Reform Commission recommends allocating 15pc of national budget to health sector

The Health Sector Reform Commission has called for greater investment in health to build a people-oriented, accessible, and universal healthcare system. It has recommended recognising primary healthcare as a legal right in the constitution and ensuring free treatment for low-income people.

The commission submitted its report to the interim government's Chief Advisor, Professor Muhammad Yunus, on Monday morning. According to the report, Bangladesh has yet to overcome major obstacles in building a fair, humane, and sustainable health system.  

Corruption, limited capacity, weak management, and poor-quality medical education pose serious threats to the sector’s future. The country’s healthcare system is facing an increasingly complex reality.

The government has consistently under-allocated funds for key sectors like health. Experts have long urged for increased investment. Over the past decade, the health sector has received an average of only 5 per cent of the national budget, and its share of GDP has never exceeded 2 per cent. The commission recommends that health receive at least 5 per cent of GDP and 15 per cent of the national budget. 

After formally submitting the report to the Chief Advisor, the Health Sector Reform Commission held a press conference at the Foreign Service Academy. During the event, members of the commission presented key points of the report to journalists. The programme was moderated by Chief Advisor's Press Secretary Shafiqul Alam. 

At the press conference, National Professor AK Azad Khan, head of the commission and President of the Bangladesh Diabetic Association, said the commission proposed several practical reforms. Among them are making primary healthcare a legal obligation, forming a separate healthcare commission, and decentralising service delivery. 

Commission member and cancer specialist Professor Syed Akram Hossain presented the main contents and recommendations of the 322-page report.

He said the commission held 32 meetings with stakeholders, consultation meetings in eight district towns outside Dhaka, and a total of 51 meetings conducted by the commission members themselves.  

They also received input from experienced individuals, professionals, and expert organisations. In addition, a survey of 8,256 adults from all eight divisions of the country was conducted by the Bangladesh Bureau of Statistics. The commission has given serious consideration to the findings of this survey. 

The Health Sector Reform Commission has highlighted that health remains a low priority in state policy and budgeting. In its report, the commission notes that over the past 15 years, health has consistently ranked eighth in national budget allocations - behind sectors such as public administration, education, transport and communication, local government and rural development, defense, agriculture, and social welfare. 

The chapter on “Health Sector Financing” in the report was authored by Dr. Ahmed Ehsanur Rahman, a scientist at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Speaking to Prothom Alo after the press conference, he said, “Except for some legal reforms, nearly all the proposed changes require substantial funding. A low budget allocation will make implementation impossible. That’s why we’ve also included recommendations for sustainable financing in the health sector.”

The report calls for an immediate increase in public health spending, recommending that at least 5 per cent of GDP and 15 per cent of the national budget be allocated to health.

According to the commission, such investment will expand access to services, reduce out-of-pocket expenses, and provide financial security for citizens. It would also enable essential investments in infrastructure, human resources, and modern medical technologies. Countries that have made progress toward universal health coverage, the report points out, typically spend 5 per cent or more of their GDP on health. 

To ensure long-term sustainability, the commission has made 33 specific recommendations, including the enactment of a ‘Health Financing Security Act’. It suggests increasing taxes on tobacco, sugary drinks, energy drinks, breast milk substitutes, processed foods high in trans fats or salt, and other harmful products. A portion of the revenue from these taxes should be earmarked specifically for the health sector.

The report also proposes taxing luxury and non-essential goods, with some of that revenue directed toward health funding. Other recommendations include establishing a health security fund using corporate social responsibility (CSR) contributions, launching health development bonds targeted at expatriates, and introducing social health insurance. Additionally, it stresses the need for cost-saving measures through more efficient procurement and spending.

At the press conference, the Health Sector Reform Commission announced a key proposal to ensure free healthcare services for the poorest 20 per cent of the population.

According to the commission, half of this group would receive free treatment from government hospitals, while the other half would be treated at private hospitals.

The report specifies that the extremely poor will have access to all types of healthcare services - outpatient, inpatient, medication, and diagnostic tests - free of charge at any nearby health facility. In public hospitals, at least 10 per cent of patients must be treated free of cost. The same requirement would apply to private hospitals. However, the report notes that this is not a new provision; such a condition has existed for private hospitals but has not been enforced due to political and institutional inertia.

Commission member Abu Mohammad Zakir Hossain told Prothom Alo, “We’ve reintroduced this provision in our report to ensure it becomes mandatory.”

The commission has also made a range of recommendations aimed at improving the quality of healthcare services for all citizens. One of the key proposals is that physicians must spend a minimum of 10 minutes with each patient. To ensure this standard is maintained, the commission has proposed regular weekly audits of physicians’ prescriptions.

Other service reforms include the requirement for government hospital pharmacies to remain open 24 hours a day, seven days a week. Daily operational hours of government hospitals and healthcare centers should be extended - from the current 9:00 am to 2:00 pm to 9:00 am to 5:00 pm on working days. The commission believes this would ease pressure on the private healthcare sector and enhance access to public health services.

The report also highlights the strength of Bangladesh’s pharmaceutical industry, which meets 98 per cent of domestic demand and offers medicines at comparatively affordable prices. To build on this success, the commission has recommended introducing incentives for pharmaceutical research and innovation.

During the press conference, journalists asked commission members which of the proposed reforms would be the easiest and most difficult to implement. The responses varied, reflecting the diverse challenges the health sector faces.

Professor Liaquat Ali, commission member and chairman of the Pothikrit Foundation, said that legal reforms outlined in the report would be the easiest to implement. “If the government has the will, it can enact these reforms swiftly - possibly even through an ordinance,” he said.

However, he noted that the most difficult task would be changing the prevailing mindset. “That applies to both policymakers and the general public,” he added.

Another commission member, Abu Mohammad Zakir Hossain, who also serves as the president of the Community Clinic Health Assistance Trust, pointed to structural reforms as the hardest to realise.

“The proposal to establish the Bangladesh Health Service will be particularly challenging,” he said, citing institutional resistance.

He also emphasised that recommendations on coordination across the health system would face similar hurdles.

Meanwhile, ICDDR,B scientist and commission member Ahmed Ehsanur Rahman offered a different perspective. “Whether a recommendation is difficult or easy isn’t the issue,” he said. “What matters is identifying which recommendations are most important and implementing them through a cluster plan.”

He underscored the commission’s core vision: “We want to see health treated as a public service, not as a commercial product. That is the responsibility of a welfare state.” 

Concluding the press conference, Azharul Islam Khan, ICDDR, B consultant and member of the Health Reform Commission, expressed concerns that emergency medical services and insurance systems had received little attention in the discussion.

He described the state of emergency medical response in Bangladesh as “dire,” noting that the private sector lacks any real emergency infrastructure. “Even in government hospitals, existing emergency services are grossly inadequate,” he added.

He urged journalists to actively raise these issues in the public discussion. 

The Health Sector Reform Commission has proposed the establishment of a dedicated National Women’s Health Institute - a specialised facility to serve as a referral, training, and research centre focused exclusively on women’s health.

Speaking at the press conference, Professor Sayeba Akhter, a commission member and leading expert in women’s health, emphasised that the national discourse on women’s health remains narrowly confined to maternal and reproductive care. “But women face a wide range of health challenges beyond childbirth,” she said. “There are 20 to 22 specialised hospitals in the country, but not one is designed to address the full spectrum of women’s health issues. That gap must be filled urgently.”

The final speaker at the event, Umair Afif - a medical student and the commission’s youngest member, said the mass uprising in July created the momentum for forming these reform commissions. That context must not be forgotten.