As climate impacts intensify across Bangladesh, the resilience of the country's health system may prove just as important as roads, bridges, embankments, and other visible development investments. Yet climate-health adaptation remains one of the least visible priorities within the country's climate-finance architecture.
Climate change impacts in Bangladesh have already turned into a public health crisis with recurring heat stress, dengue, and other vector-borne diseases that are particularly affecting women, children, older persons, and communities living in climate-vulnerable regions. Climate-related shocks are not only increasing disease burdens but are also disrupting healthcare services precisely when they are needed most.
Bangladesh has already recognized this challenge at the policy level. The Bangladesh Climate Change Strategy and Action Plan (BCCSAP) first identified health as a climate-sensitive sector. The National Adaptation Plan (NAP 2023-2050) expanded this recognition by identifying specific health adaptation priorities, including surveillance systems, climate-resilient healthcare facilities, and climate-health research.
More recently, the Health National Adaptation Plan (HNAP 2026-2030) has gone further by framing climate change as a systemic challenge affecting health service delivery, workforce preparedness, surveillance systems, governance, emergency response, and infrastructure resilience.
Yet the growing recognition of climate-health risks has not been matched by a comparable shift in financing priorities.
Figure 1. Trend in Climate-Relevant Allocation vs Total Health Budget, Health Services Division (FY 2021–22 to FY 2025–26)
While the overall health budget has grown steadily over recent years, climate-relevant allocations have not kept pace. Within the Health Services Division, climate-relevant spending accounted for 2.74% of the total budget in FY 2021-22. By FY 2025-26, that share had fallen to 1.97%. This trend raises an uncomfortable question ahead of the national budget: Are public financing priorities evolving at the same pace as climate realities?
While health is increasingly recognized within adaptation planning, it remains only partially visible within financing systems. A recent study conducted by the Center for Participatory Research and Development highlighted at least three challenges associated with the disconnect between climate planning and financing in Bangladesh's health sector.
Challenge one: Fiscal visibility
Climate-health expenditure is often embedded within broader adaptation categories rather than being identified as a distinct financing priority. Within the climate budget, health is grouped under the BCCSAP thematic pillar of "food Security, social protection, and health" alongside agriculture, livelihoods, fisheries, water, and sanitation interventions.
While this thematic pillar consistently receives the largest share of climate-related public expenditure, the way it is structured makes it difficult to identify how much is actually being spent on health adaptation.
Challenge two: Nature of climate-finance investments
Current financing structures continue to favour visible and capital-intensive infrastructure projects. Analysis of Bangladesh Climate Change Trust Fund (BCCTF) allocations shows that infrastructure-oriented sectors receive the overwhelming majority of discretionary climate-finance support, while health-led adaptation projects receive only a very limited share.
Figure 2. BCCTF Allocation by Thematic Area: Infrastructure Dominance and Limited Health Financing
This reflects a broader tendency within climate-finance systems to prioritize physical assets over institutional resilience. But Bangladesh's adaptation progress cannot be judged solely by the number of projects completed or facilities constructed.
A hospital building, for example, is important, but it does not by itself create a climate-resilient health system. Without disease surveillance, trained personnel, emergency preparedness systems, climate-health data, and operational financing, infrastructure alone cannot protect communities from climate-related health risks.
Analysis of climate-health allocations and expenditures suggests that climate-health financing remains concentrated within a relatively narrow project-oriented framework. This may not create resilience unless the budget allocations are targeted to disease surveillance, trained health workers, emergency preparedness, research, and strong public health institutions.
Challenge three: Growing disconnect
The National Adaptation Plan (NAP) and the Health National Adaptation Plan (HNAP) envision climate-health adaptation as a long-term institutional shift with sustained investments.
Here lies the disconnect. Bangladesh's adaptation plans look decades ahead and emphasize long-term resilience across multiple institutions. Budget systems, however, are still largely organized around annual spending cycles, broad expenditure categories, and development projects.
Several NAP priorities, including disease surveillance, early warning systems, mental health, climate-health research, and broader health-system resilience, remain weakly visible or entirely absent within current climate-budget structures.
Bangladesh has already identified many of the solutions. What remains uncertain is whether budgeting and financing systems will evolve quickly enough to put those solutions into practice.
Given the context, the upcoming budget provides an opportunity to start closing this gap.
First, climate-health expenditure should become more visible within public financial systems. Dedicated health adaptation budget lines, clearer sectoral disaggregation, and improved climate-budget tagging would strengthen transparency and allow policy-makers to better assess financing needs and outcomes.
Second, climate-health financing should move beyond a predominantly infrastructure-oriented approach. Greater attention should be given to recurrent investments that strengthen surveillance systems, preparedness, workforce capacity, emergency response, and continuity of care. These are the foundations of long-term resilience.
Third, the forthcoming budget should mark the transition from climate-health planning to climate-health implementation. Bangladesh has both the NAP and HNAP that clearly identify priority investments and implementation responsibilities. What remains missing is a corresponding fiscal architecture.
Unless adaptation priorities are translated into budget lines, expenditure tracking mechanisms, and medium-term financing commitments, climate-health resilience will remain stronger in policy documents than in public finance systems.
Bangladesh has already done the difficult work of recognizing climate change as a health issue and identifying what needs to be done. The next challenge is ensuring that future budgets reflect that reality.
Financing systems must be prepared to respond before risks become even more costly to manage. Investing in climate-resilient health systems is not simply a health-sector expenditure. It is an investment in economic productivity, social stability, and the country's ability to withstand a rapidly changing climate.
Sumaiya Binte Anwar, Program Manager, Centre for Participatory Research and Development. Md Shamsuddoha is Chief Executive, Centre for Participatory Research and Development.