Inefficiency, poor planning waste 80% of health budget

Bangladesh’s healthcare system has become capable of meeting the majority of domestic demand, but chronic mismanagement and poor planning are draining nearly four-fifths of the sector’s public spending, according to AM Shamim, general secretary of the Bangladesh Private Hospital, Clinic and Diagnostic Owners Association.

In a recent interview with The Daily Star, he argued that the country has reached a point of functional self-reliance in healthcare delivery, even as deep structural flaws continue to threaten efficiency, accountability and public trust.

Shamim, also the managing director of Labaid Group, one of the country’s largest private healthcare providers, said that over the past two decades, the health sector in Bangladesh has expanded in terms of both infrastructure and workforce, with the private sector now providing close to two-thirds of all health services.

The gains, however, he said, are being blunted by wastage, regulatory dysfunction and weak governance.

The Labaid MD pointed to the sharp fall in outbound medical travel as one of the indicators of the system’s growing capacity.

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Caption AM Shamim

He claimed that medical visas to India, once routine for Bangladeshi patients seeking treatment, have fallen to a tenth of their previous levels over the past 18 months.

Despite this drop, he said, the local healthcare system has faced no major disruption, reflecting its growing capacity to meet domestic demand.

Where Dhaka Medical College Hospital once served as the default option for emergencies, private hospitals such as Square and Labaid are increasingly becoming the first choice for patients seeking timely and specialised care, he said.

Shamim noted that this progress masks a disturbing reality.

“Our national health budget stands at around Tk 42,000 crore. But nearly 80 percent of that is wasted. Equipment that isn’t needed is purchased, while the ones we do need often sit idle and unused,” he said.

The problem is not a lack of resources but their deployment. For instance, he said at Labaid Cancer Hospital, two linear accelerator (LINAC) machines deliver radiotherapy to between 160 and 220 patients a day.

In contrast, he emphasised, “government cancer hospitals have 8-12 LINAC machines, yet they treat fewer patients. That’s not a technical issue -- it’s purely a matter of management.”

Red tape compounds the dysfunction. Noting that there were once around 17,500 licensed hospitals and diagnostic centres, he said that number has now dropped to just 3,000 hospitals and 7,000 diagnostic centres.

“To set up a hospital, you need approvals from at least 18 different agencies, ranging from fire services, the Department of Environment, narcotics control, boiler inspection, generator compliance, and more,” he said.

“The main issue is that licenses remain valid for just one year. By the time one agency completes its inspection, the year is already over. This opens the door for delays, bribes, and inefficiencies,” he added.

The government extended the licence validity to two years last month. But Shamim warned that the underlying problems remain.

He proposed several fixes, including a unified licensing system that would consolidate approvals under a single authority.

Besides, he called for a national accreditation programme, modelled on India’s NABH and NABL systems, which would grade hospitals from A to C based on beds, staff, equipment and services, weeding out substandard establishments.

Public-private partnerships could revive nearly 80 idle public healthcare facilities, leveraging the private sector’s proven ability to attract talent, he added, noting that two-thirds of Bangladesh’s 70,000 physicians and three-quarters of its 26,000 nurses work privately.

“This proves that public and private healthcare are complementary, not competitors,” said the general secretary of the owners’ association.

Shamim acknowledged that the private sector has its own failings. “Many doctors do not spend enough time with patients and often fail to provide adequate counselling.”

He suggested regulations on consultation lengths and daily patient loads.

He also urged the media to play a more balanced role. “Take the example of primary angioplasty after a heart attack. Worldwide, 9 out of 10 patients survive. But when that one patient dies, it makes headlines, overshadowing the success of the other nine.”

But at the end of the day, the fundamental challenge remains governance.

“People may survive skipping a meal, but they cannot function without proper treatment,” Shamim said. “It’s time we nurture and invest in this sector with the seriousness it deserves.”

Restoring public confidence in healthcare requires coordinated effort among the government, private sector, and media, he said.

“We (the private healthcare sector) are not an opposition of the government, or the people. We are part of the same system. If we work together, we can build a truly healthy Bangladesh.”