Analysis of the 2025 Health System Reform Proposal in Bangladesh
The Government of Bangladesh has taken a bold step toward overhauling its health system with the submission of the 2025 Health System Reform Proposal developed by the Health Sector Reform Commission. This comprehensive document outlines a transformative vision aimed at ensuring universal health coverage (UHC), strengthening primary health care, improving governance, and enhancing quality of care.
Key Highlights of the Reform Proposal
- Primary Health Care as a Constitutional Right
One of the most groundbreaking recommendations is to declare primary health care (PHC) as a constitutional right. This legal assurance aims to ensure every citizen, regardless of socioeconomic status, can access essential health services.
- Establishment of an Independent Bangladesh Health Commission
The proposal suggests forming a permanent, autonomous Health Commission to:
- Oversee quality of care,
- Monitor service standards,
- Ensure accountability across public and private providers,
- Separate policy, regulation, and service delivery roles.
- Integration of Fragmented Health Services
Currently, health services are delivered through multiple parallel units and departments. The proposal advocates for:
- Unified health service delivery under a coordinated structure,
- Integration of public health, clinical care, and preventive services,
- Functional decentralization at district and sub-district levels.
- Sustainable Health Financing Mechanism
The reform emphasizes shifting from out-of-pocket payments to pre-paid, pooled financing mechanisms such as:
- Social Health Insurance (SHI),
- Public-private partnerships (PPPs),
- Performance-based budgeting.
- Digital Health and Information Systems
The proposal highlights the need for:
- A national health information exchange (HIE),
- Digital patient records,
- AI-based clinical decision support systems (CDSS),
- Integration of data from public, private, and NGO health sectors.
Challenges and Discrepancies
▪ Institutional Overlaps
There is ambiguity between the roles of the Health Commission and existing institutions like the Ministry of Health and Family Welfare (MOHFW) and DGHS. Clear legal separation and role clarification are crucial.
▪ Human Resource Governance
While the reform proposes independent human resource management, it lacks a strong roadmap for aligning existing public service rules with the proposed autonomous governance framework.
▪ Implementation Feasibility
Some recommendations are resource-intensive and require legislative reforms, long-term political will, and financial commitment.