some of the highest out-of-pocket health costs in the world, while the state’s financial contribution remains among the lowest. Currently, individuals must bear up to 70% of their healthcare costs directly.
Consequently, many poor households simply cannot afford medical care. Over the past few years, thousands of fresh graduates who had managed to climb from ultra-poverty into the lower-income bracket fell back through the cracks and dropped below the abject poverty line.
Historically, the health sector's share of the national budget has hovered around 5%. However, for the first time, the government has proposed raising this allocation to 7.4% of the total national budget for FY 2026-27. This amount is equivalent to slightly over 1% of our gross domestic product (GDP), up from a meager 0.58% in the previous financial year.
Addressing out-of-pocket expenses
Should we now expect our out-of-pocket medical expenses to gradually decline?
The math of a higher allocation does not yield a straightforward answer. The true outcome depends entirely on how the health administration spends these increased funds -- or if it even has the capacity to spend them at all.
Recent history suggests we face a steep uphill battle; we have a poor track record of utilizing allocated health budgets.
A grim reality check occurred during the Covid-19 pandemic. Even in the midst of a severe public health crisis, the health administration failed to spend its allocated funds, leaving a massive pool of resources untouched.
This inability to spend stemmed primarily from systemic inefficiencies, bureaucratic red tape, and a lack of managerial capacity within the Ministry of Health and Family Welfare and its subordinate offices.
Despite the urgent need for emergency equipment, intensive care units (ICUs), and oxygen supplies during the pandemic, the ministry and its directorates processed tenders and recruited critical staff -- such as nurses and technicians -- at a snail's pace.
The health sector consistently fails to complete development projects within designated deadlines. When projects lag, the Implementation Monitoring and Evaluation Division (IMED) of the Planning Ministry slashes allocations during mid-year budget revisions, or the unspent funds simply revert to the Ministry of Finance.
Historically, this budgetary process has been highly fragmented. During mid-year reviews, up to one-third of the health allocation is typically cut, while another large portion goes unspent due to weak execution and operational waste.
A budget analysis by the think-tank Unnayan Shamannay revealed that the ministry is far more efficient at managing operating expenditures than development expenditures.
On average, the health administration spends 92% of its operating budget but manages to utilize only 76% of its development budget. In other words, nearly one-quarter of development allocations go entirely to waste.
Patients in Bangladesh have long complained that while health infrastructure is mushrooming across remote grassroots areas, these facilities offer very little actual care.
This paradox is driven by a chronic lack of essential medicine supplies, vital medical equipment, maintenance budgets, doctors, and support staff.
To access quality services, citizens are forced to spend more money traveling from unions and upazilas to district hospitals, from districts to major cities, or -- for those who can afford it -- abroad.
Bangladeshis spend over $5bn annually on medical treatment abroad, with India and Thailand being the primary destinations due to their advanced healthcare systems.
An increased national healthcare budget will only represent a meaningful investment if it directly improves local services to the point where citizens no longer need to seek costly medical care abroad.
A development budget should not merely fund the construction of new brick-and-mortar structures. Instead, it must prioritize recruiting personnel to fill thousands of vacant posts, securing medicine supplies, and funding the operation of expensive diagnostic machinery.
For instance, an acquaintance of mine had to travel to Chennai last week just to have his lung fluid monitored. As a heart patient, his condition required a Remote Dielectric Sensing (ReDS) machine -- technology that Bangladesh currently lacks.
Furthermore, the expensive medical equipment in our public hospitals frequently malfunctions due to a lack of trained operators and poor maintenance.
Admittedly, Bangladesh possesses an extensive network of physical health facilities, particularly in rural areas. This includes community clinics, union sub-centres, union health and family welfare centres, upazila health complexes, district general hospitals, medical college hospitals, and specialized institutes.
Yet, citizens remain dissatisfied. Nice buildings alone cannot deliver healthcare without equipment, medicines, and a steady presence of doctors, nurses, and technicians.
Lack of personnel
While Bangladesh's current doctor-to-population ratio is reasonable, the country suffers from an acute shortage of trained nurses, midwives, and technicians.
Moreover, a high number of registered doctors does not guarantee universal access to care. A severe urban-rural maldistribution persists, with nearly 75% of doctors and nurses serving urban areas.
It is a striking paradox that while the majority of Bangladeshis live in rural communities the vast majority of healthcare providers reside in cities.
Stark disparities also exist within the sector's internal funding priorities.
Non-communicable diseases (NCDs) now account for 71% of all deaths in Bangladesh. Despite this massive burden, only 4.2% of the total health budget goes toward NCD control.
According to the 2025 Health and Morbidity Status Survey by the Bangladesh Bureau of Statistics (BBS), hypertension ranks as the leading illness among the country’s top diseases. It is a major risk factor for heart disease, stroke, and kidney failure.
A 2025 World Health Organization report noted that cardiovascular diseases claimed 283,800 lives in Bangladesh in 2024, with hypertension responsible for 52% of those fatalities.
Research demonstrates that every 1 taka invested in hypertension screening and treatment yields an 18 taka return. Yet, due to a starved budget, primary healthcare facilities across the country still cannot guarantee an uninterrupted supply of anti-hypertensive medication.
Before we celebrate the higher health allocation in the FY 2026-27 national budget, we must first look at where those funds will actually be channeled.
Investments must target NCD control, the equitable redistribution of healthcare providers to eliminate the urban-rural divide, and strict incentives to ensure doctors posted to remote areas actually stay there.
Funds must also focus on filling vacant institutional posts and stabilizing the supply of essential medicines and machinery.
A persistent failure to spend the health budget has historically weakened the sector's leverage to bargain for larger allocations, keeping public health spending pegged at a low percentage of the GDP.
Now that the new government has committed greater funds, the sector cannot afford to falter. The ultimate challenge is to ensure this increased allocation is aggressively invested into our most pressing public health priorities, finally shielding the public from crippling out-of-pocket expenses.
Reaz Ahmad is Editor, Dhaka Tribune.