Next government must prioritise health reform

Despite repeated promises of reform, poor governance, inadequate financing, and weak leadership continue to undermine progress in the health sector. A recent policy dialogue on Universal Health Coverage (UHC) has once again highlighted the deep structural weaknesses that have persisted in our healthcare system for decades. Experts have stressed that meeting the target of achieving UHC by 2030 will require strong political will from the next government.

According to the data presented, Bangladesh’s service coverage index stands at 54 out of 100, well below the global average of 71 and ahead of only Pakistan and Afghanistan in South Asia. This is a reminder that without comprehensive reform measures, millions will continue to be deprived from access to essential healthcare, while high out-of-pocket expenditure will continue to push families further into poverty. As reported before, primary care, long recognised as the most cost-effective and equitable pathway to UHC, remains weak, underfunded, and unevenly distributed in the country, especially in urban areas. At a time when non-communicable diseases are rising sharply, this imbalance is particularly concerning. Strengthening primary healthcare, therefore, must be at the centre of the reform efforts.

Thailand’s Universal Coverage Scheme provides an important lesson for us. It started in 2002 and has continued because of the strong political commitment behind it. The programme reduced out-of-pocket health spending from about 50 percent to almost 10 percent. We also need such long-term political commitment that goes beyond elections and party politics. Financing remains a major challenge, though. Experts have repeatedly called for increasing health expenditure to at least 15 percent of the national budget or around five percent of GDP, which is needed for real progress towards achieving UHC. However, higher allocations alone will not deliver results unless accompanied by efficient utilisation, transparency, and accountability.

In this context, the recommendations of the Health Sector Reform Commission deserve renewed and serious attention. Proposals such as making primary healthcare a constitutional obligation, reorganising governance structures, decentralising service delivery, and establishing independent oversight bodies provide a credible roadmap for reform. Equally important is addressing chronic weaknesses in leadership, manpower planning, and regulation.

As experts have pointed out, health has not been sufficiently framed as a strategic national priority, despite its profound implications on poverty reduction, economic growth, and social equity. While many of our political parties have outlined health sector plans in their manifestos, the real test will be in their implementation. The next government must demonstrate genuine commitment to prioritising health sector reforms, otherwise the 2030 UHC target will remain out of reach.