Health allocation doubles, but patients’ medical expenses keep rising

The government’s allocation for the health sector has doubled on paper over the past five years. However, patients’ medical expenses have not decreased; instead, they have increased.

In the fiscal year 2021-22, the allocation for the health sector was Tk32,274 crore. In FY2026-27, it has increased to Tk69,409 crore. Yet during this period, patients’ out-of-pocket expenses have not declined; rather, they have risen to nearly 80 percent.

Every year, more than 6.1 million people are falling below the poverty line while trying to meet their medical expenses.

Experts believe that the health protection of marginalised people has virtually collapsed due to inadequate supplies of medicines, administrative waste, weak services at government hospitals and a procurement-driven development policy.

According to them, unless corruption, nepotism and contractors’ commission business are stopped, even increasing the health budget three to five times would not bring any meaningful change to the country’s healthcare system. Instead, ordinary people will become impoverished while seeking medical treatment.

Double on paper, but in reality?

There has long been a demand for allocating at least 5 percent of the national budget to the health sector. After the July uprising, the Health Sector Reform Commission formed under the interim government recommended allocating at least 15 percent of the budget to health, but the recommendation was not implemented.

According to data from the Ministry of Health and Family Welfare, the allocation for the health sector was Tk32,274 crore in FY2021-22. It was gradually increased to Tk69,409 crore in FY2026-27, equivalent to only 1.01 percent of GDP. Although the figure has doubled in the budget, it remains insignificant when compared with population growth and inflation.

Patients’ out-of-pocket expenses rise to nearly 80%

According to the Strategic Plan of the Health Economics Unit, patients’ out-of-pocket expenditure was supposed to be reduced to 32 percent by 2032. When this target was set in 2012, out-of-pocket spending stood at 64 percent. However, instead of moving toward the target over time, the opposite has happened. The figure stood at 64, 66 and 69 percent respectively from 2018 to 2020, and has now risen to around 79-80 percent.

The treatment of 79-year-old Piara Begum, who recently travelled from Rajshahi Medical College Hospital to the National Institute of Cardiovascular Diseases in Dhaka, cost around Tk12 lakh. Her son Dalim said, “Tk9 lakh alone went toward buying an ICD device (pacemaker) for my mother. We are selling our land and the only cow we own to pay for her treatment. We are now completely destitute.”

Nazmun Nahar Tamanna, 29, spent Tk42,000 after being admitted to a private hospital in Badda for four days to receive treatment for ordinary measles. Due to negligence by doctors and nurses and long queues at government hospitals, middle- and lower-income people are being forced to turn to private hospitals.

Spending on medicines

The 1998 sector programme called for allocating 60-65 percent of primary healthcare funds to medicines, but the implementation never exceeded 30 percent. As a result, ordinary patients have fewer opportunities to receive medicines free of charge.

According to the latest estimate by the government’s Health Economics Unit, the country has an annual demand for medicines worth around Tk37,000 crore. Due to inadequate government allocations, people have to purchase medicines worth Tk34,400 crore from their own pockets. In percentage terms, this amounts to around 93 percent.

Poor people in distress

According to a 2022 study by the Bangladesh Institute of Development Studies (BIDS), a family spends an average of Tk3,454 per month on healthcare. This amounts to around 10 percent of their total income. For poor families, however, the share is more than three times higher, with around 35 percent of their income going toward medical expenses. As a result, nearly 18 percent of households face catastrophic health expenditure. At the same time, more than 6.1 million people fall below the poverty line every year.

Budget shortfall and mismanagement

Professor Rumana Haque of the Institute of Health Economics at the University of Dhaka believes that the health sector’s disastrous situation is the result of budgetary shortages compared with actual needs and mismanagement.

Speaking to Asia Post, she said, “The population is growing, while the number of elderly people is also increasing. At the same time, non-communicable diseases such as cancer, hypertension and diabetes are spreading widely.

Overall medical expenses have increased significantly due to new medicines and modern treatment methods. Although the health budget has increased somewhat on paper, it is insignificant compared with the growing population and rising prices.

Moreover, a large portion of the allocation is spent on administrative and ancillary activities, while very little reaches the actual service sector.”

Only 30 percent of people in the country receive government healthcare services, while the remaining 70 percent seek services from the private sector.

In this regard, Professor Rumana Haque said, “As there is no health insurance in the country and government hospitals lack integrated services for non-communicable diseases, people are forced to rush to private hospitals in search of quicker treatment. Taking advantage of this weakness in government management, the private sector is costing people huge amounts of money, causing many families to suddenly become destitute and fall below the poverty line.”

Call to stop nepotism and corruption

Health management specialist Professor Dr Abdus Sabur Khan believes that despite demands for increasing the health budget by presenting a larger monetary figure, the increase is not having any impact on ordinary people’s access to healthcare. According to him, the crisis in the health sector cannot be resolved simply by increasing the budget or the number of buildings; rather, ensuring the presence of specialist doctors at the upazila level should be the priority.

Professor Sabur Khan told Asia Post, “Marginalised people are being deprived of the services they deserve due to inadequate allocations, a large portion of the budget being spent on officials and employees’ salaries and allowances, and corruption and procurement-driven policies. If political nepotism and corruption are not stopped, increasing the budget three to five times will still not bring any change to the service sector.”

The expert said, “A large portion of the health budget goes toward the salaries and allowances of officials and employees. Once the new pay scale is implemented, this expenditure will increase further. As a result, allocations for purchasing free medicines and equipment for patients at hospitals will decline. Patients are then forced to purchase everything from gauze and bandages to medicines with their own money, which is increasing out-of-pocket expenditure manifold.”

Asked what should be done, he said, “No doctor should be posted to district or medical college hospitals until all specialist positions at the upazila level are filled. At the same time, the outpatient department hours of government hospitals should be changed to two shifts—from 10am to 1pm and from 4pm to 7pm. This would reduce doctors’ tendency to engage in private practice in the afternoon and ensure that patients receive proper services.”