The health system of Bangladesh relies heavily on the government or the public sector for financing and setting overall policies and service delivery mechanisms. Although the health system is faced with many intractable challenges, it seems to receive little priority in terms of national resource allocation. According to the World Health Organization (WHO 2010) only about 3% of the Gross Domestic Product (GDP) is spent on health services. However, government expenditure on health is only about 34% of the total health expenditure (THE), the rest (66%) being out-of-pocket (OOP) expenses.

Successes of Bangladesh’s Health Sector

Bangladesh stands out as a country that has taken giant steps in healthcare. Long before the emergence of contemporary global health initiatives, the government placed strong emphasis on the importance of childhood immunization as a key mechanism for reducing childhood mortality.

The Expanded Programme on Immunization (EPI) in Bangladesh is considered to be a health system success because of its remarkable progress over the last two decades. It provides almost universal access to vaccination services, as measured by the percentage of children under 1 year of age who receive BCG (a vaccine against tuberculosis). This increased from 2% in 1985 to 99% in 2009. Coverage of other vaccines has also improved substantially (Brac, 2009). However, poor access to services, low quality of care, high rate of maternal mortality and poor status of child health still remain as challenges of the health sector (Ferdous A. Osaman, 2008).

Although the country has a growing private sector primarily providing tertiary level health care services, Bangladesh still does not have a comprehensive health policy to strengthen the entire health system. Clearly, the most crucial challenge is the absence of a dynamic and proactive stewardship able to design and enforce policies to further strengthen and enhance the overall health system. Such strong leadership could bring about meaningful and effective health system reform, which will work more efficiently for the betterment of the health of the people of Bangladesh, and would be built upon the values of equity and accountability.